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Sickler RW, Chandran AS, Funke ME, Mosher JC, Kommuru IM, Lankford J, Varnado SS, Von Allmen G, Watkins MW, Bonfante EE, Samant R, Kamali A, Miller BA, Shah MN. Comparison of 2 Robotic Systems for Pediatric Stereoelectroencephalography Implantation. World Neurosurg 2024; 182:e486-e492. [PMID: 38042289 DOI: 10.1016/j.wneu.2023.11.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Stereoelectroencephalography (SEEG) remains critical in guiding epilepsy surgery. Robot-assisted techniques have shown promise in improving SEEG implantation outcomes but have not been directly compared. In this single-institution series, we compared ROSA and Stealth AutoGuide robots in pediatric SEEG implantation. METHODS We retrospectively reviewed 21 sequential pediatric SEEG implantations consisting of 6 ROSA and 15 AutoGuide procedures. We determined mean operative time, time per electrode, root mean square (RMS) registration error, and surgical complications. Three-dimensional radial distances were calculated between each electrode's measured entry and target points with respective errors from the planned trajectory line. RESULTS Mean overall/per electrode operating time was 73.5/7.5 minutes for ROSA and 126.1/10.9 minutes for AutoGuide (P = 0.030 overall, P = 0.082 per electrode). Mean RMS registration error was 0.77 mm (0.55-0.93 mm) for ROSA and 0.6 mm (0.2-1.0 mm) for AutoGuide (P = 0.26). No procedures experienced complications. The mean radial (entry point error was 1.23 ± 0.11 mm for ROSA and 2.65 ± 0.12 mm for AutoGuide (P < 0.001), while the mean radial target point error was 1.86 ± 0.15 mm for ROSA and 3.25 ± 0.16 mm for AutoGuide (P < 0.001). CONCLUSIONS Overall operative time was greater for AutoGuide procedures, although there was no statistically significant difference in time per electrode. Both systems are highly accurate with no significant RMS error difference. While the ROSA robot yielded significantly lower entry and target point errors, both robots are safe and reliable for deep electrode insertion in pediatric epilepsy.
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Affiliation(s)
- Robert W Sickler
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas, USA
| | - Arjun S Chandran
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas, USA.
| | - Michael E Funke
- Department of Pediatrics, Division of Child Neurology, McGovern Medical School, Houston, Texas, USA; Department of Neurology, McGovern Medical School, Houston, Texas, USA
| | - John C Mosher
- Department of Neurology, McGovern Medical School, Houston, Texas, USA
| | - Indira M Kommuru
- Department of Pediatrics, Division of Child Neurology, McGovern Medical School, Houston, Texas, USA
| | - Jeremy Lankford
- Department of Pediatrics, Division of Child Neurology, McGovern Medical School, Houston, Texas, USA
| | - Shelley S Varnado
- Department of Pediatrics, Division of Child Neurology, McGovern Medical School, Houston, Texas, USA
| | - Gretchen Von Allmen
- Department of Pediatrics, Division of Child Neurology, McGovern Medical School, Houston, Texas, USA
| | - Michael W Watkins
- Department of Pediatrics, Division of Child Neurology, McGovern Medical School, Houston, Texas, USA
| | - Eliana E Bonfante
- Department of Radiology, McGovern Medical School, Houston, Texas, USA
| | - Rohan Samant
- Department of Neurology, McGovern Medical School, Houston, Texas, USA
| | - Arash Kamali
- Department of Neurology, McGovern Medical School, Houston, Texas, USA
| | - Brandon A Miller
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas, USA
| | - Manish N Shah
- Department of Pediatric Surgery, Division of Pediatric Neurosurgery, McGovern Medical School, Houston, Texas, USA
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Fields MC, Marsh C, Eka O, Johnson EA, Marcuse LV, Kwon CS, Young JJ, LaVega-Talbott M, Kurukumbi M, Von Allmen G, Zempel J, Friedman D, Jette N, Singh A, Yoo JY, Blank L, Panov F, Ghatan S. Responsive Neurostimulation for People With Drug-Resistant Epilepsy and Autism Spectrum Disorder. J Clin Neurophysiol 2024; 41:64-71. [PMID: 35512185 PMCID: PMC10756699 DOI: 10.1097/wnp.0000000000000939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Individuals with autism spectrum disorder (ASD) have comorbid epilepsy at much higher rates than the general population, and about 30% will be refractory to medication. Patients with drug-resistant epilepsy (DRE) should be referred for surgical evaluation, yet many with ASD and DRE are not resective surgical candidates. The aim of this study was to examine the response of this population to the responsive neurostimulator (RNS) System. METHODS This multicenter study evaluated patients with ASD and DRE who underwent RNS System placement. Patients were included if they had the RNS System placed for 1 year or more. Seizure reduction and behavioral outcomes were reported. Descriptive statistics were used for analysis. RESULTS Nineteen patients with ASD and DRE had the RNS System placed at 5 centers. Patients were between the ages of 11 and 29 (median 20) years. Fourteen patients were male, whereas five were female. The device was implanted from 1 to 5 years. Sixty-three percent of all patients experienced a >50% seizure reduction, with 21% of those patients being classified as super responders (seizure reduction >90%). For the super responders, two of the four patients had the device implanted for >2 years. The response rate was 70% for those in whom the device was implanted for >2 years. Improvements in behaviors as measured by the Clinical Global Impression Scale-Improvement scale were noted in 79%. No complications from the surgery were reported. CONCLUSIONS Based on the authors' experience in this small cohort of patients, the RNS System seems to be a promising surgical option in people with ASD-DRE.
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Affiliation(s)
- Madeline C. Fields
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Christina Marsh
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Onome Eka
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Emily A. Johnson
- Washington University School of Medicine, St. Louis, Missouri, U.S.A.
| | - Lara V. Marcuse
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - James J. Young
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Maite LaVega-Talbott
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | | | - Gretchen Von Allmen
- Division of Pediatric Epilepsy, McGovern Medical School, UTHealth, Houston, Texas, U.S.A.
| | - John Zempel
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, U.S.A.; and
| | - Daniel Friedman
- Department of Neurology, New York University Langone Medical Center, New York, New York, U.S.A.
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Anuradha Singh
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Ji Yeoun Yoo
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Leah Blank
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Fedor Panov
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
| | - Saadi Ghatan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
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Cuesta P, Bruña R, Shah E, Laohathai C, Garcia-Tarodo S, Funke M, Von Allmen G, Maestú F. An individual data-driven virtual resection model based on epileptic network dynamics in children with intractable epilepsy: a magnetoencephalography interictal activity application. Brain Commun 2023; 5:fcad168. [PMID: 37274829 PMCID: PMC10236945 DOI: 10.1093/braincomms/fcad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 01/24/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
Epilepsy surgery continues to be a recommended treatment for intractable (medication-resistant) epilepsy; however, 30-70% of epilepsy surgery patients can continue to have seizures. Surgical failures are often associated with incomplete resection or inaccurate localization of the epileptogenic zone. This retrospective study aims to improve surgical outcome through in silico testing of surgical hypotheses through a personalized computational neurosurgery model created from individualized patient's magnetoencephalography recording and MRI. The framework assesses the extent of the epileptic network and evaluates underlying spike dynamics, resulting in identification of one single brain volume as a candidate for resection. Dynamic-locked networks were utilized for virtual cortical resection. This in silico protocol was tested in a cohort of 24 paediatric patients with focal drug-resistant epilepsy who underwent epilepsy surgery. Of 24 patients who were included in the analysis, 79% (19 of 24) of the models agreed with the patient's clinical surgery outcome and 21% (5 of 24) were considered as model failures (accuracy 0.79, sensitivity 0.77, specificity 0.82). Patients with unsuccessful surgery outcome typically showed a model cluster outside of the resected cavity, while those with successful surgery showed the cluster model within the cavity. Two of the model failures showed the cluster in the vicinity of the resected tissue and either a functional disconnection or lack of precision of the magnetoencephalography-MRI overlapping could explain the results. Two other cases were seizure free for 1 year but developed late recurrence. This is the first study that provides in silico personalized protocol for epilepsy surgery planning using magnetoencephalography spike network analysis. This model could provide complementary information to the traditional pre-surgical assessment methods and increase the proportion of patients achieving seizure-free outcome from surgery.
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Affiliation(s)
- Pablo Cuesta
- Correspondence to: Pablo Cuesta Pza. Ramón y Cajal, s/n. Ciudad Universitaria 28040 Madrid, Spain E-mail:
| | - Ricardo Bruña
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, 28040, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, 28040, Spain
| | - Ekta Shah
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | - Stephanie Garcia-Tarodo
- Département de la femme, de l'enfant et de l'adolescent, Hôpital des Enfants - Hôpitaux Universitaires de Genève, Geneva, 1211 Genève 14, Switzerland
| | - Michael Funke
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Gretchen Von Allmen
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Fernando Maestú
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, 28040, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, 28040, Spain
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, 28040, Spain
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Belal A, Allmen GV, Kommuru I, Lankford J, Mosher JC, Shah M, Funke M, Watkins M, Patel R. Complete corpus callosotomy using a frameless navigation probe through a minicraniotomy in children with medically refractory epilepsy: A case series and technical note. Surg Neurol Int 2022; 13:585. [PMID: 36600777 PMCID: PMC9805650 DOI: 10.25259/sni_1188_2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 09/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background Medically refractory epilepsy constitutes up to one-third of the epilepsy pediatric patients. Corpus callosotomy (CC) has been used for the treatment of medically refractory epilepsy in children with atonic seizures and generalized tonic-clonic (GTC) seizures. In this case series study, we are describing a novel technique for CC using the frameless navigation probe through a minicraniotomy. Methods Thirteen pediatric patients with the diagnosis of medically refractory epilepsy predominantly GTC with drop attack who underwent extensive Phase I. An L-shape was done, then through a 4 × 3 cm craniotomy, we were able to open the interhemispheric fissure until the corpus callosum is visualized. The Stealth probe is then used to go down to the midline raphe which is followed anteriorly then traced posteriorly to the anterior border of the vein of Galen. Finally, the Stealth probe is used to confirm the completeness of the callosotomy. Results The procedure was accomplished successfully with no intraoperative complications; mean surgical time is 3 h:07 m. The mean follow-up was 31.5 months. All patients achieved significant seizure control. No patients experienced worsening of their atonic seizures after surgery compared with their preoperative state; however, six patients achieved Engel Class I, four patients achieved Engel Class II, and three patients achieved Engel Class III. Conclusion Complete CC using a frameless navigation probe is a novel and effective technique for the treatment of medically refractory epilepsy with a very good surgical and seizure outcomes, minimal neurological morbidity, minimal blood loss, and short OR time.
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Affiliation(s)
- Ahmed Belal
- Department of Pediatric Neurosurgery, McGovern Medical School, University of Texas, Houston and Children’s Memorial Hermann Hospital, Texas, United States.,Department of Neurosurgery, Indiana University, Texas, United States.,Corresponding author: Ahmed Belal, Department of Pediatric Neurosurgery, McGovern Medical School, University of Texas, Houston and Children’s Memorial Hermann Hospital, Houston, Texas, United States.
| | - Gretchen Von Allmen
- Department of Pediatric Neurology, McGovern Medical School at UTHouston and Children’s Memorial Hermann Hospital, Texas, United States
| | - Indira Kommuru
- Department of Pediatric Neurology, McGovern Medical School at UTHouston and Children’s Memorial Hermann Hospital, Texas, United States
| | - Jeremy Lankford
- Department of Pediatric Neurology, McGovern Medical School at UTHouston and Children’s Memorial Hermann Hospital, Texas, United States
| | - John C. Mosher
- Department of Neurology, University of Texas Health Science Center at Houston, Texas, United States
| | - Manish Shah
- Department of Pediatric Neurosurgery, McGovern Medical School, University of Texas, Houston and Children’s Memorial Hermann Hospital, Texas, United States
| | - Michael Funke
- Department of Pediatric Neurology, McGovern Medical School at UTHouston and Children’s Memorial Hermann Hospital, Texas, United States
| | - Michael Watkins
- Department of Pediatric Neurology, McGovern Medical School at UTHouston and Children’s Memorial Hermann Hospital, Texas, United States
| | - Rajan Patel
- Department of Radiology, McGovern Medical School at UTHouston and Children’s Memorial Hermann Hospital, Houston, Texas, United States
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5
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Guerrini R, Mei D, Kerti-Szigeti K, Pepe S, Koenig MK, Von Allmen G, Cho MT, McDonald K, Baker J, Bhambhani V, Powis Z, Rodan L, Nabbout R, Barcia G, Rosenfeld JA, Bacino CA, Mignot C, Power LH, Harris CJ, Marjanovic D, Møller RS, Hammer TB, Keski Filppula R, Vieira P, Hildebrandt C, Sacharow S, Maragliano L, Benfenati F, Lachlan K, Benneche A, Petit F, de Sainte Agathe JM, Hallinan B, Si Y, Wentzensen IM, Zou F, Narayanan V, Matsumoto N, Boncristiano A, la Marca G, Kato M, Anderson K, Barba C, Sturiale L, Garozzo D, Bei R, Masuelli L, Conti V, Novarino G, Fassio A. Phenotypic and genetic spectrum of ATP6V1A encephalopathy: a disorder of lysosomal homeostasis. Brain 2022; 145:2687-2703. [PMID: 35675510 PMCID: PMC10893886 DOI: 10.1093/brain/awac145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2023] Open
Abstract
Vacuolar-type H+-ATPase (V-ATPase) is a multimeric complex present in a variety of cellular membranes that acts as an ATP-dependent proton pump and plays a key role in pH homeostasis and intracellular signalling pathways. In humans, 22 autosomal genes encode for a redundant set of subunits allowing the composition of diverse V-ATPase complexes with specific properties and expression. Sixteen subunits have been linked to human disease. Here we describe 26 patients harbouring 20 distinct pathogenic de novo missense ATP6V1A variants, mainly clustering within the ATP synthase α/β family-nucleotide-binding domain. At a mean age of 7 years (extremes: 6 weeks, youngest deceased patient to 22 years, oldest patient) clinical pictures included early lethal encephalopathies with rapidly progressive massive brain atrophy, severe developmental epileptic encephalopathies and static intellectual disability with epilepsy. The first clinical manifestation was early hypotonia, in 70%; 81% developed epilepsy, manifested as developmental epileptic encephalopathies in 58% of the cohort and with infantile spasms in 62%; 63% of developmental epileptic encephalopathies failed to achieve any developmental, communicative or motor skills. Less severe outcomes were observed in 23% of patients who, at a mean age of 10 years and 6 months, exhibited moderate intellectual disability, with independent walking and variable epilepsy. None of the patients developed communicative language. Microcephaly (38%) and amelogenesis imperfecta/enamel dysplasia (42%) were additional clinical features. Brain MRI demonstrated hypomyelination and generalized atrophy in 68%. Atrophy was progressive in all eight individuals undergoing repeated MRIs. Fibroblasts of two patients with developmental epileptic encephalopathies showed decreased LAMP1 expression, Lysotracker staining and increased organelle pH, consistent with lysosomal impairment and loss of V-ATPase function. Fibroblasts of two patients with milder disease, exhibited a different phenotype with increased Lysotracker staining, decreased organelle pH and no significant modification in LAMP1 expression. Quantification of substrates for lysosomal enzymes in cellular extracts from four patients revealed discrete accumulation. Transmission electron microscopy of fibroblasts of four patients with variable severity and of induced pluripotent stem cell-derived neurons from two patients with developmental epileptic encephalopathies showed electron-dense inclusions, lipid droplets, osmiophilic material and lamellated membrane structures resembling phospholipids. Quantitative assessment in induced pluripotent stem cell-derived neurons identified significantly smaller lysosomes. ATP6V1A-related encephalopathy represents a new paradigm among lysosomal disorders. It results from a dysfunctional endo-lysosomal membrane protein causing altered pH homeostasis. Its pathophysiology implies intracellular accumulation of substrates whose composition remains unclear, and a combination of developmental brain abnormalities and neurodegenerative changes established during prenatal and early postanal development, whose severity is variably determined by specific pathogenic variants.
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Affiliation(s)
- Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer, University of Florence, Florence, Italy
| | - Davide Mei
- Neuroscience Department, Children's Hospital Meyer, University of Florence, Florence, Italy
| | | | - Sara Pepe
- Department of Experimental Medicine, University of Genoa, Italy
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia, Genova, Italy
| | - Mary Kay Koenig
- Department of Pediatrics, Division of Child and Adolescent Neurology, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Gretchen Von Allmen
- Department of Pediatrics, Division of Child and Adolescent Neurology, The University of Texas McGovern Medical School, Houston, TX, USA
| | | | - Kimberly McDonald
- Pediatric Neurology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Janice Baker
- Genetics and Genomics, Children's Minnesota, Minneapolis, MN, USA
| | - Vikas Bhambhani
- Genetics and Genomics, Children's Minnesota, Minneapolis, MN, USA
| | - Zöe Powis
- Ambry Genetics, Aliso Viejo, CA, USA
| | - Lance Rodan
- Division of Genetics and Genomics and Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Genetics, Necker Enfants Malades Hospital, APHP, member of ERN EpiCARE, Université de Paris, Paris, France
| | - Giulia Barcia
- Reference Centre for Rare Epilepsies, Department of Genetics, Necker Enfants Malades Hospital, APHP, member of ERN EpiCARE, Université de Paris, Paris, France
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Carlos A Bacino
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Cyril Mignot
- APHP, Sorbonne Université, Départément de Génétique, Centre de Référence Déficiences Intellectuelles de Causes Rares, Paris, France
- Institut du Cerveau (ICM), UMR S 1127, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France
| | - Lillian H Power
- Pediatric Neurology, Stead Family Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
| | - Catharine J Harris
- Department of Pediatric Genetics, University of Missouri Medical Center, Columbia, MO 65212, USA
| | - Dragan Marjanovic
- Danish Epilepsy Centre Filadelfia, Adult Neurology, Dianalund, Denmark
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Treatment, Danish Epilepsy Center Filadelfia, Dianalund, Denmark
- Department of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Trine B Hammer
- Department of Epilepsy Genetics and Personalized Treatment, Danish Epilepsy Center Filadelfia, Dianalund, Denmark
| | - The DDD Study
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Riikka Keski Filppula
- Department of Clinical Genetics, Oulu University Hospital, Medical Research Center Oulu and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Päivi Vieira
- Clinic for Children and Adolescents, Oulu University Hospital, Medical Research Center Oulu and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Clara Hildebrandt
- Division of Genetics and Genomics, Metabolism Program, Boston Children's Hospital, Boston, MA, USA
| | | | | | - Luca Maragliano
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia, Genova, Italy
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Fabio Benfenati
- Center for Synaptic Neuroscience and Technology, Istituto Italiano di Tecnologia, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Katherine Lachlan
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Human Development and Health, Faculty of Medicine University of Southampton, Southampton, UK
| | - Andreas Benneche
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | | | - Jean Madeleine de Sainte Agathe
- Laboratoire de Biologie Médicale Multi Sites SeqOIA, Laboratoire de Médecine Génomique, APHP. Sorbonne Université, Paris, France
| | - Barbara Hallinan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yue Si
- GeneDx, Gaithersburg, MD 20877, USA
| | | | | | - Vinodh Narayanan
- Neurogenomics Division, Center for Rare Childhood Disorders, Translational Genomics Research Institute (TGen), Phoenix, AZ 85012, USA
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Giancarlo la Marca
- Newborn Screening, Clinical Chemistry and Pharmacology Laboratory, Meyer Children’s University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine and Epilepsy Medical Center, Showa University Hospital, Tokyo, Japan
| | | | - Carmen Barba
- Neuroscience Department, Children's Hospital Meyer, University of Florence, Florence, Italy
| | - Luisa Sturiale
- CNR, Institute for Polymers, Composites and Biomaterials, IPCB, 95126 Catania, Italy
| | - Domenico Garozzo
- CNR, Institute for Polymers, Composites and Biomaterials, IPCB, 95126 Catania, Italy
| | - Roberto Bei
- Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata', Rome, Italy
| | | | - Laura Masuelli
- Department of Experimental Medicine, University of Rome ‘Sapienza', Rome, Italy
| | - Valerio Conti
- Neuroscience Department, Children's Hospital Meyer, University of Florence, Florence, Italy
| | - Gaia Novarino
- Institute of Science and Technology Austria (ISTA), Klosterneuburg, Austria
| | - Anna Fassio
- Department of Experimental Medicine, University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Laohathai C, Ebersole JS, Mosher JC, Bagić AI, Sumida A, Von Allmen G, Funke ME. Practical Fundamentals of Clinical MEG Interpretation in Epilepsy. Front Neurol 2021; 12:722986. [PMID: 34721261 PMCID: PMC8551575 DOI: 10.3389/fneur.2021.722986] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Magnetoencephalography (MEG) is a neurophysiologic test that offers a functional localization of epileptic sources in patients considered for epilepsy surgery. The understanding of clinical MEG concepts, and the interpretation of these clinical studies, are very involving processes that demand both clinical and procedural expertise. One of the major obstacles in acquiring necessary proficiency is the scarcity of fundamental clinical literature. To fill this knowledge gap, this review aims to explain the basic practical concepts of clinical MEG relevant to epilepsy with an emphasis on single equivalent dipole (sECD), which is one the most clinically validated and ubiquitously used source localization method, and illustrate and explain the regional topology and source dynamics relevant for clinical interpretation of MEG-EEG.
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Affiliation(s)
- Christopher Laohathai
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, United States
- Department of Neurology, Saint Louis University, Saint Louis, MO, United States
| | - John S. Ebersole
- Northeast Regional Epilepsy Group, Atlantic Health Neuroscience Institute, Summit, NJ, United States
| | - John C. Mosher
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Anto I. Bagić
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center, Pittsburg, PA, United States
| | - Ai Sumida
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Gretchen Von Allmen
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, United States
| | - Michael E. Funke
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, United States
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7
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Nguyen RD, Smyth MD, Zhu L, Pao LP, Swisher SK, Kennady EH, Mitra A, Patel RP, Lankford JE, Von Allmen G, Watkins MW, Funke ME, Shah MN. A comparison of machine learning classifiers for pediatric epilepsy using resting-state functional MRI latency data. Biomed Rep 2021; 15:77. [PMID: 34405049 PMCID: PMC8330002 DOI: 10.3892/br.2021.1453] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
Epilepsy affects 1 in 150 children under the age of 10 and is the most common chronic pediatric neurological condition; poor seizure control can irreversibly disrupt normal brain development. The present study compared the ability of different machine learning algorithms trained with resting-state functional MRI (rfMRI) latency data to detect epilepsy. Preoperative rfMRI and anatomical MRI scans were obtained for 63 patients with epilepsy and 259 healthy controls. The normal distribution of latency z-scores from the epilepsy and healthy control cohorts were analyzed for overlap in 36 seed regions. In these seed regions, overlap between the study cohorts ranged from 0.44-0.58. Machine learning features were extracted from latency z-score maps using principal component analysis. Extreme Gradient Boosting (XGBoost), Support Vector Machines (SVM), and Random Forest algorithms were trained with these features. Area under the receiver operating characteristics curve (AUC), accuracy, sensitivity, specificity and F1-scores were used to evaluate model performance. The XGBoost model outperformed all other models with a test AUC of 0.79, accuracy of 74%, specificity of 73%, and a sensitivity of 77%. The Random Forest model performed comparably to XGBoost across multiple metrics, but it had a test sensitivity of 31%. The SVM model did not perform >70% in any of the test metrics. The XGBoost model had the highest sensitivity and accuracy for the detection of epilepsy. Development of machine learning algorithms trained with rfMRI latency data could provide an adjunctive method for the diagnosis and evaluation of epilepsy with the goal of enabling timely and appropriate care for patients.
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Affiliation(s)
- Ryan D. Nguyen
- Division of Pediatric Neurosurgery, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Matthew D. Smyth
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Liang Zhu
- Biostatistics and Epidemiology Research Design Core, Institute for Clinical and Translational Sciences, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Ludovic P. Pao
- Division of Pediatric Neurosurgery, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Shannon K. Swisher
- Division of Pediatric Neurosurgery, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Emmett H. Kennady
- Division of Pediatric Neurosurgery, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Anish Mitra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rajan P. Patel
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Jeremy E. Lankford
- Department of Pediatric Neurology, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Gretchen Von Allmen
- Department of Pediatric Neurology, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Michael W. Watkins
- Department of Pediatric Neurology, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Michael E. Funke
- Department of Pediatric Neurology, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Manish N. Shah
- Division of Pediatric Neurosurgery, McGovern Medical School at UTHealth, Houston, TX 77030, USA
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8
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Watkins MW, Shah EG, Funke ME, Garcia-Tarodo S, Shah MN, Tandon N, Maestu F, Laohathai C, Sandberg DI, Lankford J, Thompson S, Mosher J, Von Allmen G. Indications for Inpatient Magnetoencephalography in Children - An Institution's Experience. Front Hum Neurosci 2021; 15:667777. [PMID: 34149382 PMCID: PMC8213217 DOI: 10.3389/fnhum.2021.667777] [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: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Magnetoencephalography (MEG) is recognized as a valuable non-invasive clinical method for localization of the epileptogenic zone and critical functional areas, as part of a pre-surgical evaluation for patients with pharmaco-resistant epilepsy. MEG is also useful in localizing functional areas as part of pre-surgical planning for tumor resection. MEG is usually performed in an outpatient setting, as one part of an evaluation that can include a variety of other testing modalities including 3-Tesla MRI and inpatient video-electroencephalography monitoring. In some clinical circumstances, however, completion of the MEG as an inpatient can provide crucial ictal or interictal localization data during an ongoing inpatient evaluation, in order to expedite medical or surgical planning. Despite well-established clinical indications for performing MEG in general, there are no current reports that discuss indications or considerations for completion of MEG on an inpatient basis. We conducted a retrospective institutional review of all pediatric MEGs performed between January 2012 and December 2020, and identified 34 cases where MEG was completed as an inpatient. We then reviewed all relevant medical records to determine clinical history, all associated diagnostic procedures, and subsequent treatment plans including epilepsy surgery and post-surgical outcomes. In doing so, we were able to identify five indications for completing the MEG on an inpatient basis: (1) super-refractory status epilepticus (SRSE), (2) intractable epilepsy with frequent electroclinical seizures, and/or frequent or repeated episodes of status epilepticus, (3) intractable epilepsy with infrequent epileptiform discharges on EEG or outpatient MEG, or other special circumstances necessitating inpatient monitoring for successful and safe MEG data acquisition, (4) MEG mapping of eloquent cortex or interictal spike localization in the setting of tumor resection or other urgent neurosurgical intervention, and (5) international or long-distance patients, where outpatient MEG is not possible or practical. MEG contributed to surgical decision-making in the majority of our cases (32 of 34). Our clinical experience suggests that MEG should be considered on an inpatient basis in certain clinical circumstances, where MEG data can provide essential information regarding the localization of epileptogenic activity or eloquent cortex, and be used to develop a treatment plan for surgical management of children with complicated or intractable epilepsy.
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Affiliation(s)
- Michael W Watkins
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Ekta G Shah
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Michael E Funke
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - Stephanie Garcia-Tarodo
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Pediatric Neurology Unit, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Manish N Shah
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States.,Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, Houston, TX, United States
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States
| | - Fernando Maestu
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Universidad Complutense and Universidad Politecnica de Madrid, Madrid, Spain.,Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Christopher Laohathai
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - David I Sandberg
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States.,Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, Houston, TX, United States
| | - Jeremy Lankford
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Stephen Thompson
- Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - John Mosher
- Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - Gretchen Von Allmen
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Department of Neurology, McGovern Medical School, Houston, TX, United States
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9
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Fischer GM, Vaziri Fard E, Shah MN, Patel RP, Von Allmen G, Ballester LY, Bhattacharjee MB. Filamin A-negative hyaline astrocytic inclusions in pediatric patients with intractable epilepsy: report of 2 cases. J Neurosurg Pediatr 2020; 26:38-44. [PMID: 32217802 DOI: 10.3171/2020.1.peds19706] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
Although rare, hyaline cytoplasmic inclusions isolated to astrocytes of the cerebral cortex have been identified in a spectrum of diseases ranging from intractable epilepsy in pediatric patients with only mild to moderate developmental delays to Aicardi syndrome. These inclusions classically stain positive for filamin A, giving rise to the term "filaminopathies." The authors report on 2 pediatric patients with intractable epilepsy and developmental delay who uniquely displayed filamin A-negative hyaline astrocytic inclusions in resected brain tissues. Additionally, these inclusions stained positive for S100 and negative for glial fibrillary acidic protein, chromogranin, neurofilament, CD34, vimentin, periodic acid-Schiff (PAS), and Alcian blue. These are the first reported cases of filamin A-negative hyaline astrocytic inclusions, providing a novel variation on a previously reported entity and justification to further investigate the pathogenesis of these inclusions. The authors compare their findings with previously reported cases and review the literature on hyaline astrocytic inclusions in intractable pediatric epilepsy.
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Affiliation(s)
| | | | - Manish N Shah
- 2Neurosurgery.,5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Rajan P Patel
- 3Diagnostic and Interventional Imaging, and.,5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Gretchen Von Allmen
- 4Pediatrics, The University of Texas Health Science Center at Houston; and.,5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Leomar Y Ballester
- Departments of1Pathology and Laboratory Medicine.,2Neurosurgery.,5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Meenakshi B Bhattacharjee
- Departments of1Pathology and Laboratory Medicine.,5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
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10
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Tandon N, Tong BA, Friedman ER, Johnson JA, Von Allmen G, Thomas MS, Hope OA, Kalamangalam GP, Slater JD, Thompson SA. Analysis of Morbidity and Outcomes Associated With Use of Subdural Grids vs Stereoelectroencephalography in Patients With Intractable Epilepsy. JAMA Neurol 2020; 76:672-681. [PMID: 30830149 DOI: 10.1001/jamaneurol.2019.0098] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance A major change has occurred in the evaluation of epilepsy with the availability of robotic stereoelectroencephalography (SEEG) for seizure localization. However, the comparative morbidity and outcomes of this minimally invasive procedure relative to traditional subdural electrode (SDE) implantation are unknown. Objective To perform a comparative analysis of the relative efficacy, procedural morbidity, and epilepsy outcomes consequent to SEEG and SDE in similar patient populations and performed by a single surgeon at 1 center. Design, Setting and Participants Overall, 239 patients with medically intractable epilepsy underwent 260 consecutive intracranial electroencephalographic procedures to localize their epilepsy. Procedures were performed from November 1, 2004, through June 30, 2017, and data were analyzed in June 2017 and August 2018. Interventions Implantation of SDE using standard techniques vs SEEG using a stereotactic robot, followed by resection or laser ablation of the seizure focus. Main Outcomes and Measures Length of surgical procedure, surgical complications, opiate use, and seizure outcomes using the Engel Epilepsy Surgery Outcome Scale. Results Of the 260 cases included in the study (54.6% female; mean [SD] age at evaluation, 30.3 [13.1] years), the SEEG (n = 121) and SDE (n = 139) groups were similar in age (mean [SD], 30.1 [12.2] vs 30.6 [13.8] years), sex (47.1% vs 43.9% male), numbers of failed anticonvulsants (mean [SD], 5.7 [2.5] vs 5.6 [2.5]), and duration of epilepsy (mean [SD], 16.4 [12.0] vs17.2 [12.1] years). A much greater proportion of SDE vs SEEG cases were lesional (99 [71.2%] vs 53 [43.8%]; P < .001). Seven symptomatic hemorrhagic sequelae (1 with permanent neurological deficit) and 3 infections occurred in the SDE cohort with no clinically relevant complications in the SEEG cohort, a marked difference in complication rates (P = .003). A greater proportion of SDE cases resulted in resection or ablation compared with SEEG cases (127 [91.4%] vs 90 [74.4%]; P < .001). Favorable epilepsy outcomes (Engel class I [free of disabling seizures] or II [rare disabling seizures]) were observed in 57 of 75 SEEG cases (76.0%) and 59 of 108 SDE cases (54.6%; P = .003) amongst patients undergoing resection or ablation, at 1 year. An analysis of only nonlesional cases revealed good outcomes in 27 of 39 cases (69.2%) vs 9 of 26 cases (34.6%) at 12 months in SEEG and SDE cohorts, respectively (P = .006). When considering all patients undergoing evaluation, not just those undergoing definitive procedures, favorable outcomes (Engel class I or II) for SEEG compared with SDE were similar (57 of 121 [47.1%] vs 59 of 139 [42.4%] at 1 year; P = .45). Conclusions and Relevance This direct comparison of large matched cohorts undergoing SEEG and SDE implantation reveals distinctly better procedural morbidity favoring SEEG. These modalities intrinsically evaluate somewhat different populations, with SEEG being more versatile and applicable to a range of scenarios, including nonlesional and bilateral cases, than SDE. The significantly favorable adverse effect profile of SEEG should factor into decision making when patients with pharmacoresistant epilepsy are considered for intracranial evaluations.
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Affiliation(s)
- Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health, Houston.,Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston
| | - Brian A Tong
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health, Houston
| | - Elliott R Friedman
- Department of Radiology, McGovern Medical School, University of Texas Health, Houston
| | - Jessica A Johnson
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, University of Texas Health, Houston.,Mischer Neuroscience Institute, Memorial Hermann Hospital, Texas Medical Center, Houston
| | - Gretchen Von Allmen
- Department of Pediatrics, McGovern Medical School, University of Texas Health, Houston
| | - Melissa S Thomas
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
| | - Omotola A Hope
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
| | | | - Jeremy D Slater
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
| | - Stephen A Thompson
- Department of Neurology, McGovern Medical School, University of Texas Health, Houston
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11
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Chourasia N, Ossó-Rivera H, Ghosh A, Von Allmen G, Koenig MK. Expanding the Phenotypic Spectrum of CACNA1H Mutations. Pediatr Neurol 2019; 93:50-55. [PMID: 30686625 DOI: 10.1016/j.pediatrneurol.2018.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/29/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The CACNA1H gene mutations encoding the α1H subunit of Cav3.2 T-type calcium channels have been associated with generalized epilepsy. Focal or multifocal epilepsy and systemic (immunologic and gastrointestinal) involvement associated with these mutations have not been described previously. We detail the clinical characteristics of five patients with CACNA1H mutations and expand its phenotypic spectrum. METHODS A case series of five patients with pathogenic CACNA1H mutations was evaluated. The pathogenicity of the mutations was predicted by polymorphism phenotyping (Polyphen-2) and sorting-intolerant-from-tolerant analysis. RESULTS Mean age of seizure onset was 8.2 ± 3.7 years. Three patients had de novo mutations in the CACNA1H gene, and two patients inherited the mutation from an asymptomatic parent. The patients experienced different types of seizures including absence, focal seizures without awareness, focal seizures with secondary generalization, and myoclonic, atonic, and generalized tonic-clonic seizures. Electroencephalography showed focal, multifocal, or generalized discharges. One patient had autism and global developmental delay. Two patients had failure to thrive and selective antibody deficiency. CONCLUSIONS CACNA1H mutations can be associated with susceptibility to develop generalized epilepsy and focal or multifocal epilepsy of varying severity. Phenotypic features involving other organ systems (immune, gastrointestinal) can occur in addition to epilepsy, developmental delay, and autism.
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Affiliation(s)
- Nitish Chourasia
- McGovern Medical School, UTHealth, Division of Child and Adolescent Neurology, Houston, Texas.
| | - Henry Ossó-Rivera
- McGovern Medical School, UTHealth, Division of Child and Adolescent Neurology, Houston, Texas
| | - Ankita Ghosh
- McGovern Medical School, UTHealth, Division of Child and Adolescent Neurology, Houston, Texas
| | - Gretchen Von Allmen
- McGovern Medical School, UTHealth, Division of Pediatric Epilepsy, Houston, Texas
| | - Mary Kay Koenig
- McGovern Medical School, UTHealth, Mitochondrial Center of Excellence, Houston, Texas
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12
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Stark J, Friedman E, Thompson S, Von Allmen G, Bhattacharjee M, Tandon N. Atypical presentations of dysembryoplastic neuroepithelial tumors. Epilepsia 2017; 59:e14-e17. [DOI: 10.1111/epi.13970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jessica Stark
- Vivian Smith Department of Neurosurgery; University of Texas Medical School at Houston; Houston TX USA
| | - Elliott Friedman
- Department of Radiology; University of Texas Medical School at Houston; Houston TX USA
| | - Stephen Thompson
- Department of Neurology; University of Texas Medical School at Houston; Houston TX USA
| | - Gretchen Von Allmen
- Department of Neurology; University of Texas Medical School at Houston; Houston TX USA
- Department of Pediatrics; University of Texas Medical School at Houston; Houston TX USA
| | | | - Nitin Tandon
- Vivian Smith Department of Neurosurgery; University of Texas Medical School at Houston; Houston TX USA
- Mischer Neuroscience Institute; Memorial Hermann Hospital; Texas Medical Center; Houston TX USA
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13
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Mattioli F, Schaefer E, Magee A, Mark P, Mancini GM, Dieterich K, Von Allmen G, Alders M, Coutton C, van Slegtenhorst M, Vieville G, Engelen M, Cobben JM, Juusola J, Pujol A, Mandel JL, Piton A. Mutations in Histone Acetylase Modifier BRPF1 Cause an Autosomal-Dominant Form of Intellectual Disability with Associated Ptosis. Am J Hum Genet 2017; 100:105-116. [PMID: 27939639 DOI: 10.1016/j.ajhg.2016.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/11/2016] [Indexed: 11/20/2022] Open
Abstract
Intellectual disability (ID) is a common neurodevelopmental disorder exhibiting extreme genetic heterogeneity, and more than 500 genes have been implicated in Mendelian forms of ID. We performed exome sequencing in a large family affected by an autosomal-dominant form of mild syndromic ID with ptosis, growth retardation, and hypotonia, and we identified an inherited 2 bp deletion causing a frameshift in BRPF1 (c.1052_1053del) in five affected family members. BRPF1 encodes a protein modifier of two histone acetyltransferases associated with ID: KAT6A (also known as MOZ or MYST3) and KAT6B (MORF or MYST4). The mRNA transcript was not significantly reduced in affected fibroblasts and most likely produces a truncated protein (p.Val351Glyfs∗8). The protein variant shows an aberrant cellular location, loss of certain protein interactions, and decreased histone H3K23 acetylation. We identified BRPF1 deletions or point mutations in six additional individuals with a similar phenotype. Deletions of the 3p25 region, containing BRPF1 and SETD5, cause a defined ID syndrome where most of the clinical features are attributed to SETD5 deficiency. We compared the clinical symptoms of individuals carrying mutations or small deletions of BRPF1 alone or SETD5 alone with those of individuals with deletions encompassing both BRPF1 and SETD5. We conclude that both genes contribute to the phenotypic severity of 3p25 deletion syndrome but that some specific features, such as ptosis and blepharophimosis, are mostly driven by BRPF1 haploinsufficiency.
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Affiliation(s)
- Francesca Mattioli
- Institut de Genetique et de Biologie Moleculaire et Cellulaire, 67400 Illkirch-Graffenstaden, France; INSERM U964, 67400 Illkirch-Graffenstaden, France; CNRS UMR 7104, 67400 Illkirch-Graffenstaden, France; Université de Strasbourg, 67400 Illkirch, France; Chaire de Génétique Humaine, Collège de France, 67400 Illkirch, France
| | - Elise Schaefer
- Service de Génétique Médicale, Hôpitaux Universitaires de Strasbourg, Institut de Génétique Médicale d'Alsace, 67000 Strasbourg, France
| | - Alex Magee
- Genetic Medicine, Belfast City Hospital, Belfast BT9 7AB, Ireland
| | - Paul Mark
- Spectrum Health Medical Group, Grand Rapids, MI 49544, USA
| | - Grazia M Mancini
- Department of Clinical Genetics, Erasmus MC, Rotterdam 3015, the Netherlands
| | - Klaus Dieterich
- Service de Génétique Clinique, Centre Hospitalier Universitaire de Grenoble site Nord, Hôpital Couple-Enfant, 38700 Grenoble, France
| | - Gretchen Von Allmen
- Department of Pediatrics, McGovern Medical School, University of Texas in Houston, Houston, TX 77030, USA
| | - Marielle Alders
- Department of Clinical Genetic, Academic Medical Center, Amsterdam 1100, the Netherlands
| | - Charles Coutton
- INSERM 1209, CNRS UMR 5309, Laboratoire de Génétique Chromosomique, Centre Hospitalier Universitaire Grenoble Alpes, Institut Albert Bonniot, Université Grenoble Alpes, 38706 Grenoble, France
| | | | - Gaëlle Vieville
- INSERM 1209, CNRS UMR 5309, Laboratoire de Génétique Chromosomique, Centre Hospitalier Universitaire Grenoble Alpes, Institut Albert Bonniot, Université Grenoble Alpes, 38706 Grenoble, France
| | - Mark Engelen
- Department of Clinical Genetic, Academic Medical Center, Amsterdam 1100, the Netherlands
| | - Jan Maarten Cobben
- Department of Clinical Genetic, Academic Medical Center, Amsterdam 1100, the Netherlands
| | | | - Aurora Pujol
- Neurometabolic Diseases Laboratory, Institute of Neuropathology, Institut d'Investigació Biomèdica de Bellvitge, 08908 Barcelona, Spain; Center for Biomedical Research on Rare Diseases U759, L'Hospitalet de Llobregat, 08908 Barcelona, Spain; Catalan Institution for Research and Advanced Studies, 08010 Barcelona, Spain
| | - Jean-Louis Mandel
- Institut de Genetique et de Biologie Moleculaire et Cellulaire, 67400 Illkirch-Graffenstaden, France; INSERM U964, 67400 Illkirch-Graffenstaden, France; CNRS UMR 7104, 67400 Illkirch-Graffenstaden, France; Université de Strasbourg, 67400 Illkirch, France; Chaire de Génétique Humaine, Collège de France, 67400 Illkirch, France; Laboratoire de diagnostic génétique, Institut de Génétique Médicale d'Alsace, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; University of Strasbourg Institute for Advanced studies, 67000 Strasbourg, France.
| | - Amélie Piton
- Institut de Genetique et de Biologie Moleculaire et Cellulaire, 67400 Illkirch-Graffenstaden, France; INSERM U964, 67400 Illkirch-Graffenstaden, France; CNRS UMR 7104, 67400 Illkirch-Graffenstaden, France; Université de Strasbourg, 67400 Illkirch, France; Laboratoire de diagnostic génétique, Institut de Génétique Médicale d'Alsace, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
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