1
|
Arrotta K, Ferguson L, Thompson N, Smuk V, Najm IM, Leu C, Lal D, Busch RM. Polygenic burden and its association with baseline cognitive function and postoperative cognitive outcome in temporal lobe epilepsy. Epilepsy Behav 2024; 153:109692. [PMID: 38394790 DOI: 10.1016/j.yebeh.2024.109692] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Demographic and disease factors are associated with cognitive deficits and postoperative cognitive declines in adults with pharmacoresistant temporal lobe epilepsy (TLE), but the role of genetic factors in cognition in TLE is not well understood. Polygenic scores (PGS) for neurological and neuropsychiatric disorders and IQ have been associated with cognition in patient and healthy populations. In this exploratory study, we examined the relationship between PGS for Alzheimer's disease (AD), depression, and IQ and cognitive outcomes in adults with TLE. METHODS 202 adults with pharmacoresistant TLE had genotyping and completed neuropsychological evaluations as part of a presurgical work-up. A subset (n = 116) underwent temporal lobe resection and returned for postoperative cognitive testing. Logistic regression was used to determine if PGS for AD, depression, and IQ predicted baseline domain-specific cognitive function and cognitive phenotypes as well as postoperative language and memory decline. RESULTS No significant findings survived correction for multiple comparisons. Prior to correction, higher PGS for AD and depression (i.e., increased genetic risk for the disorder), but lower PGS for IQ (i.e., decreased genetic likelihood of high IQ) appeared possibly associated with baseline cognitive impairment in TLE. In comparison, higher PGS for AD and IQ appeared as possible risk factors for cognitive decline following temporal lobectomy, while the possible relationship between PGS for depression and post-operative cognitive outcome was mixed. SIGNIFICANCE We did not observe any relationships of large effect between PGS and cognitive function or postsurgical outcome; however, results highlight several promising trends in the data that warrant future investigation in larger samples better powered to detect small genetic effects.
Collapse
Affiliation(s)
- Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Victoria Smuk
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
| | - Dennis Lal
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA, USA.
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
2
|
Wahed S, Ferguson L, Thompson N, Arrotta K, Busch RM. Influence of psychological factors on the relationship between subjective and objective memory in adults with pharmacoresistant temporal lobe epilepsy. Epilepsy Behav 2024; 150:109552. [PMID: 38134645 DOI: 10.1016/j.yebeh.2023.109552] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Many adults with temporal lobe epilepsy (TLE) report subjective cognitive impairment; however, prior studies have shown a discrepancy between these subjective complaints and objective cognitive deficits on neuropsychological measures. Mood disorders/symptoms are also common in TLE and have been linked to greater subjective cognitive difficulties. To further understand these relationships, this retrospective study sought to determine if symptoms of depression and anxiety moderate or mediate the relationship between subjective cognitive impairment and objective cognitive performance in adults with TLE. METHOD Participants were 345 adults (mean age = 40.7; 55 % female) with pharmacoresistant TLE who completed self-report screening measures of depression, anxiety, and subjective cognitive function along with objective memory measures as part of a pre-surgical clinical neuropsychological evaluation. A series of linear regression analyses was conducted to examine the potential moderating and mediating effects of mood on the relationship between subjective and objective memory function after adjusting for relevant covariates. RESULTS Consistent with existing literature, self-reported depression and anxiety symptoms were significantly correlated with subjective memory difficulties across all scales (all p < .001). Subjective memory impairment was also significantly correlated with objective memory performance on neuropsychological measures, albeit with small effect sizes (estimate range 0.04-0.20). Contrary to our hypothesis, depression and anxiety did not moderate or mediate the relationship between subjective memory complaints and objective memory performance. CONCLUSIONS While symptoms of depression and anxiety were associated with subjective memory ability in this cohort of adults with TLE, this study suggests that mood symptoms do not fully explain the relationship between subjective and objective memory function, likely reflecting the complex and multifactorial relationships among these variables. Nevertheless, our results highlight the importance of screening for depression and anxiety symptoms and assessing patients' subjective memory complaints as part of a neuropsychological evaluation as each of these factors tap into a different aspect of the patient functioning.
Collapse
Affiliation(s)
- Shejuti Wahed
- Department of Psychology, Case Western Reserve University, Cleveland, OH, United States.
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Nicolas Thompson
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
3
|
Smyth P, Ferguson L, Burrows JF, Burden RE, Tracey SR, Herron ÚM, Kovaleva M, Williams R, Porter AJ, Longley DB, Barelle CJ, Scott CJ. Evaluation of variable new antigen receptors (vNARs) as a novel cathepsin S (CTSS) targeting strategy. Front Pharmacol 2023; 14:1296567. [PMID: 38116078 PMCID: PMC10728302 DOI: 10.3389/fphar.2023.1296567] [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: 09/18/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
Aberrant activity of the cysteine protease Cathepsin S (CTSS) has been implicated across a wide range of pathologies. Notably in cancer, CTSS has been shown to promote tumour progression, primarily through facilitating invasion and migration of tumour cells and augmenting angiogenesis. Whilst an attractive therapeutic target, more efficacious CTSS inhibitors are required. Here, we investigated the potential application of Variable New Antigen Receptors (vNARs) as a novel inhibitory strategy. A panel of potential vNAR binders were identified following a phage display panning process against human recombinant proCTSS. These were subsequently expressed, purified and binding affinity confirmed by ELISA and SPR based approaches. Selected lead clones were taken forward and were shown to inhibit CTSS activity in recombinant enzyme activity assays. Further assessment demonstrated that our lead clones functioned by a novel inhibitory mechanism, by preventing the activation of proCTSS to the mature enzyme. Moreover, using an intrabody approach, we exhibited the ability to express these clones intracellularly and inhibit CTSS activity whilst lead clones were also noted to impede cell invasion in a tumour cell invasion assay. Collectively, these findings illustrate a novel mechanistic approach for inhibiting CTSS activity, with anti-CTSS vNAR clones possessing therapeutic potential in combating deleterious CTSS activity. Furthermore, this study exemplifies the potential of vNARs in targeting intracellular proteins, opening a range of previously "undruggable" targets for biologic-based therapy.
Collapse
Affiliation(s)
- P. Smyth
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | | | - J. F. Burrows
- School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - R. E. Burden
- School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
| | - S. R. Tracey
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - Ú. M. Herron
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | | | - R. Williams
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - A. J. Porter
- Elasmogen Ltd., Aberdeen, United Kingdom
- Scottish Biologics Facility, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - D. B. Longley
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | | | - C. J. Scott
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| |
Collapse
|
4
|
Bingaman N, Ferguson L, Thompson N, Reyes A, McDonald CR, Hermann BP, Arrotta K, Busch RM. The relationship between mood and anxiety and cognitive phenotypes in adults with pharmacoresistant temporal lobe epilepsy. Epilepsia 2023; 64:3331-3341. [PMID: 37814399 DOI: 10.1111/epi.17795] [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: 08/22/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Patients with temporal lobe epilepsy (TLE) are often at a high risk for cognitive and psychiatric comorbidities. Several cognitive phenotypes have been identified in TLE, but it is unclear how phenotypes relate to psychiatric comorbidities, such as anxiety and depression. This observational study investigated the relationship between cognitive phenotypes and psychiatric symptomatology in TLE. METHODS A total of 826 adults (age = 40.3, 55% female) with pharmacoresistant TLE completed a neuropsychological evaluation that included at least two measures from five cognitive domains to derive International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) cognitive phenotypes (i.e., intact, single-domain impairment, bi-domain impairment, generalized impairment). Participants also completed screening measures for depression and anxiety. Psychiatric history and medication data were extracted from electronic health records. Multivariable proportional odds logistic regression models examined the relationship between IC-CoDE phenotypes and psychiatric variables after controlling for relevant covariates. RESULTS Patients with elevated depressive symptoms had a greater odds of demonstrating increasingly worse cognitive phenotypes than patients without significant depressive symptomatology (odds ratio [OR] = 1.123-1.993, all corrected p's < .05). Number of psychotropic (OR = 1.584, p < .05) and anti-seizure medications (OR = 1.507, p < .001), use of anti-seizure medications with mood-worsening effects (OR = 1.748, p = .005), and history of a psychiatric diagnosis (OR = 1.928, p < .05) also increased the odds of a more severe cognitive phenotype, while anxiety symptoms were unrelated. SIGNIFICANCE This study demonstrates that psychiatric factors are not only associated with function in specific cognitive domains but also with the pattern and extent of deficits across cognitive domains. Results suggest that depressive symptoms and medications are strongly related to cognitive phenotype in adults with TLE and support the inclusion of these factors as diagnostic modifiers for cognitive phenotypes in future work. Longitudinal studies that incorporate neuroimaging findings are warranted to further our understanding of the complex relationships between cognition, mood, and seizures and to determine whether non-pharmacologic treatment of mood symptoms alters cognitive phenotype.
Collapse
Affiliation(s)
- Nolan Bingaman
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anny Reyes
- Department of Radiation Medicine and Applied Sciences and Psychiatry, University of California, San Diego, California, USA
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences and Psychiatry, University of California, San Diego, California, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Ohio, Cleveland, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Ohio, Cleveland, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
5
|
Stevelink R, Campbell C, Chen S, Abou-Khalil B, Adesoji OM, Afawi Z, Amadori E, Anderson A, Anderson J, Andrade DM, Annesi G, Auce P, Avbersek A, Bahlo M, Baker MD, Balagura G, Balestrini S, Barba C, Barboza K, Bartolomei F, Bast T, Baum L, Baumgartner T, Baykan B, Bebek N, Becker AJ, Becker F, Bennett CA, Berghuis B, Berkovic SF, Beydoun A, Bianchini C, Bisulli F, Blatt I, Bobbili DR, Borggraefe I, Bosselmann C, Braatz V, Bradfield JP, Brockmann K, Brody LC, Buono RJ, Busch RM, Caglayan H, Campbell E, Canafoglia L, Canavati C, Cascino GD, Castellotti B, Catarino CB, Cavalleri GL, Cerrato F, Chassoux F, Cherny SS, Cheung CL, Chinthapalli K, Chou IJ, Chung SK, Churchhouse C, Clark PO, Cole AJ, Compston A, Coppola A, Cosico M, Cossette P, Craig JJ, Cusick C, Daly MJ, Davis LK, de Haan GJ, Delanty N, Depondt C, Derambure P, Devinsky O, Di Vito L, Dlugos DJ, Doccini V, Doherty CP, El-Naggar H, Elger CE, Ellis CA, Eriksson JG, Faucon A, Feng YCA, Ferguson L, Ferraro TN, Ferri L, Feucht M, Fitzgerald M, Fonferko-Shadrach B, Fortunato F, Franceschetti S, Franke A, French JA, Freri E, Gagliardi M, Gambardella A, Geller EB, Giangregorio T, Gjerstad L, Glauser T, Goldberg E, Goldman A, Granata T, Greenberg DA, Guerrini R, Gupta N, Haas KF, Hakonarson H, Hallmann K, Hassanin E, Hegde M, Heinzen EL, Helbig I, Hengsbach C, Heyne HO, Hirose S, Hirsch E, Hjalgrim H, Howrigan DP, Hucks D, Hung PC, Iacomino M, Imbach LL, Inoue Y, Ishii A, Jamnadas-Khoda J, Jehi L, Johnson MR, Kälviäinen R, Kamatani Y, Kanaan M, Kanai M, Kantanen AM, Kara B, Kariuki SM, Kasperavičiūte D, Kasteleijn-Nolst Trenite D, Kato M, Kegele J, Kesim Y, Khoueiry-Zgheib N, King C, Kirsch HE, Klein KM, Kluger G, Knake S, Knowlton RC, Koeleman BPC, Korczyn AD, Koupparis A, Kousiappa I, Krause R, Krenn M, Krestel H, Krey I, Kunz WS, Kurki MI, Kurlemann G, Kuzniecky R, Kwan P, Labate A, Lacey A, Lal D, Landoulsi Z, Lau YL, Lauxmann S, Leech SL, Lehesjoki AE, Lemke JR, Lerche H, Lesca G, Leu C, Lewin N, Lewis-Smith D, Li GHY, Li QS, Licchetta L, Lin KL, Lindhout D, Linnankivi T, Lopes-Cendes I, Lowenstein DH, Lui CHT, Madia F, Magnusson S, Marson AG, May P, McGraw CM, Mei D, Mills JL, Minardi R, Mirza N, Møller RS, Molloy AM, Montomoli M, Mostacci B, Muccioli L, Muhle H, Müller-Schlüter K, Najm IM, Nasreddine W, Neale BM, Neubauer B, Newton CRJC, Nöthen MM, Nothnagel M, Nürnberg P, O’Brien TJ, Okada Y, Ólafsson E, Oliver KL, Özkara C, Palotie A, Pangilinan F, Papacostas SS, Parrini E, Pato CN, Pato MT, Pendziwiat M, Petrovski S, Pickrell WO, Pinsky R, Pippucci T, Poduri A, Pondrelli F, Powell RHW, Privitera M, Rademacher A, Radtke R, Ragona F, Rau S, Rees MI, Regan BM, Reif PS, Rhelms S, Riva A, Rosenow F, Ryvlin P, Saarela A, Sadleir LG, Sander JW, Sander T, Scala M, Scattergood T, Schachter SC, Schankin CJ, Scheffer IE, Schmitz B, Schoch S, Schubert-Bast S, Schulze-Bonhage A, Scudieri P, Sham P, Sheidley BR, Shih JJ, Sills GJ, Sisodiya SM, Smith MC, Smith PE, Sonsma ACM, Speed D, Sperling MR, Stefansson H, Stefansson K, Steinhoff BJ, Stephani U, Stewart WC, Stipa C, Striano P, Stroink H, Strzelczyk A, Surges R, Suzuki T, Tan KM, Taneja RS, Tanteles GA, Taubøll E, Thio LL, Thomas GN, Thomas RH, Timonen O, Tinuper P, Todaro M, Topaloğlu P, Tozzi R, Tsai MH, Tumiene B, Turkdogan D, Unnsteinsdóttir U, Utkus A, Vaidiswaran P, Valton L, van Baalen A, Vetro A, Vining EPG, Visscher F, von Brauchitsch S, von Wrede R, Wagner RG, Weber YG, Weckhuysen S, Weisenberg J, Weller M, Widdess-Walsh P, Wolff M, Wolking S, Wu D, Yamakawa K, Yang W, Yapıcı Z, Yücesan E, Zagaglia S, Zahnert F, Zara F, Zhou W, Zimprich F, Zsurka G, Zulfiqar Ali Q. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nat Genet 2023; 55:1471-1482. [PMID: 37653029 PMCID: PMC10484785 DOI: 10.1038/s41588-023-01485-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment.
Collapse
|
6
|
Busch RM, Dalton JE, Jehi L, Ferguson L, Krieger NI, Struck AF, Hermann BP. Association of Neighborhood Deprivation With Cognitive and Mood Outcomes in Adults With Pharmacoresistant Temporal Lobe Epilepsy. Neurology 2023:WNL.0000000000207266. [PMID: 37076308 DOI: 10.1212/wnl.0000000000207266] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/21/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Temporal lobe epilepsy (TLE) is the most common adult form of epilepsy and is associated with high risk for cognitive deficits and depressed mood. However, little is known about the role of environmental factors on cognition and mood in TLE. This cross-sectional study examined the relationship between neighborhood deprivation and neuropsychological function in adults with TLE. METHODS Neuropsychological data were obtained from a clinical registry of patients with TLE and included measures of intelligence, attention, processing speed, language, executive function, visuospatial skills, verbal/visual memory, depression, and anxiety. Home addresses were used to calculate the Area Deprivation Index (ADI) for each individual, which were separated into quintiles (i.e., Quintile 1=least disadvantaged, Quintile 5=most disadvantaged). Kruskal-Wallis tests compared quintile groups on cognitive domain scores as well as mood and anxiety scores. Multivariable regression models, with and without ADI, were estimated for overall cognitive phenotype as well as for mood and anxiety scores. RESULTS 800 patients (median age 38 years-old; 58% female) met all inclusion criteria.Effects of disadvantage (increasing ADI) were observed across nearly all measured cognitive domains as well as with significant increases in symptoms of depression and anxiety. Further, patients in more disadvantaged ADI quintiles had increased odds of a worse cognitive phenotype (P=0.013). Patients who self-identified as members of minoritized groups were over-represented in the most disadvantaged ADI quintiles and were 2.91 (95% confidence interval, CI: 1.87-4.54) times more likely to be in a severe cognitive phenotype than non-Hispanic Whites (P < 0.001). However, accounting for ADI attenuated this relationship, suggesting neighborhood deprivation may account for some of the relationship between race/ethnicity and cognitive phenotype (ADI-adjusted proportional odds ratio [95% CI]: 1.82 [1.37 - 2.42]). DISCUSSION These findings highlight the importance of environmental factors and regional characteristics in neuropsychological studies of epilepsy. There are many potential mechanisms by which neighborhood disadvantage can adversely impact cognition (e.g., fewer educational opportunities, limited access to health care, food insecurity/poor nutrition, greater medical comorbidities). Future research will seek to investigate these potential mechanisms and to determine whether structural and functional alterations in the brain moderate the relationship between ADI and cognition.
Collapse
Affiliation(s)
- Robyn M Busch
- Epilepsy Center, Cleveland Clinic, Cleveland, OH
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Jarrod E Dalton
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH
- Center for Computational Life Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Nikolas I Krieger
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
7
|
Aul K, Ferguson L, Russo B. Strategy to Enhance Undergraduate Nursing Students' Assertiveness. J Nurs Educ 2023; 62:263-264. [PMID: 37021943 DOI: 10.3928/01484834-20230208-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Karen Aul
- University of South Florida College of Nursing
| | | | | |
Collapse
|
8
|
López-Rivera JA, Leu C, Macnee M, Khoury J, Hoffmann L, Coras R, Kobow K, Bhattarai N, Pérez-Palma E, Hamer H, Brandner S, Rössler K, Bien CG, Kalbhenn T, Pieper T, Hartlieb T, Butler E, Genovese G, Becker K, Altmüller J, Niestroj LM, Ferguson L, Busch RM, Nürnberg P, Najm I, Blümcke I, Lal D. The genomic landscape across 474 surgically accessible epileptogenic human brain lesions. Brain 2022; 146:1342-1356. [PMID: 36226386 PMCID: PMC10115236 DOI: 10.1093/brain/awac376] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 02/16/2022] [Revised: 08/11/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
Understanding the exact molecular mechanisms involved in the etiology of epileptogenic pathologies with or without tumor activity is essential for improving treatment of drug-resistant focal epilepsy. Here, we characterize the landscape of somatic genetic variants in resected brain specimens from 474 individuals with drug-resistant focal epilepsy using deep whole-exome sequencing (>350×) and whole-genome genotyping. Across the exome, we observe a greater number of somatic single-nucleotide variants (SNV) in low-grade epilepsy-associated tumors (LEAT; 7.92 ± 5.65 SNV) than in brain tissue from malformations of cortical development (MCD; 6.11 ± 4 SNV) or hippocampal sclerosis (HS; 5.1 ± 3.04 SNV). Tumor tissues also had the largest number of likely pathogenic variant carrying cells. LEAT had the highest proportion of samples with one or more somatic copy number variants (CNV; 24.7%), followed by MCD (5.4%) and HS (4.1%). Recurring somatic whole chromosome duplications affecting Chromosome 7 (16.8%), chromosome 5 (10.9%), and chromosome 20 (9.9%) were observed among LEAT. For germline variant-associated MCD genes such as TSC2, DEPDC5, and PTEN, germline SNV were frequently identified within large loss of heterozygosity regions, supporting the recently proposed 'second hit' disease mechanism in these genes. We detect somatic variants in twelve established lesional epilepsy genes and demonstrate exome-wide statistical support for three of these in the etiology of LEAT (e.g., BRAF) and MCD (e.g., SLC35A2 and MTOR). We also identify novel significant associations for PTPN11 with LEAT and NRAS Q61 mutated protein with a complex MCD characterized by polymicrogyria and nodular heterotopia. The variants identified in NRAS are known from cancer studies to lead to hyperactivation of NRAS, which can be targeted pharmacologically. We identify large recurrent 1q21-q44 duplication including AKT3 in association with focal cortical dysplasia type 2a with hyaline astrocytic inclusions, another rare and possibly under-recognized brain lesion. The clinical genetic analyses showed that the numbers of somatic SNV across the exome and the fraction of affected cells were positively correlated with the age at seizure onset and surgery in individuals with LEAT. In summary, our comprehensive genetic screen sheds light on the genome-scale landscape of genetic variants in epileptic brain lesions, informs the design of gene panels for clinical diagnostic screening, and guides future directions for clinical implementation of epilepsy surgery genetics.
Collapse
Affiliation(s)
- Javier A López-Rivera
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA 02142, USA.,Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Marie Macnee
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Jean Khoury
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Lucas Hoffmann
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Katja Kobow
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Nisha Bhattarai
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana. Santiago 7610658, Chile
| | - Hajo Hamer
- Epilepsy Center, University Hospital Erlangen, Erlangen, Germany, and EpiCARE partner
| | - Sebastian Brandner
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany, and EpiCARE partner
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria, and EpiCARE partner
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thilo Kalbhenn
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld University, Bielefeld, Germany
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany.,Research Institute "Rehabilitation, Transition, Palliation", PMU Salzburg, Salzburg, Austria
| | - Elizabeth Butler
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Giulio Genovese
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA 02142, USA
| | - Kerstin Becker
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Genomics, Charitéplatz 1, 10117 Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Lisa Marie Niestroj
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Lisa Ferguson
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Robyn M Busch
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Imad Najm
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Ingmar Blümcke
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA.,Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA 02142, USA.,Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| |
Collapse
|
9
|
Lineweaver TT, Collins AN, Stopa MM, Horth MS, Fishbaugh ME, Haut J, Ferguson L, Klaas P, Lachhwani D, Bingaman W, Busch RM. Mother knows best… or does she? Perceptions of the memory abilities of pediatric patients with epilepsy as reported by patients and their parents across time. Epilepsy Behav 2022; 128:108589. [PMID: 35182849 DOI: 10.1016/j.yebeh.2022.108589] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study compared the self-reported and parent-reported memory of children with epilepsy across time and explored the relationships between these measures of subjective memory and the children's actual performance on objective neuropsychological tests. METHOD One-hundred and nineteen children with epilepsy who were surgical candidates underwent comprehensive neuropsychological testing that included the Everyday Verbal Memory Questionnaire (EVMQ). Each child's parent and 82 of the children themselves completed the appropriate version of this subjective memory measure. After 9 months, the children returned for a second neuropsychological evaluation with 71 parents and 39 children completing the same questionnaire. Approximately one-third of the children in the study underwent surgery between the two evaluations. Standardized regression-based norms were used to quantify change in cognitive abilities across assessments. RESULTS Results revealed significant relationships between parent reports and child reports of the children's memory abilities. Parent reports, but not child reports, correlated with the children's objective test scores at baseline. In contrast, children were more attuned to changes in their memory across time. CONCLUSIONS These findings demonstrate the importance of considering both parent and child perceptions of everyday cognitive functioning when evaluating cognition and cognitive changes over time in pediatric patients with epilepsy.
Collapse
Affiliation(s)
- Tara T Lineweaver
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States.
| | - Abbey N Collins
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Margaret M Stopa
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Madison S Horth
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Megan E Fishbaugh
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Jennifer Haut
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Lisa Ferguson
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Patricia Klaas
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Deepak Lachhwani
- Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - William Bingaman
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| |
Collapse
|
10
|
Kaur N, Nowacki AS, Haut JS, Klaas P, Ferguson L, Lachhwani D, Bingaman W, Lineweaver TT, Busch RM. Cognitive outcomes following pediatric epilepsy surgery. Epilepsy Res 2022; 180:106859. [PMID: 35042117 DOI: 10.1016/j.eplepsyres.2022.106859] [Citation(s) in RCA: 1] [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: 10/19/2021] [Revised: 12/10/2021] [Accepted: 01/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To characterize outcomes following pediatric epilepsy surgery across a broad range of cognitive domains using empirical methods (i.e., reliable change indices: RCIs), compare these outcomes with those based on traditional methods (i.e., standard deviation: SD), and identify factors associated with postoperative cognitive declines and/or improvements. METHODS This retrospective cohort study included 186 children who underwent surgical resection for treatment of pharmacoresistant epilepsy and who completed pre- and postoperative neuropsychological assessments. Postoperative testing occurred approximately 6.5 months after surgery and included measures of intelligence, attention/working memory, processing speed, language, executive functioning, visuospatial skills, memory, and academic achievement. Change scores for each patient were classified as decline, no change, or improvement using epilepsy-specific RCIs. Chi-square goodness of fit tests were used to compare the distribution of outcomes as classified with RCIs to those obtained using a traditional one SD cutoff. Multinomial regression analyses were conducted to identify factors associated with cognitive decline and/or improvement. RESULTS While 18% of children demonstrated no postoperative declines or improvements in any cognitive domain, the majority demonstrated relatively focal changes (declines and/or improvements in 1-2 cognitive domains). Rates of postoperative decline and improvement across individual cognitive domains were variable and ranged from 4-35% and 2-31%, respectively. Compared to RCIs, SD methodology often overestimated postoperative improvements and varied with respect to declines. Factors associated with RCI decline or improvement included preoperative performance, age at surgery, surgery site, and postoperative seizures. SIGNIFICANCE Results suggest substantial variability in individual cognitive outcomes approximately 6.5 months following pediatric epilepsy surgery. The differences in change distributions obtained using epilepsy-specific RCIs versus SDs highlight the need for studies using empiric methodology to study postoperative cognitive change. Variables associated with postoperative cognitive change may be used to develop multivariable prediction models in future studies to aid clinical decision-making and patient counseling.
Collapse
Affiliation(s)
- Navkiranjot Kaur
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer S Haut
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Pediatrics, Psychology Section, Texas Children's Hospital, Houston, TX, USA
| | - Patricia Klaas
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepak Lachhwani
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - William Bingaman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robyn M Busch
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
11
|
Ferguson L, Rentes VC, McCarthy L, Vinson AH. Collaborative conversations during the time of COVID-19: Building a "meta"-learning community. Learn Health Syst 2022; 6:e10284. [PMID: 35036555 PMCID: PMC8753305 DOI: 10.1002/lrh2.10284] [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: 12/18/2020] [Revised: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022] Open
Abstract
PROBLEM COVID-19 created new research, clinical, educational, and personal challenges, while simultaneously separating work teams who were under work-from-home restrictions. Addressing these challenges required new forms of collaborative groups. APPROACH To support the department community and the rapid sharing of new research, educational, clinical, and personal efforts, a Core Team from the Department of Learning Health Sciences at the University of Michigan developed a meeting series called the COVID Conversations. This Experience Report shares the organizational structure of the COVID Conversations, proposes a comparison to traditional Learning Communities, and reports the results of a questionnaire that gathered details about department members' COVID-related activities. OUTCOMES We identify and describe salient similarities and differences between the COVID Conversations and the characteristics of Learning Communities. We also developed and piloted a taxonomy for characterizing LHS research projects that may be further developed for use in Learning Community planning, in conjunction with other maturity grids and ontologies. We propose the term "Meta-Learning Community" to describe the structure and function of the COVID Conversations. NEXT STEPS In academic medicine, remote work, telemedicine, and virtual learning may be here to stay. The COVID Conversations constitute a distinct and innovative form of collaborative work in which separate teams addressing distinct goals, yet sharing a common passion to tackle the issues brought by the pandemic, are able to share experiences and learn from one other. The challenges of COVID-19 have made evident the need for multiple forms of organizing teamwork, and our study contributes the notion of a "Meta"-Learning Community as a new form of collaborative work.
Collapse
Affiliation(s)
- Lisa Ferguson
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Victor C. Rentes
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Lauren McCarthy
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Alexandra H. Vinson
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| |
Collapse
|
12
|
Motelow JE, Povysil G, Dhindsa RS, Stanley KE, Allen AS, Feng YCA, Howrigan DP, Abbott LE, Tashman K, Cerrato F, Cusick C, Singh T, Heyne H, Byrnes AE, Churchhouse C, Watts N, Solomonson M, Lal D, Gupta N, Neale BM, Cavalleri GL, Cossette P, Cotsapas C, De Jonghe P, Dixon-Salazar T, Guerrini R, Hakonarson H, Heinzen EL, Helbig I, Kwan P, Marson AG, Petrovski S, Kamalakaran S, Sisodiya SM, Stewart R, Weckhuysen S, Depondt C, Dlugos DJ, Scheffer IE, Striano P, Freyer C, Krause R, May P, McKenna K, Regan BM, Bennett CA, Leu C, Leech SL, O’Brien TJ, Todaro M, Stamberger H, Andrade DM, Ali QZ, Sadoway TR, Krestel H, Schaller A, Papacostas SS, Kousiappa I, Tanteles GA, Christou Y, Štěrbová K, Vlčková M, Sedláčková L, Laššuthová P, Klein KM, Rosenow F, Reif PS, Knake S, Neubauer BA, Zimprich F, Feucht M, Reinthaler EM, Kunz WS, Zsurka G, Surges R, Baumgartner T, von Wrede R, Pendziwiat M, Muhle H, Rademacher A, van Baalen A, von Spiczak S, Stephani U, Afawi Z, Korczyn AD, Kanaan M, Canavati C, Kurlemann G, Müller-Schlüter K, Kluger G, Häusler M, Blatt I, Lemke JR, Krey I, Weber YG, Wolking S, Becker F, Lauxmann S, Boßelmann C, Kegele J, Hengsbach C, Rau S, Steinhoff BJ, Schulze-Bonhage A, Borggräfe I, Schankin CJ, Schubert-Bast S, Schreiber H, Mayer T, Korinthenberg R, Brockmann K, Wolff M, Dennig D, Madeleyn R, Kälviäinen R, Saarela A, Timonen O, Linnankivi T, Lehesjoki AE, Rheims S, Lesca G, Ryvlin P, Maillard L, Valton L, Derambure P, Bartolomei F, Hirsch E, Michel V, Chassoux F, Rees MI, Chung SK, Pickrell WO, Powell R, Baker MD, Fonferko-Shadrach B, Lawthom C, Anderson J, Schneider N, Balestrini S, Zagaglia S, Braatz V, Johnson MR, Auce P, Sills GJ, Baum LW, Sham PC, Cherny SS, Lui CH, Delanty N, Doherty CP, Shukralla A, El-Naggar H, Widdess-Walsh P, Barišić N, Canafoglia L, Franceschetti S, Castellotti B, Granata T, Ragona F, Zara F, Iacomino M, Riva A, Madia F, Vari MS, Salpietro V, Scala M, Mancardi MM, Nobili L, Amadori E, Giacomini T, Bisulli F, Pippucci T, Licchetta L, Minardi R, Tinuper P, Muccioli L, Mostacci B, Gambardella A, Labate A, Annesi G, Manna L, Gagliardi M, Parrini E, Mei D, Vetro A, Bianchini C, Montomoli M, Doccini V, Barba C, Hirose S, Ishii A, Suzuki T, Inoue Y, Yamakawa K, Beydoun A, Nasreddine W, Khoueiry Zgheib N, Tumiene B, Utkus A, Sadleir LG, King C, Caglayan SH, Arslan M, Yapıcı Z, Topaloglu P, Kara B, Yis U, Turkdogan D, Gundogdu-Eken A, Bebek N, Uğur-İşeri S, Baykan B, Salman B, Haryanyan G, Yücesan E, Kesim Y, Özkara Ç, Tsai MH, Ho CJ, Lin CH, Lin KL, Chou IJ, Poduri A, Shiedley BR, Shain C, Noebels JL, Goldman A, Busch RM, Jehi L, Najm IM, Ferguson L, Khoury J, Glauser TA, Clark PO, Buono RJ, Ferraro TN, Sperling MR, Lo W, Privitera M, French JA, Schachter S, Kuzniecky RI, Devinsky O, Hegde M, Greenberg DA, Ellis CA, Goldberg E, Helbig KL, Cosico M, Vaidiswaran P, Fitch E, Berkovic SF, Lerche H, Lowenstein DH, Goldstein DB. Sub-genic intolerance, ClinVar, and the epilepsies: A whole-exome sequencing study of 29,165 individuals. Am J Hum Genet 2021; 108:2024. [PMID: 34626584 DOI: 10.1016/j.ajhg.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
13
|
Ferguson L, Miller M, Whiting A, Haut J, Klaas P, Bingaman W, Lachhwani D, Lineweaver TT, Floden D, Busch RM. Cognitive outcomes following frontal lobe resection for treatment of epilepsy in children and adolescents. Epilepsy Behav 2021; 124:108265. [PMID: 34509884 DOI: 10.1016/j.yebeh.2021.108265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To use reliable change indices (RCIs) developed specifically for pediatric patients with epilepsy to examine cognitive outcomes after frontal lobe resection for pharmacoresistant epilepsy. METHODS Forty-one pediatric patients (25 male, Mage = 10 years) completed comprehensive neuropsychological evaluations before and an average of 6.5 months after frontal lobe resections for treatment of epilepsy. Evaluations included tests of intelligence, attention/working memory, processing speed, language, visuospatial skills, executive function, and episodic memory. Practice effect-adjusted RCIs were used to determine clinically significant postoperative cognitive change. Demographic, disease, and surgical variables were examined to identify factors associated with postoperative cognitive decline or improvement. RESULTS Within each cognitive domain, there was a large proportion of patients (51-84%) who did not exhibit significant cognitive change. In terms of overall cognitive profile, 44% demonstrated improvement in at least one domain and 69% declined in at least one domain. Postoperative cognitive improvement occurred most commonly in the domain of processing speed, whereas postoperative cognitive decline occurred most frequently in the domain of visuospatial skills. Younger age at surgery was associated with cognitive improvement. Older age at seizure onset and higher baseline cognitive performance were associated with cognitive decline. SIGNIFICANCE Approximately 6.5 months after frontal lobe resection, only 15% of our sample showed stable performance across all cognitive domains. Seventeen percent of patients showed improvements without declines, 42% showed declines without improvements, and 27% showed a mix of improvements and declines across different cognitive domains. Age and baseline abilities were associated with postoperative cognitive change on multiple measures. With 1 in 8 children demonstrating postoperative decline across three or more domains, further research is needed to identify factors associated with cognitive decline in order to inform clinical decision-making and patient/family counseling.
Collapse
Affiliation(s)
- Lisa Ferguson
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Margaret Miller
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Alexander Whiting
- Department of Neurosurgery, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jennifer Haut
- Department of Pediatrics, Psychology Section, Texas Children's Hospital, 6701 Fannin Street, Suite 1630, Houston, TX 77003, USA.
| | - Patricia Klaas
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - William Bingaman
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Deepak Lachhwani
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Tara T Lineweaver
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, USA.
| | - Darlene Floden
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
14
|
Haq M, Reyal Y, Tiffin N, Szakacs S, Ferguson L. T-cell pseudolymphoma secondary to ixazomib for multiple myeloma. Skin Health Dis 2021; 1:e57. [PMID: 35663138 PMCID: PMC9060122 DOI: 10.1002/ski2.57] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
We present a case of a 54‐year‐old male with multiple myeloma (MM) who presented with widespread pruritic erythematous lesions following ixazomib treatment. This occurred after his third cycle of treatment with ixazomib, thalidomide and dexamethasone and was controlled by potent steroids and temporary cessation of ixazomib. The strong correlation between the timeline of the rash, ixazomib treatment and subsequent cessation led to a diagnosis of a drug‐induced rash. Skin biopsy histology, immunochemistry and the absence of monoclonal T‐cell receptor gene rearrangement further confirmed the diagnosis of a T‐cell pseudolymphoma secondary to ixazomib. Ixazomib is an oral proteasome inhibitor used in the treatment of MM. Other proteasome inhibitors have been reported to trigger cutaneous adverse effects. However, to our knowledge, this is the first report of pseudolymphoma following proteasome inhibitor use. Dermatologists should be aware of this potential effect and the possible management pathways such as cessation and dose reduction.
Collapse
Affiliation(s)
- M Haq
- Faculty of Medicine St George's, University of London London UK
| | - Y Reyal
- Department of Haematology St George's Healthcare NHS Trust London UK
| | - N Tiffin
- South West London Pathology St George's Healthcare NHS Trust London UK
| | - S Szakacs
- Department of Histopathology William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust Ashford UK
| | - L Ferguson
- Department of Dermatology St George's Healthcare NHS Trust London UK
| |
Collapse
|
15
|
Doherty C, Kinzy TG, Ferguson L, Altemus J, Hermann BP, Eng C, Najm I, Busch RM. The role of genetic polymorphisms in executive functioning performance in temporal lobe epilepsy. Epilepsy Behav 2021; 121:108088. [PMID: 34102472 PMCID: PMC8238870 DOI: 10.1016/j.yebeh.2021.108088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the role of several genetic polymorphisms (APOE ε4, BDNF Met, and COMT Val) in executive functioning performance in patients with pharmacoresistant temporal lobe epilepsy (TLE). METHODS Ninety-three adults (51 female, mean age = 39 years) with TLE completed executive functioning measures as part of a comprehensive preoperative neuropsychological evaluation, including Trail Making Test (Part B), Wisconsin Card Sorting Test (Conceptual Level Responses and Perseverative Errors), Color Word Interference from the Delis Kaplan Executive Function System, and measures of phonemic and semantic verbal fluency. Genotyping of the APOE, BDNF, and COMT genes was conducted using DNA extracted from peripheral blood or brain tissue (from epilepsy surgery). RESULTS After adjustment for general cognitive ability, COMT Val carriers showed poorer performance on semantic verbal fluency and color word interference than non-carriers, and BDNF Met carriers showed poorer performance on phonemic verbal fluency than those without a Met allele. SIGNIFICANCE Results suggest that COMT and BDNF polymorphisms are associated with performance on several EF measures in patients with TLE, including tasks assessing verbal fluency and response inhibition and account for up to 16% of the variance in test performance. The APOE polymorphism was not significantly associated with any of the executive function measures analyzed.
Collapse
Affiliation(s)
- Christine Doherty
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
| | - Tyler G Kinzy
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Jessica Altemus
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, Madison, WI, USA.
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
16
|
Busch RM, Hogue O, Miller M, Ferguson L, McAndrews MP, Hamberger M, Kim M, McDonald CR, Reyes A, Drane DL, Hermann BP, Bingaman W, Najm IM, Kattan MW, Jehi L. Nomograms to Predict Verbal Memory Decline After Temporal Lobe Resection in Adults With Epilepsy. Neurology 2021; 97:e263-e274. [PMID: 34011574 PMCID: PMC8302146 DOI: 10.1212/wnl.0000000000012221] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop and externally validate models to predict the probability of postoperative verbal memory decline in adults after temporal lobe resection (TLR) for epilepsy using easily accessible preoperative clinical predictors. METHODS Multivariable models were developed to predict delayed verbal memory outcome on 3 commonly used measures: Rey Auditory Verbal Learning Test (RAVLT) and Logical Memory (LM) and Verbal Paired Associates (VPA) subtests from Wechsler Memory Scale-Third Edition. With the use of the Harrell step-down procedure for variable selection, models were developed in 359 adults who underwent TLR at the Cleveland Clinic and validated in 290 adults at 1 of 5 epilepsy surgery centers in the United States or Canada. RESULTS Twenty-nine percent of the development cohort and 26% of the validation cohort demonstrated significant decline on at least 1 verbal memory measure. Initial models had good to excellent predictive accuracy (calibration [c] statistic range 0.77-0.80) in identifying patients with memory decline; however, models slightly underestimated decline in the validation cohort. Model coefficients were updated with data from both cohorts to improve stability. The model for RAVLT included surgery side, baseline memory score, and hippocampal resection. The models for LM and VPA included surgery side, baseline score, and education. Updated model performance was good to excellent (RAVLT c = 0.81, LM c = 0.76, VPA c = 0.78). Model calibration was very good, indicating no systematic overestimation or underestimation of risk. CONCLUSIONS Nomograms are provided in 2 easy-to-use formats to assist clinicians in estimating the probability of verbal memory decline in adults considering TLR for treatment of epilepsy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that multivariable prediction models accurately predict verbal memory decline after TLR for epilepsy in adults.
Collapse
Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Olivia Hogue
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Margaret Miller
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Mary Pat McAndrews
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Marla Hamberger
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Michelle Kim
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Carrie R McDonald
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Anny Reyes
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel L Drane
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce P Hermann
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - William Bingaman
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Imad M Najm
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Michael W Kattan
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lara Jehi
- From the Epilepsy Center (R.M.B., L.F., W.B., I.M.N., L.J.) and Department of Neurology (R.M.B., M.M., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Lerner Research Institute, Cleveland Clinic, OH; Department of Psychology (M.P.M.), University of Toronto; Krembil Brain Institute (M.P.M.), University Health Network, Toronto, Ontario, Canada; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology (M.K., D.L.D.), University of Washington School of Medicine, Seattle; Department of Psychiatry (C.R.M., A.R.), University of California, San Diego; Departments of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; and Department of Neurology (B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| |
Collapse
|
17
|
Huang J, Bhargava E, Walsh M, Pennell D, Attya H, Jablenska L, Ferguson L, Lilly I, Pepper C, Tweedie D, Possamai V. 786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic. Br J Surg 2021. [PMCID: PMC8135831 DOI: 10.1093/bjs/znab134.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A < 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population. Method Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020. Results 61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID. Conclusions Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.
Collapse
Affiliation(s)
- J Huang
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - E Bhargava
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - M Walsh
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - D Pennell
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - H Attya
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - L Jablenska
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - L Ferguson
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - I Lilly
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - C Pepper
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - D Tweedie
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - V Possamai
- Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
18
|
|
19
|
Ferguson L, Ho B, Weir J, Francis N, West K, Rathbone B, Larkin J, Heelan K. Extensive mucocutaneous, oesophageal and otic lichen planus secondary to nivolumab therapy. Skin Health Dis 2021; 1:e8. [PMID: 35664814 PMCID: PMC9060137 DOI: 10.1002/ski2.8] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 02/01/2023]
Abstract
We report a 73-year-old female with metastatic renal cell carcinoma who developed a widespread lichenoid reaction following nivolumab treatment. The timeline of the reaction strongly correlated with the nivolumab treatment and subsequent cessation. Our patient had cutaneous, mucosal, otic, ophthalmic and oesophageal involvement, demonstrating the potentially extensive nature of lichenoid reactions to anti-programmed cell death receptor-1 (anti-PD1) therapies. Although lichenoid reactions to anti-PD1 therapies are now well recognized, there have been no previous reports of otic or oesophageal involvement in the literature. Although cutaneous lichenoid reactions do not tend to be severe or treatment limiting, more widespread systemic lichenoid reactions are challenging to manage, particularly in the context of malignancy. This very unusual case highlights the importance of considering involvement beyond the skin in all lichenoid skin reactions.
Collapse
Affiliation(s)
| | - B. Ho
- Dermatology DepartmentSt George's University Hospitals NHS Foundation TrustLondonUK
| | - J. Weir
- Department of HistopathologyImperial College Healthcare NHS TrustLondonUK
| | - N. Francis
- Department of HistopathologyImperial College Healthcare NHS TrustLondonUK
| | - K. West
- Histopathology DepartmentLeicester Royal InfirmaryLeicesterUK
| | - B. Rathbone
- Gastroenterology DepartmentLeicester Royal InfirmaryLeicesterUK
| | - J. Larkin
- Royal Marsden Hospital NHS TrustLondonUK
| | - K. Heelan
- Royal Marsden Hospital NHS TrustLondonUK
| |
Collapse
|
20
|
Sharpley FA, Larham J, Haines A, Djebbari F, Tseu B, Leary H, Vallance G, Panitsas F, Ferguson L, Roberts P, Peniket A, Gooding S, Kothari J, Moore S, Ramasamy K. Myeloma clinical outcomes following the first wave of COVID-19: results from the Thames Valley Cancer Alliance (UK). Br J Haematol 2020; 192:e136-e139. [PMID: 33326594 DOI: 10.1111/bjh.17261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Faye A Sharpley
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Jemma Larham
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Angus Haines
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Faouzi Djebbari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Bing Tseu
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Heather Leary
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Grant Vallance
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Fotios Panitsas
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Lisa Ferguson
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Pamela Roberts
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Andrew Peniket
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Sarah Gooding
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Jaimal Kothari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Sally Moore
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| |
Collapse
|
21
|
Meyer D, Trotochaud M, Ferguson L, Vines J, Barlow R, Nuzzo JB. A US metropolitan county health department's response to a measles outbreak in a childcare facility - challenges faced and lessons learned. Perspect Public Health 2020; 142:42-45. [PMID: 33200687 DOI: 10.1177/1757913920955201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS In June 2018, the Multnomah County Health Department located in Portland, Oregon, US, responded to a measles exposure in a local childcare facility. This analysis describes lessons learned and challenges encountered during this measles response that may inform public health policy and help other local public health authorities prepare for measles outbreaks. These lessons will become increasingly important as measles cases continue to increase in both the US and abroad. METHODS A semi-structured videoconference interview was conducted with nine health department staff who were directly involved in the health department's response to the measles outbreak. Interview notes were iteratively discussed between all authors to identify those outbreak response challenges and lessons learned that were generalizable to the broader public health community. RESULTS Some of the key challenges and lessons learned included the need for increased provider recognition and reporting of measles cases, difficulty in determining which staff and children to exclude from attending daycare during the 21-day postexposure monitoring period, determining who would be prioritized to receive immunoglobulin, and the need for childcare staff vaccine status requirements. CONCLUSION Lessons from this response highlight important considerations for public health practitioners and policy makers. Given the relative severity of measles and the potential for spread in facilities that serve infants and young children, the public health community must continue to address key gaps through planning and policy.
Collapse
Affiliation(s)
- Diane Meyer
- Johns Hopkins Center for Health Security, 621 East Pratt Street Suite 210, Baltimore, MD 21202, USA
| | - Marc Trotochaud
- Johns Hopkins Center for Health Security, Baltimore, MD, USA
| | - Lisa Ferguson
- Multnomah County Health Department, Portland, OR, USA
| | | | | | | |
Collapse
|
22
|
Gramm M, Leu C, Pérez-Palma E, Ferguson L, Jehi L, Daly MJ, Najm IM, Busch RM, Lal D. Polygenic risk heterogeneity among focal epilepsies. Epilepsia 2020; 61:e179-e185. [PMID: 33090489 DOI: 10.1111/epi.16717] [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: 05/28/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
Focal epilepsy (FE) is clinically highly heterogeneous. It has been shown recently that not only rare but also a subset of common genetic variants confer risk for FE. The relatively modest power of genetic studies in FE suggests a high genetic heterogeneity of FE when grouped as one disorder. We hypothesize that the clinical heterogeneity of FE is correlated with genetic heterogeneity on a common risk variant level. To test the hypothesis, we used an FE polygenic risk score "FE-PRS" that combines small effect sizes of thousands of common variants from the largest FE-GWAS (genome-wide association study) into a single measure. We grouped 414 individuals with FE according to common clinical features into subgroups, either by one feature at a time or by all features combined in a cluster analysis. We examined their association with FE-PRS compared to 20 435 matched population controls and observed heterogeneous FE-PRS burden among the subgroups. The highest phenotypic variance explained by FE-PRS was identified in a cluster analysis-defined FE subgroup where all individuals had unknown etiologies and psychiatric comorbidities, and the majority had early onset seizures. Our results indicate that genetic factors associated with FE have differential burden among FE subtypes. Future studies using better-powered FE-PRS might have clinical utility.
Collapse
Affiliation(s)
- Marie Gramm
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA, USA
| | - Eduardo Pérez-Palma
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lara Jehi
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark J Daly
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.,Institute of Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robyn M Busch
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Cologne Center for Genomics, University of Cologne, Cologne, Germany.,Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, MA, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
23
|
Turner N, Ferguson L, Hill M, Nesbitt T, O'Callaghan E, O'Mahony P, Clarke M. Perspectives on paid work among men and women with schizophrenia: The results of a two study comparison in Ireland. Work 2020; 67:507-515. [PMID: 33074214 DOI: 10.3233/wor-203300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While research indicates that people with serious mental health conditions want to work, few studies have examined motivation and concerns associated with employment. OBJECTIVES This study examined the work attitudes among two samples of Irish people with psychotic conditions, primarily schizophrenia. METHODS Data gathered through two work related research projects was used. A self-report instrument, the work motivation scale (WMS), gathered data in two separate studies. It was possible to examine participants' motives and concerns due to the two factor structure, positive and negative, of this scale. Descriptive statistical analysis was conducted for each of the two samples individually. A sub-analysis by gender was also conducted. RESULTS Across the two samples, analysis showed the consistent motivators were increased coping ability, improved self-identity, and enhanced self-worth. Men particularly wanted others to see them as good workers. On the other hand, women regarded a job as a means to forget about having a mental illness. A sizeable minority in both samples expressed apprehensions such as work being boring and an expectation from others that they should work rather than them being personally motivated to do so. CONCLUSIONS While caution must be exercised in interpreting the results due to the small sample size, this study has extended our understanding in this under-researched but important topic.
Collapse
Affiliation(s)
- Niall Turner
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Lisa Ferguson
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Michele Hill
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Tara Nesbitt
- St John of Gods Community Mental Health Services, Blackrock, Co. Dublin, Ireland
| | - Eadbhard O'Callaghan
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Paul O'Mahony
- School of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
24
|
Morita-Sherman M, Louis S, Vegh D, Busch RM, Ferguson L, Bingaman J, Bulacio J, Najm I, Jones S, Zajichek A, Hogue O, Kattan MW, Blumcke I, Cendes F, Jehi L. Outcomes of resections that spare vs remove an MRI-normal hippocampus. Epilepsia 2020; 61:2545-2557. [PMID: 33063852 DOI: 10.1111/epi.16694] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To characterize seizure and cognitive outcomes of sparing vs removing an magnetic resonance imaging (MRI)-normal hippocampus in patients with temporal lobe epilepsy. METHODS In this retrospective cohort study, we reviewed clinical, imaging, surgical, and histopathological data on 152 individuals with temporal lobe epilepsy and nonlesional hippocampi categorized into hippocampus-spared (n = 74) or hippocampus-resected (n = 78). Extra-hippocampal lesions were allowed. Pre- and postoperative cognitive data were available on 86 patients. Predictors of seizure and cognitive outcomes were identified using Cox-proportional hazard modeling followed by treatment-specific model reduction according to Akaike information criterion, and built into an online risk calculator. RESULTS Seizures recurred in 40% within one postoperative year, and in 63% within six postoperative years. Male gender (P = .03), longer epilepsy duration (P < .01), normal MRI (P = .04), invasive evaluation (P = .02), and acute postoperative seizures (P < .01) were associated with a higher risk of recurrence. We found no significant difference in postoperative seizure freedom rates at 5 years between those whose hippocampus was spared and those whose hippocampus was resected (P = .17). Seizure outcome models built with pre- and postoperative data had bootstrap validated concordance indices of 0.65 and 0.72. The dominant hippocampus-spared group had lower rates of decline in verbal memory (39% vs 70%; P = .03) and naming (41% vs 79%; P = .01) compared to the hippocampus-resected group. Partial hippocampus sparing had the same risk of verbal memory decline as for complete removal. SIGNIFICANCE Sparing or removing an MRI-normal hippocampus yielded similar long-term seizure outcome. A more conservative approach, sparing the hippocampus, only partially shields patients from postoperative cognitive deficits. Risk calculators are provided to facilitate clinical counseling.
Collapse
Affiliation(s)
| | - Shreya Louis
- Cleveland Clinic Lerner College of Medicine, Medical School, Cleveland, OH, USA
| | - Deborah Vegh
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Justin Bingaman
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Juan Bulacio
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen Jones
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Olivia Hogue
- Quantitative Health Sciences, Cleveland, OH, USA
| | | | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
25
|
Leu C, Bautista JF, Sudarsanam M, Niestroj LM, Stefanski A, Ferguson L, Daly MJ, Jehi L, Najm IM, Busch RM, Lal D. Neurological disorder-associated genetic variants in individuals with psychogenic nonepileptic seizures. Sci Rep 2020; 10:15205. [PMID: 32938993 PMCID: PMC7495430 DOI: 10.1038/s41598-020-72101-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/30/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are diagnosed in approximately 30% of patients referred to tertiary care epilepsy centers. Little is known about the molecular pathology of PNES, much less about possible underlying genetic factors. We generated whole-exome sequencing and whole-genome genotyping data to identify rare, pathogenic (P) or likely pathogenic (LP) variants in 102 individuals with PNES and 448 individuals with focal (FE) or generalized (GE) epilepsy. Variants were classified for all individuals based on the ACMG-AMP 2015 guidelines. For research purposes only, we considered genes associated with neurological or psychiatric disorders as candidate genes for PNES. We observe in this first genetic investigation of PNES that six (5.88%) individuals with PNES without coexistent epilepsy carry P/LP variants (deletions at 10q11.22-q11.23, 10q23.1-q23.2, distal 16p11.2, and 17p13.3, and nonsynonymous variants in NSD1 and GABRA5). Notably, the burden of P/LP variants among the individuals with PNES was similar and not significantly different to the burden observed in the individuals with FE (3.05%) or GE (1.82%) (PNES vs. FE vs. GE (3 × 2 χ2), P = 0.30; PNES vs. epilepsy (2 × 2 χ2), P = 0.14). The presence of variants in genes associated with monogenic forms of neurological and psychiatric disorders in individuals with PNES shows that genetic factors are likely to play a role in PNES or its comorbidities in a subset of individuals. Future large-scale genetic research studies are needed to further corroborate these interesting findings in PNES.
Collapse
Affiliation(s)
- Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA.
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
| | - Jocelyn F Bautista
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Monica Sudarsanam
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Lisa-Marie Niestroj
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, DE, 50931, USA
| | - Arthur Stefanski
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Mark J Daly
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA
- Institute of Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Lara Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA.
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, DE, 50931, USA.
| |
Collapse
|
26
|
Cato-Addison WB, Ferguson L, Strachan RD, Clark R, Murray JS, Moore I. Intra-dialytic intracranial pressure monitoring in a patient with lumbo-peritoneal shunt for idiopathic intracranial hypertension. Br J Neurosurg 2020:1-3. [DOI: 10.1080/02688697.2020.1774509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- W. B. Cato-Addison
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - L. Ferguson
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - R. D. Strachan
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - R. Clark
- Renal Unit, James Cook University Hospital, Middlesbrough, UK
| | - J. S. Murray
- Renal Unit, James Cook University Hospital, Middlesbrough, UK
| | - I. Moore
- Renal Unit, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
27
|
Reyes A, Kaestner E, Ferguson L, Jones JE, Seidenberg M, Barr WB, Busch RM, Hermann BP, McDonald CR. Cognitive phenotypes in temporal lobe epilepsy utilizing data- and clinically driven approaches: Moving toward a new taxonomy. Epilepsia 2020; 61:1211-1220. [PMID: 32363598 PMCID: PMC7341371 DOI: 10.1111/epi.16528] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify cognitive phenotypes in temporal lobe epilepsy (TLE) and test their reproducibility in a large, multi-site cohort of patients using both data-driven and clinically driven approaches. METHOD Four-hundred seven patients with TLE who underwent a comprehensive neuropsychological evaluation at one of four epilepsy centers were included. Scores on tests of verbal memory, naming, fluency, executive function, and psychomotor speed were converted into z-scores based on 151 healthy controls (HCs). For the data-driven method, cluster analysis (k-means) was used to determine the optimal number of clusters. For the clinically driven method, impairment was defined as >1.5 standard deviations below the mean of the HC, and patients were classified into groups based on the pattern of impairment. RESULTS Cluster analysis revealed a three-cluster solution characterized by (a) generalized impairment (29%), (b) language and memory impairment (28%), and (c) no impairment (43%). Based on the clinical criteria, the same broad categories were identified, but with a different distribution: (a) generalized impairment (37%), (b) language and memory impairment (30%), and (c) no impairment (33%). There was a 82.6% concordance rate with good agreement (κ = .716) between the methods. Forty-eight patients classified as having a normal profile based on cluster analysis were classified as having generalized impairment (n = 16) or an isolated language/memory impairment (n = 32) based on the clinical criteria. Patients with generalized impairment had a longer disease duration and patients with no impairment had more years of education. However, patients demonstrating the classic TLE profile (ie, language and memory impairment) were not more likely to have an earlier age at onset or mesial temporal sclerosis. SIGNIFICANCE We validate previous findings from single-site studies that have identified three unique cognitive phenotypes in TLE and offer a means of translating the patterns into a clinical diagnostic criteria, representing a novel taxonomy of neuropsychological status in TLE.
Collapse
Affiliation(s)
- Anny Reyes
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Lisa Ferguson
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Jana E. Jones
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - William B. Barr
- Departments of Neurology and Psychiatry, NYU-Langone Medical Center and NYU School of Medicine, New York, NY, USA
| | - Robyn M. Busch
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce P. Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Carrie R. McDonald
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| |
Collapse
|
28
|
De Brito M, Ferguson L, Mansour S, Khan I. An unusual manifestation of X‐linked hypohidrotic ectodermal dysplasia with palmoplantar keratoderma. Clin Exp Dermatol 2020; 45:352-353. [DOI: 10.1111/ced.14096] [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] [Received: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- M. De Brito
- Department of Dermatology St George’s Healthcare NHS Trust London UK
| | - L. Ferguson
- Department of Dermatology St George’s Healthcare NHS Trust London UK
| | - S. Mansour
- St George’s Healthcare NHS Trust St George’s, University of London London UK
| | - I. Khan
- Department of Dermatology St George’s Healthcare NHS Trust London UK
| |
Collapse
|
29
|
Coleman KA, Boscan P, Ferguson L, Twedt D, Monnet E. Evaluation of gastric motility in nine dogs before and after prophylactic laparoscopic gastropexy: a pilot study. Aust Vet J 2019; 97:225-230. [PMID: 31236930 DOI: 10.1111/avj.12829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 03/22/2019] [Accepted: 04/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of a prophylactic laparoscopic gastropexy on gastric motility in healthy large-breed dogs. METHODS This was a prospective pilot study with nine healthy client-owned dogs. Each dog was its own control. Gastric motility was evaluated before and after laparoscopic gastropexy. Dogs were fed a standard diet three weeks before and after surgery. Gastric motility was measured before and 3 weeks after surgery. A wireless motility capsule (WMC) was used to measure gastric pH, intragastric pressure, temperature, frequency of contractions, motility index (MI) and transit time. Non-parametric statistical analysis was used to compare the paired data. Clients were contacted for follow-up information 2 years postoperatively. RESULTS Median frequency of gastric contractions was 1.3 (range, 0.6-1.9 contractions/min) before gastropexy and 1.0 (range, 0.3-2.6 contractions/min) after gastropexy (P = 0.820). Median MI was 49.2 (range, 23.7-96.6) before gastropexy and 28.1 (range, 12.2-148.9) after gastropexy (P = 0.652). Median gastric emptying time was 1140 (range, 486-1230 min) before gastropexy and 1110 (range, 306-2610 min) after gastropexy (P = 0.570). During the hour before the WMC passed through the pylorus, median MI was 72.2 (range, 48.2-549.3) before gastropexy and 52.9 (range, 15.20-322.8) after gastropexy (P = 0.734), and frequency of contractions was 1.1 (range, 0.9-4.1 contractions/min) before gastropexy and 1.2 (range, 0.5-3.0 contractions/min) after gastropexy (P = 0.652). CONCLUSION Motility in the stomach did not change in healthy dogs after prophylactic laparoscopic gastropexy. We conclude that preventive laparoscopic gastropexy does not induce gastroparesis.
Collapse
Affiliation(s)
- K A Coleman
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - P Boscan
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - L Ferguson
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - D Twedt
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - E Monnet
- Department of Clinical Sciences, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA
| |
Collapse
|
30
|
McGovern RA, N V Moosa A, Jehi L, Busch R, Ferguson L, Gupta A, Gonzalez-Martinez J, Wyllie E, Najm I, Bingaman WE. Hemispherectomy in adults and adolescents: Seizure and functional outcomes in 47 patients. Epilepsia 2019; 60:2416-2427. [PMID: 31677151 DOI: 10.1111/epi.16378] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 05/03/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents. METHODS We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed. RESULTS Thirty-six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow-up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6-month follow-up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes. SIGNIFICANCE Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.
Collapse
Affiliation(s)
- Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | | | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | - Robyn Busch
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | | | - Ajay Gupta
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
| | | |
Collapse
|
31
|
Leu C, Stevelink R, Smith AW, Goleva SB, Kanai M, Ferguson L, Campbell C, Kamatani Y, Okada Y, Sisodiya SM, Cavalleri GL, Koeleman BPC, Lerche H, Jehi L, Davis LK, Najm IM, Palotie A, Daly MJ, Busch RM, Lal D. Polygenic burden in focal and generalized epilepsies. Brain 2019; 142:3473-3481. [PMID: 31608925 PMCID: PMC6821205 DOI: 10.1093/brain/awz292] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023] Open
Abstract
Rare genetic variants can cause epilepsy, and genetic testing has been widely adopted for severe, paediatric-onset epilepsies. The phenotypic consequences of common genetic risk burden for epilepsies and their potential future clinical applications have not yet been determined. Using polygenic risk scores (PRS) from a European-ancestry genome-wide association study in generalized and focal epilepsy, we quantified common genetic burden in patients with generalized epilepsy (GE-PRS) or focal epilepsy (FE-PRS) from two independent non-Finnish European cohorts (Epi25 Consortium, n = 5705; Cleveland Clinic Epilepsy Center, n = 620; both compared to 20 435 controls). One Finnish-ancestry population isolate (Finnish-ancestry Epi25, n = 449; compared to 1559 controls), two European-ancestry biobanks (UK Biobank, n = 383 656; Vanderbilt biorepository, n = 49 494), and one Japanese-ancestry biobank (BioBank Japan, n = 168 680) were used for additional replications. Across 8386 patients with epilepsy and 622 212 population controls, we found and replicated significantly higher GE-PRS in patients with generalized epilepsy of European-ancestry compared to patients with focal epilepsy (Epi25: P = 1.64×10-15; Cleveland: P = 2.85×10-4; Finnish-ancestry Epi25: P = 1.80×10-4) or population controls (Epi25: P = 2.35×10-70; Cleveland: P = 1.43×10-7; Finnish-ancestry Epi25: P = 3.11×10-4; UK Biobank and Vanderbilt biorepository meta-analysis: P = 7.99×10-4). FE-PRS were significantly higher in patients with focal epilepsy compared to controls in the non-Finnish, non-biobank cohorts (Epi25: P = 5.74×10-19; Cleveland: P = 1.69×10-6). European ancestry-derived PRS did not predict generalized epilepsy or focal epilepsy in Japanese-ancestry individuals. Finally, we observed a significant 4.6-fold and a 4.5-fold enrichment of patients with generalized epilepsy compared to controls in the top 0.5% highest GE-PRS of the two non-Finnish European cohorts (Epi25: P = 2.60×10-15; Cleveland: P = 1.39×10-2). We conclude that common variant risk associated with epilepsy is significantly enriched in multiple cohorts of patients with epilepsy compared to controls-in particular for generalized epilepsy. As sample sizes and PRS accuracy continue to increase with further common variant discovery, PRS could complement established clinical biomarkers and augment genetic testing for patient classification, comorbidity research, and potentially targeted treatment.
Collapse
Affiliation(s)
- Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, UK
| | - Remi Stevelink
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander W Smith
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA
| | - Slavina B Goleva
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | - Masahiro Kanai
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ciaran Campbell
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin 2, Ireland
- The FutureNeuro Research Centre, Dublin 2, Ireland
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Okada
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, UK
- Chalfont Centre for Epilepsy, Chalfont-St-Peter, Buckinghamshire, UK
| | - Gianpiero L Cavalleri
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin 2, Ireland
- The FutureNeuro Research Centre, Dublin 2, Ireland
| | - Bobby P C Koeleman
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lara Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lea K Davis
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aarno Palotie
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA
- Institute of Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Mark J Daly
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Institute of Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| |
Collapse
|
32
|
García-Ruiz NS, Nejad B, Wilson M, Ferguson L. 2485 Identifying Barriers for Same-Day Discharge of Minimally Invasive Hysterectomies. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
33
|
Williams S, Hossain M, Ferguson L, Busch RM, Marchi N, Gonzalez-Martinez J, Perucca E, Najm IM, Ghosh C. Neurovascular Drug Biotransformation Machinery in Focal Human Epilepsies: Brain CYP3A4 Correlates with Seizure Frequency and Antiepileptic Drug Therapy. Mol Neurobiol 2019; 56:8392-8407. [PMID: 31243719 DOI: 10.1007/s12035-019-01673-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/07/2019] [Indexed: 01/01/2023]
Abstract
Pharmacoresistance is a major clinical challenge for approximately 30% of patients with epilepsy. Previous studies indicate nuclear receptors (NRs), drug efflux transporters, and cytochrome P450 enzymes (CYPs) control drug passage across the blood-brain barrier (BBB) in drug-resistant epilepsy. Here, we (1) evaluate BBB changes, neurovascular nuclear receptors, and drug transporters in lesional/epileptic (EPI) and non-lesional/non-epileptic (NON-EPI) regions of the same brain, (2) examine regional CYP expression and activity, and (3) investigate the association among CYP brain expression, seizure frequency, duration of epilepsy, and antiepileptic drug (AED) combination. We used surgically resected brain specimens from patients with medically intractable epilepsy (n = 22) where the epileptogenic loci were well-characterized by invasive and non-invasive methods; histology confirmed distinction of small NON-EPI regions from EPI tissues. NRs, transporters, CYPs, and tight-junction proteins were assessed by western blots/immunohistochemistry, and CYP metabolic activity was determined and compared. The relationship of CYP expression with seizure frequency, duration of epilepsy, and prescribed AEDs was evaluated. Decreased BBB tight-junction proteins accompanied IgG leakage in EPI regions and correlated with upregulated NR and efflux transporter levels. CYP expression and activity significantly increased in EPI compared to NON-EPI tissues. Change in EPI and NON-EPI CYP3A4 expression increased in patients taking AEDs that were CYP substrates, was downregulated when CYP- and non-CYP-substrate AEDs were given together, and correlated with seizure frequency. Our studies suggest focal neurovascular CYP-NR-transporter alterations, as demonstrated by the relationship of seizure frequency and AED combination to brain CYP3A4, might together impact biotransformation machinery of human pharmacoresistant epilepsy.
Collapse
Affiliation(s)
- Sherice Williams
- Cerebrovascular Research Laboratory, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mohammed Hossain
- Cerebrovascular Research Laboratory, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicola Marchi
- Cerebrovascular Mechanisms of Brain Disorders Laboratory, Department of Neuroscience, Institute of Functional Genomics (CNRS-INSERM), University of Montpellier, Montpellier, France
| | | | - Emilio Perucca
- Department of Internal Medicine and Therapeutics, University of Pavia, Clinical Trial Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chaitali Ghosh
- Cerebrovascular Research Laboratory, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. .,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
34
|
Busch RM, Hogue O, Ferguson L, Parsons MW, Kubu CS, Floden DP. Validation of computerized episodic memory measures in a diverse clinical sample referred for neuropsychological assessment. Clin Neuropsychol 2019; 33:557-570. [PMID: 29996710 PMCID: PMC6333509 DOI: 10.1080/13854046.2018.1488995] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the convergent and discriminant validity of two brief computerized episodic memory measures in a large, diverse clinical sample of adults undergoing neuropsychological assessment. METHOD Computerized measures of word and face memory were administered to 233 adults (age 30 and over) who also completed comprehensive neuropsychological testing. RESULTS Moderate correlations were observed between the computerized memory tests and a wide range of traditional neuropsychological measures of episodic memory (e.g. word-list learning, story recall, face recognition, design recall). Select measures of visuomotor processing speed and language were also related to performance on the computerized tasks. In contrast, the computerized memory tests showed weak correlations with tests in other cognitive domains (i.e. visuospatial skills, attention/working memory, executive function, motor dexterity, academic skills) and self-report screening measures of mood and anxiety. Similar to traditional measures of episodic memory, the computerized memory measures were sensitive to effects of age and gender. CONCLUSIONS Computerized measures of word and face memory showed good convergent and discriminant validity in this diverse clinical sample supporting the construct validity of these measures. This indicates that it may be feasible to measure memory function in clinical settings using brief, well-designed computerized memory measures.
Collapse
Affiliation(s)
- Robyn M. Busch
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic
- Epilepsy Center, Neurological Institute, Cleveland Clinic
| | | | - Lisa Ferguson
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic
- Epilepsy Center, Neurological Institute, Cleveland Clinic
| | - Michael W. Parsons
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic
- Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic
| | - Cynthia S. Kubu
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
| | - Darlene P. Floden
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
| |
Collapse
|
35
|
Greco T, Ferguson L, Giza C, Prins ML. Mechanisms underlying vulnerabilities after repeat mild traumatic brain injuries. Exp Neurol 2019; 317:206-213. [PMID: 30853388 DOI: 10.1016/j.expneurol.2019.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 11/16/2022]
Abstract
Traumatic brain injury (TBI) has drawn national attention for its high incidence and mechanistic complexity. The majority of TBI cases are "mild" in nature including concussions and mild TBI (mTBI). Concussions are a distinct form of mTBI where diagnosis is difficult, quantification of the incidence is challenging and there is greater risk for subsequent injuries. While concussions occur in the general population, it has become a hallmark injury consistently observed among adolescent and young adult athletes and the risks for repeat TBI (rTBI) is significant. Clinical and experimental evidence shows that the magnitude and duration of deficits is dependent on the number and the interval between injuries. Several studies suggest that metabolic vulnerabilities after injury may contribute to the window for cerebral vulnerability from rTBI. In addition to metabolism, this review addresses how age, sex and hormones also play an important role in the response to repeat concussions. Understanding how these factors collectively contribute to concussion and rTBI recovery is critically important in establishing age/sex appropriate return to play guidelines, injury prevention, therapeutic interventions and mitigation of long-term consequences of rTBI.
Collapse
Affiliation(s)
- T Greco
- UCLA Department of Neurosurgery, 300 Stein Plaza, Los Angeles, CA 90095, United States
| | - L Ferguson
- UCLA Department of Neurosurgery, 300 Stein Plaza, Los Angeles, CA 90095, United States
| | - C Giza
- UCLA Department of Neurosurgery, 300 Stein Plaza, Los Angeles, CA 90095, United States
| | - M L Prins
- UCLA Department of Neurosurgery, 300 Stein Plaza, Los Angeles, CA 90095, United States.
| |
Collapse
|
36
|
Malone V, Ezard N, Hodge S, Ferguson L, Schembri A, Bonevski B. Nurse provision of support to help inpatients quit smoking. Health Promot J Austr 2019; 28:251-254. [PMID: 28002718 DOI: 10.1071/he16082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/13/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Identification of the factors that facilitate nurses to provide smoking cessation advice to hospitalised patients. Method Six semistructured focus groups with 26 nurses were conducted in June 2015. Participants completed a structured survey to collect patient demographic data and assess attitudes towards their role in addressing smoking cessation among inpatients. Results Important themes that emerged from the qualitative data were: nurses' negative perceptions of smokers, nurses' confidence in their knowledge of smoking cessation care and nurses' uncertainty around whose role it is to provide smoking cessation care. Conclusion Nurses require training in order to confidently and competently address smoking among inpatients as part of routine care. Formal ways to document the smoking status of inpatients and the offer of smoking cessation support from a nurse to an inpatient would enhance the communication between nurses around which inpatients had been asked about their smoking status and which had not. For patients who are resistant to conventional cessation strategies, innovative ways are needed to reduce the harm caused to them by tobacco use. So what? Nurses need to be provided with education and training around smoking cessation to increase their confidence and skills to provide smoking cessation care to inpatients.
Collapse
Affiliation(s)
- V Malone
- Level 2, The O'Brien Centre, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
| | - N Ezard
- Level 2, The O'Brien Centre, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
| | - S Hodge
- Network of Alcohol and Other Drugs Agencies, PO Box 2345, Strawberry Hills, NSW 2012, Australia
| | - L Ferguson
- Level 2, The O'Brien Centre, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
| | - A Schembri
- Level 2, The O'Brien Centre, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia
| | - B Bonevski
- University of Newcastle, 5014 Level 5, McAuley Centre, Calvary Mater Hospital, Edith Street, Waratah, NSW 2298, Australia
| |
Collapse
|
37
|
Busch RM, Hogue O, Kattan MW, Hamberger M, Drane DL, Hermann B, Kim M, Ferguson L, Bingaman W, Gonzalez-Martinez J, Najm IM, Jehi L. Nomograms to predict naming decline after temporal lobe surgery in adults with epilepsy. Neurology 2018; 91:e2144-e2152. [PMID: 30404781 DOI: 10.1212/wnl.0000000000006629] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop and externally validate models to predict the probability of postoperative naming decline in adults following temporal lobe epilepsy surgery using easily accessible preoperative clinical predictors. METHODS In this retrospective, prediction model development study, multivariable models were developed in a cohort of 719 patients who underwent temporal lobe epilepsy surgery at Cleveland Clinic and externally validated in a cohort of 138 patients who underwent temporal lobe surgery at one of 3 epilepsy surgery centers in the United States (Columbia University Medical Center, Emory University School of Medicine, University of Washington School of Medicine). RESULTS The development cohort was 54% female with an average age at surgery of 36 years (SD 12). Twenty-six percent of this cohort experienced clinically relevant postoperative naming decline. The model included 5 variables: side of surgery, age at epilepsy onset, age at surgery, sex, and education. When applied to the external validation cohort, the model performed very well, with excellent calibration and a c statistic (reflecting discriminatory ability) of 0.81. A second model predicting moderate to severe postoperative naming decline included 3 variables: side of surgery, age at epilepsy onset, and preoperative naming score. This model generated a c statistic of 0.84 in the external validation cohort and showed good calibration. CONCLUSION Externally validated nomograms are provided in 2 easy-to-use formats (paper version and online calculator) clinicians can use to estimate the probability of naming decline in patients considering epilepsy surgery for treatment of pharmacoresistant temporal lobe epilepsy.
Collapse
Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle.
| | - Olivia Hogue
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Michael W Kattan
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Marla Hamberger
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Daniel L Drane
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Bruce Hermann
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Michelle Kim
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - William Bingaman
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Jorge Gonzalez-Martinez
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Imad M Najm
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| | - Lara Jehi
- From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle
| |
Collapse
|
38
|
Affiliation(s)
- L. Ferguson
- Dermatology Department Chelsea and Westminster Hospital London UK
| | - L. Fearfield
- Dermatology Department Chelsea and Westminster Hospital London UK
| |
Collapse
|
39
|
Miura K, Vail A, Chambers D, Hopkins PM, Ferguson L, Grant M, Rhodes LE, Green AC. Omega-3 fatty acid supplement skin cancer prophylaxis in lung transplant recipients: A randomized, controlled pilot trial. J Heart Lung Transplant 2018; 38:59-65. [PMID: 30352778 DOI: 10.1016/j.healun.2018.09.009] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lung transplant recipients (LTRs) are at very high risk of skin cancer. Omega-3 fatty acids (FAs) are anti-inflammatory and immune-modulating and could potentially reduce this risk. We assessed the feasibility of omega-3 FA supplementation to reduce skin cancer among these patients. METHODS LTRs aged 18+ years, at least 1 year post-transplant, were recruited from the outpatient clinic of The Prince Charles Hospital, Brisbane. Participants were randomly allocated to 4-times-daily supplements containing either omega-3 FA (3.36 eicosapentaenoic acid [EPA] + docosahexaenoic acid) or placebo (4 g olive oil) for 12 months. Primary outcomes were rates of recruitment, retention, adherence (assessed by plasma omega-3 FA), and safety. Secondary outcomes were incident skin cancers. RESULTS Among 106 eligible lung transplant recipients, 49 consented to take part (46%) with 25 allocated to omega-3 FA and 24 to placebo supplements. Of these, 22 (88%) and 20 (83%), respectively, completed the trial. After 12 months, median plasma EPA increased substantially in the intervention group (125.0 to 340.0 µmol/L), but not the placebo group (98.0 to 134.5 µmol/L). In the intervention group, 6 patients developed skin cancers compared with 11 in the placebo group, giving an odds ratio (95% confidence interval) of 0.34 (0.09 to 1.32). There were no serious, active intervention-related adverse events. CONCLUSIONS This pilot trial among LTRs showed acceptable recruitment and high retention and adherence. We demonstrated a signal for reduction of new skin cancer cases in those taking omega-3 FA supplements, which supports the notion that a larger, more definitive trial is warranted.
Collapse
Affiliation(s)
- Kyoko Miura
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
| | - Andy Vail
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Daniel Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter M Hopkins
- Queensland Lung Transplant Service, The Prince Charles Hospital Campus and School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Ferguson
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Michelle Grant
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Lesley E Rhodes
- Dermatology Research Centre, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Adèle C Green
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; CRUK Manchester Institute, University of Manchester, Manchester, UK
| |
Collapse
|
40
|
Ferguson L, Fearfield L. Paraneoplastic pemphigus foliaceus related to underlying breast cancer. Clin Exp Dermatol 2018; 43:817-818. [PMID: 29770472 DOI: 10.1111/ced.13602] [Citation(s) in RCA: 2] [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] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- L Ferguson
- Department of Dermatology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - L Fearfield
- Department of Dermatology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| |
Collapse
|
41
|
Palmer J, Patel T, Eldredge-Hindy H, Keith S, Patel T, Malatesta T, DiNome J, Lowther A, Ferguson L, Wagenborg S, Smyles J, Babaria U, Stabile R, Gressen E, Rudoler S, Fisher S. EP-1675: Patients undergoing radiation therapy at risk for financial toxicity: A prospective survey study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
42
|
Saghafi S, Ferguson L, Hogue O, Gales JM, Prayson R, Busch RM. Histopathologic subtype of hippocampal sclerosis and episodic memory performance before and after temporal lobectomy for epilepsy. Epilepsia 2018. [PMID: 29537075 DOI: 10.1111/epi.14036] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The International League Against Epilepsy (ILAE) proposed a classification system for hippocampal sclerosis (HS) based on location and extent of hippocampal neuron loss. The literature debates the usefulness of this classification system when studying memory in people with temporal lobe epilepsy (TLE) and determining memory outcome after temporal lobe resection (TLR). This study further explores the relationship between HS ILAE subtypes and episodic memory performance in patients with TLE and examines memory outcomes after TLR. METHODS This retrospective study identified 213 patients with TLE who underwent TLR and had histopathological evidence of HS (HS ILAE type 1a = 92; type 1b = 103; type 2 = 18). Patients completed the Wechsler Memory Scale-3rd Edition prior to surgery, and 78% of patients had postoperative scores available. Linear regressions examined differences in preoperative memory scores as a function of pathology classification, controlling for potential confounders. Fisher's exact tests were used to compare pathology subtypes on the magnitude of preoperative memory impairment and the proportion of patients who experienced clinically meaningful postoperative memory decline. RESULTS Individuals with HS ILAE type 2 demonstrated better preoperative verbal memory performance than patients with HS ILAE type 1; however, individual data revealed verbal and visual episodic memory impairments in many patients with HS ILAE type 2. The base rate of postoperative memory decline was similar among all 3 pathology groups. SIGNIFICANCE This is the largest reported overall sample and the largest subset of patients with HS ILAE type 2. Group data suggest that patients with HS ILAE type 2 perform better on preoperative memory measures, but individually there were no differences in the magnitude of memory impairment. Following surgery, there were no statistically significant differences between groups in the proportion of patients who declined. Future research should focus on quantitative measurements of hippocampal neuronal loss, and multicenter collaboration is encouraged.
Collapse
Affiliation(s)
| | - Lisa Ferguson
- Department of Psychology and Psychiatry, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Olivia Hogue
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Jordan M Gales
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Robyn M Busch
- Department of Psychology and Psychiatry, Cleveland Clinic, Cleveland, OH, USA.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
43
|
Panitsas F, Kothari J, Vallance G, Djebbari F, Ferguson L, Sultanova M, Ramasamy K. Treat or palliate: outcomes of very elderly myeloma patients. Haematologica 2017; 103:e32-e34. [PMID: 29025911 DOI: 10.3324/haematol.2017.173617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Fotios Panitsas
- Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust
| | - Jaimal Kothari
- Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust
| | - Grant Vallance
- Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust
| | - Faouzi Djebbari
- Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust
| | - Lisa Ferguson
- Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust
| | - Manuela Sultanova
- Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust
| | - Karthik Ramasamy
- Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust.,NIHR BRC Blood Theme, Oxford, UK
| |
Collapse
|
44
|
Turner N, Ferguson L, Hill M, Nesbitt T, O'Callaghan E, O'Mahony P, Clarke M. An exploratory study of the extent of social inclusion among people with psychosis and psychotic-related conditions. Int J Soc Psychiatry 2017; 63:195-202. [PMID: 28466747 DOI: 10.1177/0020764017691551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding social inclusion among at-risk populations will deepen our understanding of their specific needs. AIM This study explored the level of social inclusion among people with psychotic-related conditions using a standardised interview. METHOD The Social Inclusion Interview Schedule was used in two research projects. People with psychosis participated in both studies and had been recruited as part of an Irish programme of research on psychotic conditions. Descriptive statistics were used to quantify participants' level of social exclusion. RESULTS Data from 71 participants were available, 38 in one cohort and 33 in the other. The smaller cohort had a shorter mean duration of illness. Participants' mean age was 40. The majority lived in the community and were satisfied with their living arrangements. In each cohort, the same two areas of community integration emerged as problematic - having something productive to do and being close to someone in the community. There was a higher level of perceived stigma among the cohort with the longer duration of illness. DISCUSSION/CONCLUSION While evidence of social inclusion was found among participants, there were areas of concern particularly with regard to integration into work and social connectedness.
Collapse
Affiliation(s)
- Niall Turner
- 1 St John of Gods Community Mental Health Services, Co. Dublin, Ireland
| | - Lisa Ferguson
- 2 DETECT Early Intervention in Psychosis Service, Co. Dublin, Ireland
| | | | - Tara Nesbitt
- 1 St John of Gods Community Mental Health Services, Co. Dublin, Ireland
| | - Eadbhard O'Callaghan
- 2 DETECT Early Intervention in Psychosis Service, Co. Dublin, Ireland.,4 School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland
| | - Paul O'Mahony
- 5 Occupational Therapy, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Mary Clarke
- 2 DETECT Early Intervention in Psychosis Service, Co. Dublin, Ireland.,4 School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
45
|
Prayson BE, Floden DP, Ferguson L, Kim KH, Jehi L, Busch RM. Effects of surgical side and site on psychological symptoms following epilepsy surgery in adults. Epilepsy Behav 2017; 68:108-114. [PMID: 28142129 PMCID: PMC5373962 DOI: 10.1016/j.yebeh.2016.11.004] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/28/2016] [Accepted: 11/03/2016] [Indexed: 11/18/2022]
Abstract
This retrospective study examined the potential role of side and site of surgery in psychological symptom change after epilepsy surgery and determined the base rate of psychological change at the individual level. Two-hundred twenty-eight adults completed the Personality Assessment Inventory (PAI) before and after temporal (TLR; n=190) or frontal lobe resection (FLR; n=38). Repeated measures ANOVAs with bootstrapping examined differences in psychological outcome as a function of surgical site separately in patients who underwent left- versus right-sided resections. Individual's PAI score changes were then used to determine the prevalence of clinically meaningful postoperative symptom change. Following left-sided resections, there were significant group-by-time interactions on Somatic Complaints, Anxiety, and Anxiety Related Disorders. There was also a trend in this direction on the Depression scale. TLR patients endorsed greater preoperative symptoms than FLR patients on all of these scales, except the Somatic Complaints scale. After surgery, TLR patients reported symptom improvement on all four scales, while scores of FLR patients remained relatively stable over time. Endorsement of Mania-related symptoms increased in both TLR and FLR groups from pre-to post-surgical testing. Following right-sided resections, both groups endorsed symptom improvements on Somatic Complaints, Anxiety, and Depression scales following surgery. In addition, the TLR group endorsed more Mania-related symptoms than the FLR group regardless of time. Patterns of meaningful change in individual patients were generally consistent with group findings, with the most frequent improvements observed following TLR. However, there were a small subset of patients who reported symptom exacerbation after surgery. Our results suggest that surgical lateralization and localization are important factors in postoperative psychological outcome and highlight the importance of considering psychological change at the individual patient level. Further research is needed to identify potential risk factors for symptom exacerbation to aid in preoperative counseling and identify those patients most in need of postoperative psychological surveillance.
Collapse
Affiliation(s)
- Brigid E Prayson
- Wellesley College, 106 Central Street, Wellesley, MA 02481, United States
| | - Darlene P Floden
- Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Center for Neurological Restoration, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Lisa Ferguson
- Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Kevin H Kim
- Department of Psychology in Education, University of Pittsburgh, 5918 Wesley W. Posvar Hall, Pittsburgh, PA 15260, United States
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| |
Collapse
|
46
|
Ferguson L, Chong H, Singh M. Ecthyma gangrenosum without bacteraemia: evidence in favour of a broader definition. Clin Exp Dermatol 2017; 42:324-327. [PMID: 28239902 DOI: 10.1111/ced.13064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 11/29/2022]
Abstract
Ecthyma gangrenosum (EG) is often defined as a cutaneous manifestation of Pseudomonas aeruginosa septicaemia, typically secondary to neutropenia. There is increasing recognition that a broader definition is warranted, as numerous causative organisms and predisposing conditions have been reported. We describe two cases of EG that occurred without bacteraemia. In this atypical subset of cases, the skin is thought to represent the primary inoculation site from which haematogenous spread can occur. The first case occurred in the context of human immunodeficiency virus (HIV) infection, a rarely reported association. The evidence base guiding clinicians on management of EG is very limited, particularly in relation to patients with HIV, in whom recurrence risk may be higher than normal. Recurrent EG is described in our second case, in an individual with Good syndrome, a rare association of thymoma and immunodeficiency.
Collapse
Affiliation(s)
- L Ferguson
- Department of Dermatology, St George's Hospital, London, UK
| | - H Chong
- Department of Cellular Pathology, St George's Hospital, London, UK
| | - M Singh
- Department of Dermatology, St George's Hospital, London, UK
| |
Collapse
|
47
|
Busch RM, Floden DP, Ferguson L, Mahmoud S, Mullane A, Jones S, Jehi L, Bingaman W, Najm IM. Neuropsychological outcome following frontal lobectomy for pharmacoresistant epilepsy in adults. Neurology 2017; 88:692-700. [PMID: 28087827 DOI: 10.1212/wnl.0000000000003611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/18/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This retrospective cohort study characterized cognitive and motor outcomes in a large sample of adults who underwent frontal lobe resections for treatment of pharmacoresistant epilepsy. METHODS Ninety patients who underwent unilateral frontal lobe resection for epilepsy (42 language-dominant hemisphere/48 nondominant hemisphere) between 1989 and 2014 completed comprehensive preoperative and postoperative neuropsychological evaluations that included measures of verbal and nonverbal intellectual functioning, attention/working memory, processing speed, language, executive functioning, verbal and visual memory, and motor functioning. Objective methods were used to assess meaningful change across a wide range of abilities and to identify factors associated with neuropsychological decline following frontal lobectomy. Detailed postoperative neuroimaging analysis was conducted to characterize region, extent, and volume of resection. RESULTS Forty-eight percent of patients did not demonstrate meaningful postoperative declines in cognition and an additional 42% demonstrated decline in 1 or 2 cognitive domains. When cognitive decline was observed, it usually occurred on measures of intelligence, visuomotor processing speed, or executive functioning. Side and site of resection were unrelated to cognitive outcome, but played a role in decline of contralateral manual dexterity following supplementary motor area resection. Higher preoperative ability, older age at surgery, absence of a malformation of cortical development on MRI, and poor seizure outcome were related to cognitive decline on some measures, but had poor sensitivity in identifying at-risk patients. CONCLUSIONS The vast majority of patients who undergo frontal lobectomy for treatment of pharmacoresistant epilepsy demonstrate good cognitive and motor outcomes.
Collapse
Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH.
| | - Darlene P Floden
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| | - Shamseldeen Mahmoud
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| | - Audrina Mullane
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| | - Stephen Jones
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| | - Lara Jehi
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| | - William Bingaman
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| | - Imad M Najm
- From the Epilepsy Center (R.M.B., L.F., S.J., L.J., W.B., I.M.N.), Psychiatry & Psychology (R.M.B., D.P.F., L.F., A.M.), Center for Neurological Restoration (D.P.F.), and Diagnostic Radiology (S.M., S.J.), Neurological Institute, Cleveland Clinic, OH
| |
Collapse
|
48
|
Busch RM, Floden DP, Prayson B, Chapin JS, Kim KH, Ferguson L, Bingaman W, Najm IM. Estimating risk of word-finding problems in adults undergoing epilepsy surgery. Neurology 2016; 87:2363-2369. [PMID: 27815406 DOI: 10.1212/wnl.0000000000003378] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/22/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This retrospective, observational study examined the frequency and magnitude of change in naming ability as a function of side/site of epilepsy surgery and identified predictive factors to assist clinicians in identifying patients at low, moderate, or high risk of postoperative naming decline. METHODS A total of 875 adults with pharmacoresistant epilepsy (454 left/421 right; 763 temporal/87 frontal/25 posterior quadrant) met inclusion criteria and completed the Boston Naming Test before and after surgery. Clinically meaningful change in naming ability was assessed using reliable change indices for epilepsy. Demographic, cognitive, and seizure variables were examined to determine factors most predictive of naming decline and to develop a decision tree to assist with clinical decision-making. RESULTS Naming decline was rare in right-sided resections and did not exceed the level expected by chance (5% overall; 90% confidence interval [CI] ± 2%). Naming decline occurred in 41% (CI ± 5%) of patients after left temporal resection (TLR) compared to 10%-12% (CI ± 10%-19%) in other left-sided surgical groups. A sizable proportion of left TLR patients (17%; CI ± 4%) showed substantial declines in naming (>11 points). Decline following left TLR was related to later age at seizure onset, older age at surgery, and higher preoperative naming ability. These factors correctly predicted naming decline in 68% of patients and were associated with degree of decline following left TLR. A decision tree is provided to assist clinicians in identifying patients at low, moderate, or high risk for postoperative naming declines. CONCLUSIONS In addition to discussions regarding risk for memory decline following left TLR, patients should be counseled about potential decline in word-finding ability.
Collapse
Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA.
| | - Darlene P Floden
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA
| | - Brigid Prayson
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA
| | - Jessica S Chapin
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA
| | - Kevin H Kim
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA
| | - William Bingaman
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA
| | - Imad M Najm
- From the Epilepsy Center (R.M.B., W.B., I.M.N., L.F.), Department of Psychiatry & Psychology (R.M.B., D.P.F., L.F.), and Center for Neurological Restoration (D.P.F.), Neurological Institute, Cleveland Clinic, OH; Wellesley College (B.P.), MA; Behavioral Health Services (J.S.C.), Aurora Health Care, Grafton, WI; and Department of Psychology in Education (K.H.K.), University of Pittsburgh, PA
| |
Collapse
|
49
|
Ferguson L, MacAndie C. From the bathroom to the bone-anchored hearing aid: an idea on how to remove a stripped abutment screw from a bone-anchored hearing aid. Clin Otolaryngol 2015; 41:620-1. [PMID: 26585704 DOI: 10.1111/coa.12446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- L Ferguson
- Department of Otolaryngology and Head and Neck Surgery, Royal Alexandra Hospital, Paisley, UK.
| | - C MacAndie
- Department of Otolaryngology and Head and Neck Surgery, Royal Alexandra Hospital, Paisley, UK
| |
Collapse
|
50
|
Iannacone MR, Pandeya N, Isbel N, Campbell S, Fawcett J, Soyer HP, Ferguson L, Davis M, Whiteman DC, Green AC. Sun Protection Behavior in Organ Transplant Recipients in Queensland, Australia. Dermatology 2015; 231:360-6. [DOI: 10.1159/000439428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/13/2015] [Indexed: 11/19/2022] Open
|