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Togni CL, Frontzek K, Schubring-Giese M, Imbach LL, Jelcic I. Posttransplant Anti-GABA A Receptor Antibody-Associated Autoimmune Encephalitis. Neurology 2024; 102:e209245. [PMID: 38452326 DOI: 10.1212/wnl.0000000000209245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Claudio L Togni
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Karl Frontzek
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Maximilian Schubring-Giese
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Lukas L Imbach
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
| | - Ilijas Jelcic
- From the Department of Neurology (C.L.T., L.L.I., I.J.); Institute of Neuropathology (K.F.), University Hospital Zurich and University of Zurich, Switzerland; Institute of Neurology (K.F.), Queen Square Brain Bank, University College London, United Kingdom; Cantonal Hospital of Zug (M.S.-G.), Baar; Swiss Epilepsy Center (L.L.I.), Klinik Lengg, Zurich; Neuroimmunology and MS Research (NIMS) (I.J.), Department of Neurology and University of Zurich, University Hospital Zurich; and Neuroimmunology Outpatient Clinic (I.J.), Center for Multiple Sclerosis, Neurocenter, Bellevue, Zurich, Switzerland
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Bobin M, Sulzer N, Bründler G, Staib M, Imbach LL, Stieglitz LH, Krauss P, Bichsel O, Baumann CR, Frühholz S. Direct subthalamic nucleus stimulation influences speech and voice quality in Parkinson's disease patients. Brain Stimul 2024; 17:112-124. [PMID: 38272256 DOI: 10.1016/j.brs.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND DBS of the subthalamic nucleus (STN) considerably ameliorates cardinal motor symptoms in PD. Reported STN-DBS effects on secondary dysarthric (speech) and dysphonic symptoms (voice), as originating from vocal tract motor dysfunctions, are however inconsistent with rather deleterious outcomes based on post-surgical assessments. OBJECTIVE To parametrically and intra-operatively investigate the effects of deep brain stimulation (DBS) on perceptual and acoustic speech and voice quality in Parkinson's disease (PD) patients. METHODS We performed an assessment of instantaneous intra-operative speech and voice quality changes in PD patients (n = 38) elicited by direct STN stimulations with variations of central stimulation features (depth, laterality, and intensity), separately for each hemisphere. RESULTS First, perceptual assessments across several raters revealed that certain speech and voice symptoms could be improved with STN-DBS, but this seems largely restricted to right STN-DBS. Second, computer-based acoustic analyses of speech and voice features revealed that both left and right STN-DBS could improve dysarthric speech symptoms, but only right STN-DBS can considerably improve dysphonic symptoms, with left STN-DBS being restricted to only affect voice intensity features. Third, several subareas according to stimulation depth and laterality could be identified in the motoric STN proper and close to the associative STN with optimal (and partly suboptimal) stimulation outcomes. Fourth, low-to-medium stimulation intensities showed the most optimal and balanced effects compared to high intensities. CONCLUSIONS STN-DBS can considerably improve both speech and voice quality based on a carefully arranged stimulation regimen along central stimulation features.
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Affiliation(s)
- Marine Bobin
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
| | - Neil Sulzer
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland
| | - Gina Bründler
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland
| | - Matthias Staib
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
| | - Lukas L Imbach
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Swiss Epilepsy Center, Klinik Lengg, 8008 Zurich, Switzerland
| | - Lennart H Stieglitz
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Philipp Krauss
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; Department of Neurosurgery, University Hospital Augsburg, 86159 Augsburg, Germany
| | - Oliver Bichsel
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christian R Baumann
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sascha Frühholz
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Psychology, University of Oslo, 0373 Oslo, Norway.
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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.
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Bögli SY, Schmidt T, Imbach LL, Nellessen F, Brandi G. Nonconvulsive status epilepticus in neurocritical care: A critical reappraisal of outcome prediction scores. Epilepsia 2023; 64:2409-2420. [PMID: 37392404 DOI: 10.1111/epi.17708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Nonconvulsive status epilepticus (NCSE) is a frequent condition in the neurocritical care unit (NCCU) patient population, with high morbidity and mortality. We aimed to assess the validity of available outcome prediction scores for prognostication in an NCCU patient population in relation to their admission reason (NCSE vs. non-NCSE related). METHODS All 196 consecutive patients diagnosed with NCSE during the NCCU stay between January 2010 and December 2020 were included. Demographics, Simplified Acute Physiology Score II (SAPS II), NCSE characteristics, and in-hospital and 3-month outcome were extracted from the electronic charts. Status Epilepticus Severity Score (STESS), Epidemiology-Based Mortality Score in Status Epilepticus (EMSE), and encephalitis, NCSE, diazepam resistance, imaging features, and tracheal intubation score (END-IT) were evaluated as previously described. Univariable and multivariable analysis and comparison of sensitivity/specificity/positive and negative predictive values/accuracy were performed. RESULTS A total of 30.1% died during the hospital stay, and 63.5% of survivors did not achieve favorable outcome at 3 months after onset of NCSE. Patients admitted primarily due to NCSE had longer NCSE duration and were more likely to be intubated at diagnosis. The receiver operating characteristic (ROC) for SAPS II, EMSE, and STESS when predicting mortality was between .683 and .762. The ROC for SAPS II, EMSE, STESS, and END-IT when predicting 3-month outcome was between .649 and .710. The accuracy in predicting mortality/outcome was low, when considering both proposed cutoffs and optimized cutoffs (estimated using the Youden Index) as well as when adjusting for admission reason. SIGNIFICANCE The scores EMSE, STESS, and END-IT perform poorly when predicting outcome of patients with NCSE in an NCCU environment. They should be interpreted cautiously and only in conjunction with other clinical data in this particular patient group.
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Affiliation(s)
- Stefan Y Bögli
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tanja Schmidt
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland
| | - Friederike Nellessen
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Buenzli JC, Werth E, Baumann CR, Belvedere A, Renzel R, Stieglitz LH, Imbach LL. Deep brain stimulation of the anterior nucleus of the thalamus increases slow wave activity in non-rapid eye movement sleep. Epilepsia 2023; 64:2044-2055. [PMID: 37209093 DOI: 10.1111/epi.17657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Previous studies suggest that intermittent deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) affects physiological sleep architecture. Here, we investigated the impact of continuous ANT DBS on sleep in epilepsy patients in a multicenter crossover study in 10 patients. METHODS We assessed sleep stage distribution, delta power, delta energy, and total sleep time in standardized 10/20 polysomnographic investigations before and 12 months after DBS lead implantation. RESULTS In contrast to previous studies, we found no disruption of sleep architecture or alterations of sleep stage distribution under active ANT DBS (p = .76). On the contrary, we observed more consolidated and deeper slow wave sleep (SWS) under continuous high-frequency DBS as compared to baseline sleep prior to DBS lead implantation. In particular, biomarkers of deep sleep (delta power and delta energy) showed a significant increase post-DBS as compared to baseline (36.67 ± 13.68 μV2 /Hz and 799.86 ± 407.56 μV2 *s, p < .001). Furthermore, the observed increase in delta power was related to the location of the active stimulation contact within the ANT; we found higher delta power and higher delta energy in patients with active stimulation in more superior contacts as compared to inferior ANT stimulation. We also observed significantly fewer nocturnal electroencephalographic discharges in DBS ON condition. In conclusion, our findings suggest that continuous ANT DBS in the most cranial part of the target region leads to more consolidated SWS. SIGNIFICANCE From a clinical perspective, these findings suggest that patients with sleep disruption under cyclic ANT DBS could benefit from an adaptation of stimulation parameters to more superior contacts and continuous mode stimulation.
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Affiliation(s)
- Jana C Buenzli
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Anina Belvedere
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roland Renzel
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland
| | - Lennart H Stieglitz
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland
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Sinka L, Abraira L, Imbach LL, Zieglgänsberger D, Santamarina E, Álvarez-Sabín J, Ferreira-Atuesta C, Katan M, Scherrer N, Bicciato G, Terziev R, Simmen C, Schubert KM, Elshahabi A, Baumann CR, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Nilo A, Janes F, Merlino G, Valente M, Zafra-Sierra MP, Bayona-Ortiz H, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Pinho e Melo T, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model. JAMA Neurol 2023; 80:605-613. [PMID: 37036702 PMCID: PMC10087089 DOI: 10.1001/jamaneurol.2023.0611] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/16/2022] [Indexed: 04/11/2023]
Abstract
Importance Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. Objective To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. Design, Setting, and Participants This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. Exposures Type of acute symptomatic seizure. Main Outcomes and Measures All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). Results A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. Conclusions and Relevance In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up.
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Affiliation(s)
- Lucia Sinka
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | | | | | - Estevo Santamarina
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - José Álvarez-Sabín
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Carolina Ferreira-Atuesta
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Mira Katan
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Natalie Scherrer
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Giulio Bicciato
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cyril Simmen
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kai Michael Schubert
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Adham Elshahabi
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nico Döhler
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
- Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | | | - Ansgar Felbecker
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Philip Siebel
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Michael Winklehner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tim J. von Oertzen
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Judith N. Wagner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Gian Luigi Gigli
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Anna Serafini
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Francesco Janes
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Giovanni Merlino
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Mariarosaria Valente
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - María Paula Zafra-Sierra
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Hernan Bayona-Ortiz
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Julian Conrad
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology and German Center for Vertigo and Balance Disorders-IFB-LMU, Ludwig Maximilians University of Munich, Munich, Germany
| | - Stefan Evers
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Frauke Roell
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mark R. Keezer
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - John S. Duncan
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Josemir W. Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Barbara Tettenborn
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Matthias J. Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
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7
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Cusinato R, Alnes SL, van Maren E, Boccalaro I, Ledergerber D, Adamantidis A, Imbach LL, Schindler K, Baud MO, Tzovara A. Intrinsic Neural Timescales in the Temporal Lobe Support an Auditory Processing Hierarchy. J Neurosci 2023; 43:3696-3707. [PMID: 37045604 PMCID: PMC10198454 DOI: 10.1523/jneurosci.1941-22.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 04/14/2023] Open
Abstract
During rest, intrinsic neural dynamics manifest at multiple timescales, which progressively increase along visual and somatosensory hierarchies. Theoretically, intrinsic timescales are thought to facilitate processing of external stimuli at multiple stages. However, direct links between timescales at rest and sensory processing, as well as translation to the auditory system are lacking. Here, we measured intracranial EEG in 11 human patients with epilepsy (4 women), while listening to pure tones. We show that, in the auditory network, intrinsic neural timescales progressively increase, while the spectral exponent flattens, from temporal to entorhinal cortex, hippocampus, and amygdala. Within the neocortex, intrinsic timescales exhibit spatial gradients that follow the temporal lobe anatomy. Crucially, intrinsic timescales at baseline can explain the latency of auditory responses: as intrinsic timescales increase, so do the single-electrode response onset and peak latencies. Our results suggest that the human auditory network exhibits a repertoire of intrinsic neural dynamics, which manifest in cortical gradients with millimeter resolution and may provide a variety of temporal windows to support auditory processing.SIGNIFICANCE STATEMENT Endogenous neural dynamics are often characterized by their intrinsic timescales. These are thought to facilitate processing of external stimuli. However, a direct link between intrinsic timing at rest and sensory processing is missing. Here, with intracranial EEG, we show that intrinsic timescales progressively increase from temporal to entorhinal cortex, hippocampus, and amygdala. Intrinsic timescales at baseline can explain the variability in the timing of intracranial EEG responses to sounds: cortical electrodes with fast timescales also show fast- and short-lasting responses to auditory stimuli, which progressively increase in the hippocampus and amygdala. Our results suggest that a hierarchy of neural dynamics in the temporal lobe manifests across cortical and limbic structures and can explain the temporal richness of auditory responses.
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Affiliation(s)
- Riccardo Cusinato
- Institute of Computer Science, University of Bern, Bern 3012, Switzerland
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Sigurd L Alnes
- Institute of Computer Science, University of Bern, Bern 3012, Switzerland
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Ellen van Maren
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Ida Boccalaro
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | | | - Antoine Adamantidis
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Lukas L Imbach
- Swiss Epilepsy Center, Klinik Lengg, Zurich 8008, Switzerland
| | - Kaspar Schindler
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Maxime O Baud
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Athina Tzovara
- Institute of Computer Science, University of Bern, Bern 3012, Switzerland
- Center for Experimental Neurology, Sleep Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
- Helen Wills Neuroscience Institute, University of California-Berkeley, Berkeley 94720, California
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8
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Heuer C, Disse L, Ledergerber D, Jelcic I, Imbach LL. EEG-Delta brushes in DPPX encephalitis - Welcome to the club. Clin Neurophysiol Pract 2022; 8:12-15. [PMID: 36583162 PMCID: PMC9792293 DOI: 10.1016/j.cnp.2022.11.003] [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: 10/01/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 12/07/2022] Open
Abstract
Background Extreme Delta Brushes are a rare interictal EEG pattern that was first described in NMDA-R encephalitis and has been considered a pathognomonic pattern for this subtype of autoimmune encephalitis. Recently, extreme delta brushes have been described as a rare EEG phenomenon in other forms of encephalitis. Case report We describe to our knowledge the first occurrence of EEG Delta brushes in DPPX encephalitis. In this article, we present a comprehensive case report and discuss clinical differential diagnosis with special emphasis on the diagnostic value of the EEG, leading the way to the correct diagnosis. We also present current diagnostic criteria and clinical screening scales for initial evaluation for patients with suspected autoimmune encephalitis.
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Affiliation(s)
- Christine Heuer
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Leah Disse
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Ilijas Jelcic
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lukas L. Imbach
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland,Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland,Corresponding author at: Swiss Epilepsy Center, Clinic Lengg, Zurich, Switzerland.
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9
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Schreiner SJ, Werth E, Ballmer L, Valko PO, Schubert KM, Imbach LL, Baumann CR, Maric A, Baumann-Vogel H. Sleep spindle and slow wave activity in Parkinson disease with excessive daytime sleepiness. Sleep 2022; 46:6649751. [PMID: 35877159 DOI: 10.1093/sleep/zsac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study Objectives
Excessive daytime sleepiness (EDS) is a common and devastating symptom in Parkinson disease (PD), but surprisingly most studies showed that EDS is independent from nocturnal sleep disturbance measured with polysomnography. Quantitative electroencephalography (EEG) may reveal additional insights by measuring the EEG hallmarks of non-rapid eye movement (NREM) sleep, namely slow waves and spindles. Here, we tested the hypothesis that EDS in PD is associated with nocturnal sleep disturbance revealed by quantitative NREM sleep EEG markers.
Methods
Patients with PD (n = 130) underwent polysomnography followed by spectral analysis to calculate spindle frequency activity, slow-wave activity (SWA), and overnight SWA decline, which reflects the dissipation of homeostatic sleep pressure. We used the Epworth Sleepiness Scale (ESS) to assess subjective daytime sleepiness and define EDS (ESS > 10). All examinations were part of an evaluation for deep brain stimulation.
Results
Patients with EDS (n = 46) showed reduced overnight decline of SWA (p = 0.036) and reduced spindle frequency activity (p = 0.032) compared with patients without EDS. Likewise, more severe daytime sleepiness was associated with reduced SWA decline (ß= −0.24 p = 0.008) and reduced spindle frequency activity (ß= −0.42, p < 0.001) across all patients. Reduced SWA decline, but not daytime sleepiness, was associated with poor sleep quality and continuity at polysomnography.
Conclusions
Our data suggest that daytime sleepiness in PD patients is associated with sleep disturbance revealed by quantitative EEG, namely reduced overnight SWA decline and reduced spindle frequency activity. These findings could indicate that poor sleep quality, with incomplete dissipation of homeostatic sleep pressure, may contribute to EDS in PD.
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Affiliation(s)
- Simon J Schreiner
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Leonie Ballmer
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Kai M Schubert
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Swiss Epilepsy Center, Klinik Lengg , Zurich , Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Sleep and Health Zurich (SHZ), University of Zurich , Zurich , Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, University of Zurich , Zurich , Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich , Zurich , Switzerland
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10
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Capecchi F, di Giacopo A, Keller E, Mothershill I, Imbach LL. Stimulus Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs) and its Association with Non-convulsive Status Epilepticus in Critically Ill Patients. Clin EEG Neurosci 2022; 54:247-254. [PMID: 35473446 PMCID: PMC10084515 DOI: 10.1177/15500594221095434] [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] [Indexed: 11/15/2022]
Abstract
Stimulus induced repetitive periodic or ictal discharges (SIRPIDs) are a commonly observed EEG pattern in critically ill patients. However, the epileptic significance of SIRPIDs remain unclear. We identified and reviewed 55 cases with SIRPIDs according to the ACNS criteria. SIRPIDs occurred after standardized painful stimuli during a standard 20-minute EEG. These cases were investigated regarding their relation to non-convulsive status epilepticus (NCSE) according to Salzburg Consensus Criteria and in-hospital mortality. In 37/55 patients (67.3%), SIRPIDs were associated with NCSE. In most patients (26/37 cases, 70.3%) with concurrent status epilepticus, SIRPIDs occurred after status epilepticus (on average 4.8 days later), but in 3/37 patients (8.1%) they were observed before a later status epilepticus. In four cases (4/37 cases, 10.8%), SIRPIDs appeared both before and after an episode of NCSE and in other four cases the two patterns coexisted in the same EEG. In 50% of the patients, status epilepticus was refractory, super-refractory or the patient died before its resolution. The overall mortality in the cohort was high at 58.2%. These findings corroborate the hypothesis that SIRPIDs might represent a state with increased epileptogenic potential, commonly co-occurring with NCSE. Furthermore, SIRPIDs are associated with therapy-refractory course of status epilepticus and high mortality.
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Affiliation(s)
- Francesco Capecchi
- Department of Neurology, 27243University Hospital and University of Zurich, Zurich, Switzerland
| | - Andrea di Giacopo
- Department of Neurology, Ente Ospedaliero Cantonale, 31033Lugano, Switzerland
| | - Emanuela Keller
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ian Mothershill
- 31033Swiss Epilepsy Clinic, Klinik Lengg AG, Zurich, Switzerland
| | - Lukas L Imbach
- 31033Swiss Epilepsy Clinic, Klinik Lengg AG, Zurich, Switzerland
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11
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Bögli SY, Wang S, Romaguera N, Schütz V, Rafi O, Gilone M, Keller E, Imbach LL, Brandi G. Impact of Seizures and Status Epilepticus on Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2022; 36:751-759. [PMID: 35411540 PMCID: PMC9110510 DOI: 10.1007/s12028-022-01489-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/14/2022] [Indexed: 10/29/2022]
Abstract
BACKGROUND We aimed to evaluate the association between seizures as divided by timing and type (seizures or status epilepticus) and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS All consecutive patients with aSAH admitted to the neurocritical care unit of the University Hospital Zurich between 2016 and 2020 were included. Seizure type and frequency were extracted from electronic patient files. RESULTS Out of 245 patients, 76 experienced acute symptomatic seizures, with 39 experiencing seizures at onset, 18 experiencing acute seizures, and 19 experiencing acute nonconvulsive status epilepticus (NCSE). Multivariate analysis revealed that acute symptomatic NCSE was an independent predictor of unfavorable outcome (odds ratio 14.20, 95% confidence interval 1.74-116.17, p = 0.013) after correction for age, Hunt-Hess grade, Fisher grade, and delayed cerebral ischemia. Subgroup analysis showed a significant association of all seizures/NCSE with higher Fisher grade (p < 0.001 for acute symptomatic seizures/NCSE, p = 0.031 for remote symptomatic seizures). However, although acute seizures/NCSE (p = 0.750 and 0.060 for acute seizures/NCSE respectively) were not associated with unfavorable outcome in patients with a high Hunt-Hess grade, they were significantly associated with unfavorable outcome in patients with a low Hunt-Hess grade (p = 0.019 and p < 0.001 for acute seizures/NCSE, respectively). CONCLUSIONS Acute symptomatic NCSE independently predicts unfavorable outcome after aSAH. Seizures and NCSE are associated with unfavorable outcome, particularly in patients with a low Hunt-Hess grade. We propose that NCSE and the ictal or postictal reduction of Glasgow Coma Scale may hamper close clinical evaluation for signs of delayed cerebral ischemia, and thus possibly leading to delayed diagnosis and therapy thereof in patients with a low Hunt-Hess grade.
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Affiliation(s)
- Stefan Yu Bögli
- Institute for Intensive Care Medicine, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland. .,Department of Neurology, University Hospital Zurich, Zurich, Switzerland. .,Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Sophie Wang
- Institute for Intensive Care Medicine, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Natalia Romaguera
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Valerie Schütz
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Omar Rafi
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Gilone
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Emanuela Keller
- Institute for Intensive Care Medicine, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Swiss Epilepsy Center, Klinik Lengg AG, Zurich, Switzerland
| | - Giovanna Brandi
- Institute for Intensive Care Medicine, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
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12
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Rothacher Y, Nguyen A, Efthymiou E, Werth E, Baumann CR, Lenggenhager B, Brugger P, Kunz A, Imbach LL. Dissociation of motor control from motor awareness in awake sleepwalkers: An EEG study in virtual reality. Cortex 2022; 149:165-172. [DOI: 10.1016/j.cortex.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022]
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13
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Mahendran S, Bichsel O, Gassert R, Baumann CR, Imbach LL, Waldvogel D. Differentiation of Parkinson’s disease tremor and essential tremor based on a novel hand posture. Clin Park Relat Disord 2022; 7:100146. [PMID: 35647517 PMCID: PMC9136132 DOI: 10.1016/j.prdoa.2022.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Tremor is one of the most common movement disorders but the correct diagnosis of tremor disorders, especially the differentiation between Parkinson’s disease tremor (PT) and essential tremor (ET) remains a challenge for clinicians. Method We examined a novel hand position to distinguish PT from ET. We prospectively collected accelerometric tremor data in 14 ET patients and 14 PT patients with arms and hands fully stretched against arms stretched and hands relaxed, i. e. hanging down. The total acceleration from the three pairwise-perpendicular accelerometric axes during the 1-minute blocks of the two hand positions were computed and high-passed filtered at 2 Hz. The power spectral density during each hand position was calculated and summed up over the frequency domain. Results Our results showed a significantly higher occurrence of tremor in the hands hanging down position in PT patients compared to ET patients (p = 0.0262). Moreover, in PT patients the tremor intensity significantly increased when transitioning from the stretched hand position to the hanging-down position (83 % of cohort) and vice versa in ET patients (75 % of cohort). Conclusion In conclusion, the new hand posture can differentiate between PT and ET with high accuracy (sensitivity 83 %, specificity 75 % for PT) and may be a helpful tool in the clinical assessment of tremor.
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14
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Morawska MM, Moreira CG, Ginde VR, Valko PO, Weiss T, Büchele F, Imbach LL, Masneuf S, Kollarik S, Prymaczok N, Gerez JA, Riek R, Baumann CR, Noain D. Slow-wave sleep affects synucleinopathy and regulates proteostatic processes in mouse models of Parkinson's disease. Sci Transl Med 2021; 13:eabe7099. [PMID: 34878820 DOI: 10.1126/scitranslmed.abe7099] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Marta M Morawska
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland.,University of Zurich (UZH), Neuroscience Center Zurich (ZNZ), Winterthurerstrasse 190, Zurich 8057, Switzerland
| | - Carlos G Moreira
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland.,ETH Zurich, Neuroscience Center Zurich (ZNZ), Winterthurerstrasse 190, Zurich 8057, Switzerland
| | - Varun R Ginde
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Tobias Weiss
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Fabian Büchele
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Sophie Masneuf
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Sedef Kollarik
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland.,University of Zurich (UZH), Neuroscience Center Zurich (ZNZ), Winterthurerstrasse 190, Zurich 8057, Switzerland
| | - Natalia Prymaczok
- ETH Zurich, Laboratory of Physical Chemistry, Department of Chemistry and Applied Biosciences, Vladimir-Prelog-Weg 2, Zurich 8093, Switzerland
| | - Juan A Gerez
- ETH Zurich, Laboratory of Physical Chemistry, Department of Chemistry and Applied Biosciences, Vladimir-Prelog-Weg 2, Zurich 8093, Switzerland
| | - Roland Riek
- ETH Zurich, Laboratory of Physical Chemistry, Department of Chemistry and Applied Biosciences, Vladimir-Prelog-Weg 2, Zurich 8093, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland.,University of Zurich (UZH), Neuroscience Center Zurich (ZNZ), Winterthurerstrasse 190, Zurich 8057, Switzerland.,Center of Competence Sleep and Health Zurich, University of Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
| | - Daniela Noain
- Department of Neurology, University Hospital Zurich (USZ), Frauenklinikstrasse 26, Zurich 8091, Switzerland.,University of Zurich (UZH), Neuroscience Center Zurich (ZNZ), Winterthurerstrasse 190, Zurich 8057, Switzerland.,Center of Competence Sleep and Health Zurich, University of Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland
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15
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Ferreira‐Atuesta C, Döhler N, Erdélyi‐Canavese B, Felbecker A, Siebel P, Scherrer N, Bicciato G, Schweizer J, Sinka L, Imbach LL, Katan M, Abraira L, Santamarina E, Álvarez‐Sabín J, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Janes F, Merlino G, Valente M, Gregoraci G, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Melo TPE, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. Seizures after Ischemic Stroke: A Matched Multicenter Study. Ann Neurol 2021; 90:808-820. [PMID: 34505305 PMCID: PMC9292028 DOI: 10.1002/ana.26212] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/30/2023]
Abstract
Objective The purpose of this study was to identify risk factors for acute symptomatic seizures and post‐stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods We assessed the risk factors for post‐stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging‐confirmed ischemic stroke. We compared the risk of post‐stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large‐artery atherosclerosis. Strokes caused by small‐vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post‐stroke epilepsy. Risk factors for post‐stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large‐artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post‐stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post‐stroke epilepsy or the risk of acute symptomatic seizures. Interpretation Post‐stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post‐stroke epilepsy. ANN NEUROL 2021;90:808–820
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Affiliation(s)
- Carolina Ferreira‐Atuesta
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Nico Döhler
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
- Specialist Clinic for Neurorehabilitation, Kliniken BeelitzBeelitz‐HeilstättenGermany
| | | | - Ansgar Felbecker
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Philip Siebel
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Natalie Scherrer
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Giulio Bicciato
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Juliane Schweizer
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Lucia Sinka
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Lukas L. Imbach
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Mira Katan
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of ZurichZurichSwitzerland
| | - Laura Abraira
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - Estevo Santamarina
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - José Álvarez‐Sabín
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - Michael Winklehner
- Department of Neurology 1Kepler UniversitätsklinikumLinzAustria
- Division of Neuropathology and Neurochemistry, Department of NeurologyMedical University of ViennaViennaAustria
| | | | | | - Gian Luigi Gigli
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Anna Serafini
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Francesco Janes
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Giovanni Merlino
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Mariarosaria Valente
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | | | - Julian Conrad
- Department of NeurologyUniversity of MuensterMuensterGermany
- Department of Neurology and German Center for Vertigo and Balance Disorders‐IFB‐LMULudwig Maximilians University of MunichMunichGermany
| | - Stefan Evers
- Department of NeurologyUniversity of MuensterMuensterGermany
- Department of NeurologyKrankenhaus LindenbrunnCoppenbrüggeGermany
| | | | - Frauke Roell
- Department of NeurologySaarland University Medical CenterHomburgGermany
| | - Francesco Brigo
- Division of NeurologyHospital of Merano‐Meran (SABES‐ASDAA)MeranoItaly
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Mark R. Keezer
- Stichting Epilepsie Instellingen Nederland – (SEIN)HeemstedeThe Netherlands
- Centre Hospitalier de l'Université de MontréalMontrealQuebecCanada
| | - John S. Duncan
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
| | - Josemir W. Sander
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Stichting Epilepsie Instellingen Nederland – (SEIN)HeemstedeThe Netherlands
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
- Department of Neurology, West of China HospitalChengduChina
| | | | - Matthias J. Koepp
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
| | - Marian Galovic
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
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16
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Martínez-Fernández R, Mahendran S, Pineda-Pardo JA, Imbach LL, Máñez-Miró JU, Büchele F, Del Álamo M, Rodriguez-Rojas R, Hernández-Fernández F, Werner B, Matarazzo M, Obeso I, Gonzalez-Quarante LH, Deuschl G, Stieglitz L, Baumann CR, Obeso JA. Bilateral staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of essential tremor: a case series study. J Neurol Neurosurg Psychiatry 2021; 92:927-931. [PMID: 33906933 DOI: 10.1136/jnnp-2020-325278] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/22/2021] [Accepted: 04/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unilateral magnetic resonance-guided focused ultrasound (FUS) thalamotomy is efficacious for the treatment of medically refractory essential tremor (ET). Viability of bilateral FUS ablation is unexplored. METHODS Patients diagnosed with medically refractory ET and previously treated with unilateral FUS thalamotomy at least 5 months before underwent bilateral treatment. The timepoints were baseline (before first thalamotomy) and FUS1 and FUS2 (4 weeks before and 6 months after second thalamotomy, respectively). The primary endpoint was safety. Efficacy was assessed through the Clinical Rating Scale for Tremor (CRST), which includes subscales for tremor examination (part A), task performance (part B) and tremor-related disability (part C). RESULTS Nine patients were treated. No permanent adverse events were registered. Six patients presented mild gait instability and one dysarthria, all resolving within the first few weeks. Three patients reported perioral hypoesthesia, resolving in one case. Total CRST score improved by 71% from baseline to FUS2 (from 52.3±12 to 15.5±9.4, p<0.001), conveying a 67% reduction in bilateral upper limb A+B (from 32.3±7.8 to 10.8±7.3, p=0.001). Part C decreased by 81% (from 16.4±3.6 to 3.1±2.9, p<0.001). Reduction in head and voice tremor was 66% (from 1.2±0.44 to 0.4±0.54, p=0.01) and 45% (from 1.8±1.1 to 1±0.8, p=0.02), respectively. CONCLUSION Bilateral staged FUS thalamotomy for ET is feasible and might be safe and effective. Voice and head tremor might also improve. A controlled study is warranted.
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Affiliation(s)
- Raúl Martínez-Fernández
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Sujitha Mahendran
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jose Angel Pineda-Pardo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Lukas L Imbach
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jorge U Máñez-Miró
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Fabian Büchele
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marta Del Álamo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Rafael Rodriguez-Rojas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Frida Hernández-Fernández
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Beat Werner
- Center for Focused Ultrasound, Children's Hospital Zurich, Zurich, Switzerland
| | - Michele Matarazzo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Ignacio Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Lain H Gonzalez-Quarante
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Department of Neurosurgery, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Günther Deuschl
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.,Department of Neurology, Universitätsklinikum Schleswig-Holstein Kiel, Campus Christian-Albrechts-University, Kiel, Germany
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jose A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain .,Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
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17
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Narula G, Haeberlin M, Balsiger J, Strässle C, Imbach LL, Keller E. Detection of EEG burst-suppression in neurocritical care patients using an unsupervised machine learning algorithm. Clin Neurophysiol 2021; 132:2485-2492. [PMID: 34454277 DOI: 10.1016/j.clinph.2021.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The burst suppression pattern in clinical electroencephalographic (EEG) recordings is an important diagnostic tool because of its association with comas of various etiologies, as with hypoxia, drug related intoxication or deep anesthesia. The detection of bursts and the calculation of burst/suppression ratio are often used to monitor the level of anesthesia during treatment of status epilepticus. However, manual counting of bursts is a laborious process open to inter-rater variation and motivates a need for automatic detection. METHODS We describe a novel unsupervised learning algorithm that detects bursts in EEG and generates burst-per-minute estimates for the purpose of monitoring sedation level in an intensive care unit (ICU). We validated the algorithm on 29 hours of burst annotated EEG data from 29 patients suffering from status epilepticus and hemorrhage. RESULTS We report competitive results in comparison to neural networks learned via supervised learning. The mean absolute error (SD) in bursts per minute was 0.93 (1.38). CONCLUSION We present a novel burst suppression detection algorithm that adapts to each patient individually, reports bursts-per-minute quickly, and does not require manual fine-tuning unlike previous approaches to burst-suppression pattern detection. SIGNIFICANCE Our algorithm for automatic burst suppression quantification can greatly reduce manual oversight in depth of sedation monitoring.
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Affiliation(s)
- G Narula
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland.
| | - M Haeberlin
- Department of Epileptology, Neurology Clinic, University Hospital Zürich, Zürich, Switzerland
| | - J Balsiger
- Department of Epileptology, Neurology Clinic, University Hospital Zürich, Zürich, Switzerland
| | - C Strässle
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland
| | - L L Imbach
- Department of Epileptology, Neurology Clinic, University Hospital Zürich, Zürich, Switzerland
| | - E Keller
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland
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18
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Singh KD, Osswald M, Ziesenitz VC, Awchi M, Usemann J, Imbach LL, Kohler M, García-Gómez D, van den Anker J, Frey U, Datta AN, Sinues P. Personalised therapeutic management of epileptic patients guided by pathway-driven breath metabolomics. Commun Med (Lond) 2021; 1:21. [PMID: 35602217 PMCID: PMC9053280 DOI: 10.1038/s43856-021-00021-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Therapeutic management of epilepsy remains a challenge, since optimal systemic antiseizure medication (ASM) concentrations do not always correlate with improved clinical outcome and minimal side effects. We tested the feasibility of noninvasive real-time breath metabolomics as an extension of traditional therapeutic drug monitoring for patient stratification by simultaneously monitoring drug-related and drug-modulated metabolites. METHODS This proof-of-principle observational study involved 93 breath measurements of 54 paediatric patients monitored over a period of 2.5 years, along with an adult's cohort of 37 patients measured in two different hospitals. Exhaled breath metabolome of epileptic patients was measured in real time using secondary electrospray ionisation-high-resolution mass spectrometry (SESI-HRMS). RESULTS We show that systemic ASM concentrations could be predicted by the breath test. Total and free valproic acid (VPA, an ASM) is predicted with concordance correlation coefficient (CCC) of 0.63 and 0.66, respectively. We also find (i) high between- and within-subject heterogeneity in VPA metabolism; (ii) several amino acid metabolic pathways are significantly enriched (p < 0.01) in patients suffering from side effects; (iii) tyrosine metabolism is significantly enriched (p < 0.001), with downregulated pathway compounds in non-responders. CONCLUSIONS These results show that real-time breath analysis of epileptic patients provides reliable estimations of systemic drug concentrations along with risk estimates for drug response and side effects.
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Affiliation(s)
- Kapil Dev Singh
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Martin Osswald
- grid.7400.30000 0004 1937 0650University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victoria C. Ziesenitz
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Mo Awchi
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Jakob Usemann
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Lukas L. Imbach
- grid.7400.30000 0004 1937 0650University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- grid.7400.30000 0004 1937 0650University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Diego García-Gómez
- grid.11762.330000 0001 2180 1817Department of Analytical Chemistry, University of Salamanca, Salamanca, Spain
| | - Johannes van den Anker
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Urs Frey
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Alexandre N. Datta
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Pablo Sinues
- grid.6612.30000 0004 1937 0642University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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19
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Wolpert F, Lareida A, Terziev R, Grossenbacher B, Neidert MC, Roth P, Poryazova R, Imbach LL, Le Rhun E, Weller M. Risk factors for the development of epilepsy in patients with brain metastases. Neuro Oncol 2021; 22:718-728. [PMID: 31498867 DOI: 10.1093/neuonc/noz172] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/13/2022] Open
Abstract
BACKGROUND Current guidelines do not recommend primary prophylactic anti-epileptic drug (AED) therapy for patients with brain metastases (BM). Yet, subgroups of patients at high seizure risk might still benefit from prophylaxis. METHODS We identified 799 patients diagnosed with BM by retrospective screening of our electronic chart system. Candidate risk factors for the development of epilepsy were tested by univariate and multivariate Cox regression models. RESULTS Epilepsy was diagnosed in 226 of 799 patients (28%). Risk factors for epilepsy in non-operated patients were single BM (P = 0.002, hazard ratio [HR] 3.2, 95% CI: 1.5-6.6) and detection of tumoral hemorrhage (P = 0.008, HR 2.5, 95% CI: 1.3-4.9). Preoperative seizures occurred predominantly in patients with supratentorial BM (P = 0.003, HR 20.78, 95% CI: 2.8-153.4) and lung cancer (P = 0.022; HR 2.0, 95% CI: 1.1-3.6). Postoperative seizures were associated with supratentorial localization (P = 0.017, HR 5.8, 95% CI: 1.4-24.3), incomplete resection (P = 0.005, HR 4.6, 95% CI: 1.6-13.1), and by trend for multiple brain surgeries (P = 0.095, HR 1.9, 95% CI: 0.9-4.0). These risk factors were integrated into a predictive score model for postoperative epilepsy (score sum 0-8). A gradual increase of seizure rates along with higher sum score was confirmed post hoc (score 0 = no seizures; score 8 = 48% seizures). Receiver operating characteristic analysis supported diagnostic accuracy (P = 0.00001, area under the curve = 0.75). CONCLUSIONS Here we have defined risk profiles for the development of BM-related epilepsy and derived a score which might help to estimate the risk of postoperative seizures and identify individuals at risk who might benefit from primary prophylactic AED therapy.
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Affiliation(s)
- Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Anna Lareida
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bettina Grossenbacher
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Neuro-oncology, Department of Neurosurgery, University Hospital Lille, Salengro Hospital, Lille, France; Neurology, Department of Medical Oncology, Oscar Lambret Center, Lille, France and Inserm U-1192, Villeneuve d'Ascq, France
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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20
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Sousouri G, Baumann CR, Imbach LL, Huber R, Werth E. Sleep electroencephalographic asymmetry in Parkinson's disease patients before and after deep brain stimulation. Clin Neurophysiol 2021; 132:857-863. [PMID: 33636602 DOI: 10.1016/j.clinph.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Unilateral manifestation of motor dysfunction is a prominent hallmark of Parkinson's disease (PD). We investigated how the motor laterality of the disorder affects sleep neural asymmetry before and after Deep Brain Stimulation (DBS). METHODS Twenty-seven PD patients of the akinetic-rigid subtype were studied; 11 with right dominant (RD) and 16 with left dominant (LD) motor symptoms. Neuronal sleep asymmetry was computed as the difference of sleep slow-wave energy (SWE) between left and right hemispheres. We used linear mixed models to assess the relationship between symptomatic profile and SWE asymmetry. RESULTS LD PD patients exhibited frontal electroencephalographic (EEG) asymmetry and motor laterality pre-DBS with increased SWE contralateral to their affected body side, which diminished post-DBS. The RD group did not exhibit neither neural asymmetry nor motor laterality pre- and post-DBS. There was a significant negative correlation between the motor laterality and sleep EEG asymmetry. CONCLUSIONS Our results suggest evidence for a local use-dependent modulation of SWE as a result of the lateralized pathological motor profile. More bilateral motor symptoms and optimized treatment contribute to diminished sleep EEG asymmetry. SIGNIFICANCE These novel findings about the association between symptomatic motor laterality and sleep neural asymmetry may provide targeted therapeutic insights.
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Affiliation(s)
- Georgia Sousouri
- Child Development Centre, University Children's Hospital, Zürich, Switzerland; Department of Health Sciences and Technology, ETH Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Reto Huber
- Child Development Centre, University Children's Hospital, Zürich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital Zürich, Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zürich, Zürich, Switzerland.
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21
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Schreiner SJ, Imbach LL, Valko PO, Maric A, Maqkaj R, Werth E, Baumann CR, Baumann-Vogel H. Reduced Regional NREM Sleep Slow-Wave Activity Is Associated With Cognitive Impairment in Parkinson Disease. Front Neurol 2021; 12:618101. [PMID: 33679584 PMCID: PMC7933203 DOI: 10.3389/fneur.2021.618101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
Growing evidence implicates a distinct role of disturbed slow-wave sleep in neurodegenerative diseases. Reduced non-rapid eye movement (NREM) sleep slow-wave activity (SWA), a marker of slow-wave sleep intensity, has been linked with age-related cognitive impairment and Alzheimer disease pathology. However, it remains debated if SWA is associated with cognition in Parkinson disease (PD). Here, we investigated the relationship of regional SWA with cognitive performance in PD. In the present study, 140 non-demented PD patients underwent polysomnography and were administered the Montréal Cognitive Assessment (MoCA) to screen for cognitive impairment. We performed spectral analysis of frontal, central, and occipital sleep electroencephalography (EEG) derivations to measure SWA, and spectral power in other frequency bands, which we compared to cognition using linear mixed models. We found that worse MoCA performance was associated with reduced 1–4 Hz SWA in a region-dependent manner (F2, 687 =11.67, p < 0.001). This effect was driven by reduced regional SWA in the lower delta frequencies, with a strong association of worse MoCA performance with reduced 1–2 Hz SWA (F2, 687 =18.0, p < 0.001). The association of MoCA with 1–2 Hz SWA (and 1–4 Hz SWA) followed an antero-posterior gradient, with strongest, weaker, and absent associations over frontal (rho = 0.33, p < 0.001), central (rho = 0.28, p < 0.001), and occipital derivations, respectively. Our study shows that cognitive impairment in PD is associated with reduced NREM sleep SWA, predominantly in lower delta frequencies (1–2 Hz) and over frontal regions. This finding suggests a potential role of reduced frontal slow-wave sleep intensity in cognitive impairment in PD.
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Affiliation(s)
- Simon J Schreiner
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Rina Maqkaj
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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22
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Masneuf S, Imbach LL, Büchele F, Colacicco G, Penner M, Moreira CG, Ineichen C, Jahanshahi A, Temel Y, Baumann CR, Noain D. Altered sleep intensity upon DBS to hypothalamic sleep-wake centers in rats. Transl Neurosci 2021; 12:611-625. [PMID: 35070444 PMCID: PMC8729228 DOI: 10.1515/tnsci-2020-0202] [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: 06/24/2021] [Revised: 11/04/2021] [Accepted: 11/22/2021] [Indexed: 11/15/2022] Open
Abstract
Deep brain stimulation (DBS) has been scarcely investigated in the field of sleep research. We hypothesize that DBS onto hypothalamic sleep- and wake-promoting centers will produce significant neuromodulatory effects and potentially become a therapeutic strategy for patients suffering severe, drug-refractory sleep–wake disturbances. We aimed to investigate whether continuous electrical high-frequency DBS, such as that often implemented in clinical practice, in the ventrolateral preoptic nucleus (VLPO) or the perifornical area of the posterior lateral hypothalamus (PeFLH), significantly modulates sleep–wake characteristics and behavior. We implanted healthy rats with electroencephalographic/electromyographic electrodes and recorded vigilance states in parallel to bilateral bipolar stimulation of VLPO and PeFLH at 125 Hz and 90 µA over 24 h to test the modulating effects of DBS on sleep–wake proportions, stability and spectral power in relation to the baseline. We unexpectedly found that VLPO DBS at 125 Hz deepens slow-wave sleep (SWS) as measured by increased delta power, while sleep proportions and fragmentation remain unaffected. Thus, the intensity, but not the amount of sleep or its stability, is modulated. Similarly, the proportion and stability of vigilance states remained altogether unaltered upon PeFLH DBS but, in contrast to VLPO, 125 Hz stimulation unexpectedly weakened SWS, as evidenced by reduced delta power. This study provides novel insights into non-acute functional outputs of major sleep–wake centers in the rat brain in response to electrical high-frequency stimulation, a paradigm frequently used in human DBS. In the conditions assayed, while exerting no major effects on the sleep–wake architecture, hypothalamic high-frequency stimulation arises as a provocative sleep intensity-modulating approach.
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Affiliation(s)
- Sophie Masneuf
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Büchele
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Marco Penner
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carlos G Moreira
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Ineichen
- Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, DPPP, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Ali Jahanshahi
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela Noain
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich (ZNZ), University of Zurich, Zurich, Switzerland.,Center of Competence Sleep & Health, University of Zurich, Zurich, Switzerland
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23
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Kirschenbaum D, Imbach LL, Rushing EJ, Frauenknecht KBM, Gascho D, Ineichen BV, Keller E, Kohler S, Lichtblau M, Reimann RR, Schreib K, Ulrich S, Steiger P, Aguzzi A, Frontzek K. Intracerebral endotheliitis and microbleeds are neuropathological features of COVID-19. Neuropathol Appl Neurobiol 2020; 47:454-459. [PMID: 33249605 PMCID: PMC7753688 DOI: 10.1111/nan.12677] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 19 (COVID‐19) is a rapidly evolving pandemic caused by the coronavirus Sars‐CoV‐2. Clinically manifest central nervous system symptoms have been described in COVID‐19 patients and could be the consequence of commonly associated vascular pathology, but the detailed neuropathological sequelae remain largely unknown. A total of six cases, all positive for Sars‐CoV‐2, showed evidence of cerebral petechial hemorrhages and microthrombi at autopsy. Two out of six patients showed an elevated risk for disseminated intravascular coagulopathy according to current criteria and were excluded from further analysis. In the remaining four patients, the hemorrhages were most prominent at the grey and white matter junction of the neocortex, but were also found in the brainstem, deep grey matter structures and cerebellum. Two patients showed vascular intramural inflammatory infiltrates, consistent with Sars‐CoV‐2‐associated endotheliitis, which was associated by elevated levels of the Sars‐CoV‐2 receptor ACE2 in the brain vasculature. Distribution and morphology of patchy brain microbleeds was clearly distinct from hypertension‐related hemorrhage, critical illness‐associated microbleeds and cerebral amyloid angiopathy, which was ruled out by immunohistochemistry. Cerebral microhemorrhages in COVID‐19 patients could be a consequence of Sars‐ CoV‐2‐induced endotheliitis and more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy.
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Affiliation(s)
| | - Lukas L Imbach
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | | | | | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Emanuela Keller
- Department of Neurosurgery and Institute of Intensive Care Medicine, University of Zurich, Zurich, Switzerland
| | - Sibylle Kohler
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University of Zurich, Zurich, Switzerland
| | - Regina R Reimann
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Katharina Schreib
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University of Zurich, Zurich, Switzerland
| | - Peter Steiger
- Institute of Intensive Care Medicine, University of Zurich, Zurich, Switzerland
| | - Adriano Aguzzi
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Karl Frontzek
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
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24
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Akeret K, Stumpo V, Staartjes VE, Vasella F, Velz J, Marinoni F, Dufour JP, Imbach LL, Regli L, Serra C, Krayenbühl N. Topographic brain tumor anatomy drives seizure risk and enables machine learning based prediction. Neuroimage Clin 2020; 28:102506. [PMID: 33395995 PMCID: PMC7711280 DOI: 10.1016/j.nicl.2020.102506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/05/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to identify relevant risk factors for epileptic seizures upon initial diagnosis of a brain tumor and to develop and validate a machine learning based prediction to allow for a tailored risk-based antiepileptic therapy. METHODS Clinical, electrophysiological and high-resolution imaging data was obtained from a consecutive cohort of 1051 patients with newly diagnosed brain tumors. Factor-associated seizure risk difference allowed to determine the relevance of specific topographic, demographic and histopathologic variables available at the time of diagnosis for seizure risk. The data was divided in a 70/30 ratio into a training and test set. Different machine learning based predictive models were evaluated before a generalized additive model (GAM) was selected considering its traceability while maintaining high performance. Based on a clinical stratification of the risk factors, three different GAM were trained and internally validated. RESULTS A total of 923 patients had full data and were included. Specific topographic anatomical patterns that drive seizure risk could be identified. The involvement of allopallial, mesopallial or primary motor/somatosensory neopallial structures by brain tumors results in a significant and clinically relevant increase in seizure risk. While topographic input was most relevant for the GAM, the best prediction was achieved by a combination of topographic, demographic and histopathologic information (Validation: AUC: 0.79, Accuracy: 0.72, Sensitivity: 0.81, Specificity: 0.66). CONCLUSIONS This study identifies specific phylogenetic anatomical patterns as epileptic drivers. A GAM allowed the prediction of seizure risk using topographic, demographic and histopathologic data achieving fair performance while maintaining transparency.
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Affiliation(s)
- Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Vittorio Stumpo
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Flavio Vasella
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Velz
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Federica Marinoni
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jean-Philippe Dufour
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Division of Pediatric Neurosurgery, University Children's Hospital, Zurich, Switzerland
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25
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Keller E, Brandi G, Winklhofer S, Imbach LL, Kirschenbaum D, Frontzek K, Steiger P, Dietler S, Haeberlin M, Willms J, Porta F, Waeckerlin A, Huber M, Abela IA, Lutterotti A, Stippich C, Globas C, Varga Z, Jelcic I. Large and Small Cerebral Vessel Involvement in Severe COVID-19: Detailed Clinical Workup of a Case Series. Stroke 2020; 51:3719-3722. [PMID: 33054673 PMCID: PMC7678671 DOI: 10.1161/strokeaha.120.031224] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Supplemental Digital Content is available in the text. Case series indicating cerebrovascular disorders in coronavirus disease 2019 (COVID-19) have been published. Comprehensive workups, including clinical characteristics, laboratory, electroencephalography, neuroimaging, and cerebrospinal fluid findings, are needed to understand the mechanisms.
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Affiliation(s)
- Emanuela Keller
- Neurocritical Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine (E.K.), University Hospital and University of Zurich, Switzerland
| | - Giovanna Brandi
- Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology (S.W., C.S.), University Hospital and University of Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology (L.L.I., M. Haeberlin), University Hospital and University of Zurich, Switzerland
| | - Daniel Kirschenbaum
- Department of Neuropathology (D.K., K.F.), University Hospital and University of Zurich, Switzerland
| | - Karl Frontzek
- Department of Neuropathology (D.K., K.F.), University Hospital and University of Zurich, Switzerland
| | - Peter Steiger
- Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland
| | - Sabeth Dietler
- Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland
| | - Marcellina Haeberlin
- Department of Neurology (L.L.I., M. Haeberlin), University Hospital and University of Zurich, Switzerland
| | - Jan Willms
- Institute of Intensive Care Medicine (G.B., P.S., S.D., J.W.), University Hospital and University of Zurich, Switzerland
| | - Francesca Porta
- Intensive Care Unit, Graubuenden Cantonal Hospital, Chur, Switzerland (F.P., A.W.)
| | - Adrian Waeckerlin
- Intensive Care Unit, Graubuenden Cantonal Hospital, Chur, Switzerland (F.P., A.W.)
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Switzerland (M. Huber)
| | - Irene A Abela
- Department of Infectious Diseases and Hospital Epidemiology (I.A.A.), University Hospital and University of Zurich, Switzerland
| | - Andreas Lutterotti
- Neuroimmunology and Multiple Sclerosis Research Section (A.L., I.J.), University Hospital and University of Zurich, Switzerland
| | - Christoph Stippich
- Department of Neuroradiology (S.W., C.S.), University Hospital and University of Zurich, Switzerland
| | - Christoph Globas
- Stroke Unit, Department of Neurology (C.G.), University Hospital and University of Zurich, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology (Z.V.), University Hospital and University of Zurich, Switzerland
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section (A.L., I.J.), University Hospital and University of Zurich, Switzerland
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26
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Capecchi F, Mothersill I, Imbach LL. The medial pulvinar as a subcortical relay in temporal lobe status epilepticus. Seizure 2020; 81:276-279. [DOI: 10.1016/j.seizure.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/03/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
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Kaufmann E, Bartolomei F, Boon P, Chabardes S, Colon AJ, Eross L, Fabó D, Gonçalves-Ferreira A, Imbach LL, Van Paesschen W, Peltola J, Rego R, Theys T, Voges B. European Expert Opinion on ANT-DBS therapy for patients with drug-resistant epilepsy (a Delphi consensus). Seizure 2020; 81:201-209. [PMID: 32861153 DOI: 10.1016/j.seizure.2020.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Although deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) represents an established third-line therapy for patients with drug-resistant focal epilepsy, guiding reports on practical treatment principles remain scarce. METHODS An Expert Panel (EP) of 10 European neurologists and 4 neurosurgeons was assembled to share their experience with ANT-DBS therapy. The process included a review of the current literature, which served as a basis for an online survey completed by the EP prior to and following a face-to-face meeting (Delphi method). An agreement level of ≥71 % was considered as consensus. RESULTS Out of 86 reviewed studies, 46 (53 %) were selected to extract information on the most reported criteria for patient selection, management, and outcome. The Delphi process yielded EP consensus on 4 parameters for selection of good candidates and patient management as well as 7 reasons of concern for this therapy. Since it was not possible to give strict device programming advice due to low levels of evidence, the experts shared their clinical practice: all of them start with monopolar stimulation, 79 % using the cycling mode. Most (93 %) EP members set the initial stimulation frequency and pulse width according to the SANTE parameters, while there is more variability in the amplitudes used. Further agreement was achieved on a list of 7 patient outcome parameters to be monitored during the follow-up. CONCLUSIONS Although current evidence is too low for definite practical guidelines, this EP report could support the selection and management of patients with ANT-DBS.
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Affiliation(s)
- Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
| | - Fabrice Bartolomei
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France; APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Paul Boon
- Reference Center for Refractory Epilepsy, Ghent University Hospital Belgium - Academic Center for Epileptology, Heeze-Maastricht, the Netherlands
| | - Stéphan Chabardes
- Department of Neurosurgery-Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Department of Neurosurgery, Grenoble Alpes University Hospital, Grenoble, France; Grenoble Institute of Neurosciences GIN-INSERM U1216/CEA/UGA, Grenoble, France; Grenoble Alpes University, Grenoble, France
| | - Albert J Colon
- Academic Centre for Epileptology, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands; Academic Centre for Epileptology, Kempenhaeghe, Heeze, the Netherlands
| | - Loránd Eross
- Faculty of Information Technology and Bionics, Péter Pázmány Catholic University, Budapest, Hungary; Department of Functional Neurosurgery, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Antonio Gonçalves-Ferreira
- Department of Neurosurgery, University Hospital Santa Maria, Faculdade Medicina Lisboa, Lisbon, Portugal
| | - Lukas L Imbach
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wim Van Paesschen
- Department of Neurology, UZ Leuven, Leuven, Belgium; Laboratory for Epilepsy Research, KU Leuven, Leuven, Belgium
| | - Jukka Peltola
- Department of Neurology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Ricardo Rego
- Department of Neurophysiology, Hospital De São João, Porto, Portugal
| | - Tom Theys
- Laboratory for Experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Berthold Voges
- Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Germany
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28
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Rüegge D, Mahendran S, Stieglitz LH, Oertel MF, Gassert R, Lambercy O, Baumann CR, Imbach LL. Tremor analysis with wearable sensors correlates with outcome after thalamic deep brain stimulation. Clin Park Relat Disord 2020; 3:100066. [PMID: 34316646 PMCID: PMC8298798 DOI: 10.1016/j.prdoa.2020.100066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/12/2020] [Accepted: 08/02/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Thalamic deep brain stimulation (DBS) provides excellent tremor control in most patients with essential tremor (ET). However, not all tremor patients show clinically significant improvement after DBS surgery. Currently, there is no reliable clinical or instrument-based measure to predict how patients respond to DBS. Therefore, we set out to provide a method for tremor outcome prediction prior to surgery. METHODS We retrospectively analysed quantitative tremor data collected with inertial measurement units (IMU) in 13 patients who underwent DBS surgery in the ventral intermediate nucleus of the thalamus (VIM). All patients were diagnosed with either ET or ET-plus according to current diagnostic criteria of the movement disorder society. We used linear and logistic regression models to evaluate the influence of different tremor characteristics on tremor outcome. RESULTS We found that the ratio between the amplitude of the first overtone and the amplitude of the fundamental frequency, denoted as the Harmonic Index, has a significant influence on tremor reduction after DBS surgery. This measure shows a strong correlation with the post-operative improvement of tremor outcome based on the Whiget Tremor Rating Scale. CONCLUSION Based on these findings, we propose a novel approach to predict tremor outcome after DBS surgery. Quantitative tremor assessment adds to the preoperative prediction of DBS response and might therefore have a relevant clinical impact in the management of patients suffering from pharmacoresistant tremor.
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Affiliation(s)
- Dayle Rüegge
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Sujitha Mahendran
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lennart H. Stieglitz
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus F. Oertel
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lukas L. Imbach
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
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29
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Kirschenbaum D, Imbach LL, Ulrich S, Rushing EJ, Keller E, Reimann RR, Frauenknecht KBM, Lichtblau M, Witt M, Hummel T, Steiger P, Aguzzi A, Frontzek K. Inflammatory olfactory neuropathy in two patients with COVID-19. Lancet 2020; 396:166. [PMID: 32659210 PMCID: PMC7351381 DOI: 10.1016/s0140-6736(20)31525-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Daniel Kirschenbaum
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Lukas L Imbach
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Silvia Ulrich
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Elisabeth J Rushing
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Emanuela Keller
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Regina R Reimann
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland
| | | | - Mona Lichtblau
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Martin Witt
- Department of Anatomy and Centre of Transdisciplinary Neuroscience, University Medicine Rostock, Rostock, Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Peter Steiger
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland.
| | - Adriano Aguzzi
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland.
| | - Karl Frontzek
- University of Zurich, University Hospital of Zurich, 8091 Zurich, Switzerland.
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30
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Valko Y, Werth E, Imbach LL, Valko PO, Weber KP. The eyes wake up: Screening for benign paroxysmal positional vertigo with polysomnography. Clin Neurophysiol 2020; 131:616-624. [PMID: 31972505 DOI: 10.1016/j.clinph.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE While positional nystagmus of benign paroxysmal positional vertigo (BPPV) has been shown to be detectable in electrooculography (EOG) tracings of polysomnography (PSG), the frequency of undiagnosed BPPV in patients referred for sleep-wake examination has never been investigated. METHODS Prospective evaluation of positional nystagmus in 129 patients, referred to a neurological sleep laboratory for sleep-wake examination with PSG. Both in the evening and morning, patients had diagnostic positioning maneuvers under ongoing EOG-PSG registration, followed by visual inspection of EOG for positional nystagmus. RESULTS In 19 patients (14.7%), we found patterns of positional nystagmus, typically appearing few seconds after changes in head position. In 9 of these patients (47%), the nystagmus was also provoked by the positioning maneuvers. Nystagmus only occurred during wakefulness, not during sleep. In a patient with severe cupulolithiasis, we observed disappearance of nystagmus while entering N1 sleep stage. Nocturnal positional nystagmus was independently associated with positive positioning maneuvers. CONCLUSIONS Inspection of EOG-PSG demonstrated that positional nystagmus is common, occurring only when wake, and independently associated with positive positioning maneuvers. SIGNIFICANCE By routinely searching for positional nystagmus in PSG, sleep physicians may substantially contribute to the identification of patients with so-far undiagnosed BPPV.
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Affiliation(s)
- Yulia Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Sleep & Health Zurich, University Hospital Zurich, University of Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Sleep & Health Zurich, University Hospital Zurich, University of Zurich, Switzerland
| | - Konrad P Weber
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Switzerland
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31
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Imbach LL, Baumann CR, Poryazova R, Geissler O, Brugger P, Sarnthein J, Mothersill I, Weller M, Oertel MF, Stieglitz LH. Anticonvulsive effect of anterior thalamic deep brain stimulation in super-refractory status epilepticus crucially depends on active stimulation zone—A single case observation. Seizure 2019; 71:286-288. [DOI: 10.1016/j.seizure.2019.08.015] [Citation(s) in RCA: 8] [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: 06/13/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022] Open
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32
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Büchele F, Hackius M, Schreglmann SR, Omlor W, Werth E, Maric A, Imbach LL, Hägele-Link S, Waldvogel D, Baumann CR. Sodium Oxybate for Excessive Daytime Sleepiness and Sleep Disturbance in Parkinson Disease: A Randomized Clinical Trial. JAMA Neurol 2019; 75:114-118. [PMID: 29114733 DOI: 10.1001/jamaneurol.2017.3171] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Importance Sleep-wake disorders are a common and debilitating nonmotor manifestation of Parkinson disease (PD), but treatment options are scarce. Objective To determine whether nocturnal administration of sodium oxybate, a first-line treatment in narcolepsy, is effective and safe for excessive daytime sleepiness (EDS) and disturbed nighttime sleep in patients with PD. Design, Setting, and Participants Randomized, double-blind, placebo-controlled, crossover phase 2a study carried out between January 9, 2015, and February 24, 2017. In a single-center study in the sleep laboratory at the University Hospital Zurich, Zurich, Switzerland, 18 patients with PD and EDS (Epworth Sleepiness Scale [ESS] score >10) were screened in the sleep laboratory. Five patients were excluded owing to the polysomnographic diagnosis of sleep apnea and 1 patient withdrew consent. Thus, 12 patients were randomized to a treatment sequence (sodium oxybate followed by placebo or placebo followed by sodium oxybate, ratio 1:1) and, after dropout of 1 patient owing to an unrelated adverse event during the washout period, 11 patients completed the study. Two patients developed obstructive sleep apnea during sodium oxybate treatment (1 was the dropout) and were excluded from the per-protocol analysis (n = 10) but included in the intention-to-treat analysis (n = 12). Interventions Nocturnal sodium oxybate and placebo taken at bedtime and 2.5 to 4.0 hours later with an individually titrated dose between 3.0 and 9.0 g per night for 6 weeks with a 2- to 4-week washout period interposed. Main Outcomes and Measures Primary outcome measure was change of objective EDS as electrophysiologically measured by mean sleep latency in the Multiple Sleep Latency Test. Secondary outcome measures included change of subjective EDS (ESS), sleep quality (Parkinson Disease Sleep Scale-2), and objective variables of nighttime sleep (polysomnography). Results Among 12 patients in the intention-to-treat population (10 men, 2 women; mean [SD] age, 62 [11.1] years; disease duration, 8.4 [4.6] years), sodium oxybate substantially improved EDS as measured objectively (mean sleep latency, +2.9 minutes; 95% CI, 2.1 to 3.8 minutes; P = .002) and subjectively (ESS score, -4.2 points ; 95% CI, -5.3 to -3.0 points; P = .001). Thereby, 8 (67%) patients exhibited an electrophysiologically defined positive treatment response. Moreover, sodium oxybate significantly enhanced subjective sleep quality and objectively measured slow-wave sleep duration (+72.7 minutes; 95% CI, 55.7 to 89.7 minutes; P < .001). Differences were more pronounced in the per-protocol analysis. Sodium oxybate was generally well tolerated under dose adjustments (no treatment-related dropouts), but it induced de novo obstructive sleep apnea in 2 patients and parasomnia in 1 patient, as detected by polysomnography, all of whom did not benefit from sodium oxybate treatment. Conclusions and Relevance This study provides class I evidence for the efficacy of sodium oxybate in treating EDS and nocturnal sleep disturbance in patients with PD. Special monitoring with follow-up polysomnography is necessary to rule out treatment-related complications and larger follow-up trials with longer treatment durations are warranted for validation. Trial Registration clinicaltrials.gov Identifier: NCT02111122.
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Affiliation(s)
- Fabian Büchele
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Marc Hackius
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | | | - Wolfgang Omlor
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Stefan Hägele-Link
- Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Daniel Waldvogel
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
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Schreiner SJ, Imbach LL, Werth E, Poryazova R, Baumann‐Vogel H, Valko PO, Murer T, Noain D, Baumann CR. Slow‐wave sleep and motor progression in Parkinson disease. Ann Neurol 2019; 85:765-770. [DOI: 10.1002/ana.25459] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/02/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Lukas L. Imbach
- Department of NeurologyUniversity Hospital Zurich Zurich Switzerland
| | - Esther Werth
- Department of NeurologyUniversity Hospital Zurich Zurich Switzerland
| | - Rositsa Poryazova
- Department of NeurologyUniversity Hospital Zurich Zurich Switzerland
| | | | - Philipp O. Valko
- Department of NeurologyUniversity Hospital Zurich Zurich Switzerland
| | - Tobias Murer
- Department of NeurologyUniversity Hospital Zurich Zurich Switzerland
| | - Daniela Noain
- Department of NeurologyUniversity Hospital Zurich Zurich Switzerland
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Akeret K, Serra C, Rafi O, Staartjes VE, Fierstra J, Bellut D, Maldaner N, Imbach LL, Wolpert F, Poryazova R, Regli L, Krayenbühl N. Anatomical features of primary brain tumors affect seizure risk and semiology. Neuroimage Clin 2019; 22:101688. [PMID: 30710869 PMCID: PMC6354289 DOI: 10.1016/j.nicl.2019.101688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 11/23/2022]
Abstract
Objective An epileptic seizure is the most common clinical manifestation of a primary brain tumor. Due to modern neuroimaging, detailed anatomical information on a brain tumor is available early in the diagnostic process and therefore carries considerable potential in clinical decision making. The goal of this study was to gain a better understanding of the relevance of anatomical tumor characteristics on seizure prevalence and semiology. Methods We reviewed prospectively collected clinical and imaging data of all patients operated on a supratentorial intraparenchymal primary brain tumor at our department between January 2009 and December 2016. The effect of tumor histology, anatomical location and white matter infiltration on seizure prevalence and semiology were assessed using uni- and multivariate analyses. Results Of 678 included patients, 311 (45.9%) presented with epileptic seizures. Tumor location within the central lobe was associated with higher seizure prevalence (OR 4.67, 95% CI: 1.90–13.3, p = .002), especially within the precentral gyrus or paracentral lobule (100%). Bilateral extension, location within subcortical structures and invasion of deeper white matter sectors were associated with a lower risk (OR 0.45, 95% CI: 0.25–0.78; OR 0.10, 95% CI: 0.04–0.21 and OR 0.39, 95% CI: 0.14–0.96, respectively). Multivariate analysis revealed the impact of a location within the central lobe on seizure risk to be highly significant and more relevant than histopathology (OR: 4.79, 95% CI: 1.82–14.52, p = .003). Seizures due to tumors within the central lobe differed from those of other locations by lower risk of secondary generalization (p < .001). Conclusions Topographical lobar and gyral location, as well as extent of white matter infiltration impact seizure risk and semiology. This finding may have a high therapeutic potential, for example regarding the use of prophylactic antiepileptic therapy. Brain tumor location affects seizure prevalence and semiology. Central lobe location is the strongest independent pro-epileptogenic factor. The precentral gyrus and paracentral lobule are most epileptogenic. Central lobe tumors rarely cause bilateral tonic-clonic seizures. Tumor location and white matter infiltration may guide antiepileptic therapy.
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Affiliation(s)
- Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Omar Rafi
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Victor E Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Bellut
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Wolpert
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Division of Epileptology, Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Division of Pediatric Neurosurgery, University Children's Hospital, Zurich, Switzerland
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Tarnutzer AA, Mothersill I, Imbach LL. Ictal nausea and vomiting - Is it left or right? Seizure 2018; 61:83-88. [PMID: 30118929 DOI: 10.1016/j.seizure.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Ictal nausea/vomiting has been linked to the non-dominant hemisphere and has been considered a lateralizing sign. However, small case series and single cases have reported seizure localisation in the dominant hemisphere. Here we aimed to determine the seizure localisation and lateralization in cases with ictal nausea/retching/vomiting to test the hypothesis that these signs are of lateralizing value. METHODS We searched two large tertiary epilepsy-center video-EEG databases (period: 1980-2017) for reports on ictal nausea/retching/vomiting and retrieved ictal EEG seizure location, lateralization and clinical symptoms. RESULTS We identified 13 patients with focal epilepsy and video-EEG-documented ictal nausea (n = 2), nausea and retching (n = 3), retching followed by vomiting (n = 5) or only vomiting (n = 3). Aetiology was genetic (n = 1), structural/metabolic (n = 7) or of unclear origin (n = 5). While in 12/13 patients epileptic discharges were temporal, a single case was parietal. A left-sided seizure origin was more frequent than a right-sided origin (62 vs. 38%). Assuming a left-sided language dominance in the single left-handed patient and in those two patients with unclear handedness (based on the known distribution of hemispheric speech-dominance), the distribution of ictal nausea/retching/vomiting to the dominant vs. non-dominant hemisphere was not significantly different from a random distribution (8 vs. 5, p = 0.581). CONCLUSION Ictal nausea/retching/vomiting are most frequently of temporal origin. In contrast to previous studies, our ictal video-EEG data suggests that these signs have no lateralizing value. Thus, video-EEG should be performed and while this clinical sign points to a temporal seizure origin, it does not determine its lateralization.
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Affiliation(s)
- Alexander A Tarnutzer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
| | - Ian Mothersill
- Swiss Epilepsy Center, Clinic Lengg, Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
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Bichsel O, Gassert R, Stieglitz L, Uhl M, Baumann-Vogel H, Waldvogel D, Baumann CR, Imbach LL. Functionally separated networks for self-paced and externally-cued motor execution in Parkinson's disease: Evidence from deep brain recordings in humans. Neuroimage 2018; 177:20-29. [PMID: 29738912 DOI: 10.1016/j.neuroimage.2018.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/12/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022] Open
Abstract
Spatially segregated cortico-basal ganglia networks have been proposed for the control of goal-directed and habitual behavior. In Parkinson's disease, selective loss of dopaminergic neurons regulating sensorimotor (habitual) behavior might therefore predominantly cause deficits in habitual motor control, whereas control of goal-directed movement is relatively preserved. Following this hypothesis, we examined the electrophysiology of cortico-basal ganglia networks in Parkinson patients emulating habitual and goal-directed motor control during self-paced and externally-cued finger tapping, respectively, while simultaneously recording local field potentials in the subthalamic nucleus (STN) and surface EEG. Only externally-cued movements induced a pro-kinetic event-related beta-desynchronization, whereas beta-oscillations were continuously suppressed during self-paced movements. Connectivity analysis revealed higher synchronicity (phase-locking value) between the STN and central electrodes during self-paced and higher STN to frontal phase-locking during externally-cued movements. Our data provide direct electrophysiological support for the existence of functionally segregated cortico-basal ganglia networks controlling motor behavior in Parkinson patients, and corroborate the assumption of Parkinson patients being shifted from habitual towards goal-directed behavior.
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Affiliation(s)
- Oliver Bichsel
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Lennart Stieglitz
- Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniel Waldvogel
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland.
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Noain D, Büchele F, Schreglmann SR, Valko PO, Gavrilov YV, Morawska MM, Imbach LL, Baumann CR. Increased Sleep Need and Reduction of Tuberomammillary Histamine Neurons after Rodent Traumatic Brain Injury. J Neurotrauma 2018; 35:85-93. [DOI: 10.1089/neu.2017.5067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Daniela Noain
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Büchele
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian R. Schreglmann
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp O. Valko
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Yuri V. Gavrilov
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Marta M. Morawska
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L. Imbach
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Murer T, Imbach LL, Hackius M, Taddei RN, Werth E, Poryazova R, Gavrilov YV, Winkler S, Waldvogel D, Baumann CR, Valko PO. Optimizing MSLT Specificity in Narcolepsy With Cataplexy. Sleep 2017; 40:4561656. [DOI: 10.1093/sleep/zsx173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Schoch SF, Werth E, Poryazova R, Scammell TE, Baumann CR, Imbach LL. Dysregulation of Sleep Behavioral States in Narcolepsy. Sleep 2017; 40:4344838. [DOI: 10.1093/sleep/zsx170] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Efthymiou E, Renzel R, Baumann CR, Poryazova R, Imbach LL. Predictive value of EEG in postanoxic encephalopathy: A quantitative model-based approach. Resuscitation 2017; 119:27-32. [PMID: 28750884 DOI: 10.1016/j.resuscitation.2017.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The majority of comatose patients after cardiac arrest do not regain consciousness due to severe postanoxic encephalopathy. Early and accurate outcome prediction is therefore essential in determining further therapeutic interventions. The electroencephalogram is a standardized and commonly available tool used to estimate prognosis in postanoxic patients. The identification of pathological EEG patterns with poor prognosis relies however primarily on visual EEG scoring by experts. We introduced a model-based approach of EEG analysis (state space model) that allows for an objective and quantitative description of spectral EEG variability. METHODS We retrospectively analyzed standard EEG recordings in 83 comatose patients after cardiac arrest between 2005 and 2013 in the intensive care unit of the University Hospital Zürich. Neurological outcome was assessed one month after cardiac arrest using the Cerebral Performance Category. For a dynamic and quantitative EEG analysis, we implemented a model-based approach (state space analysis) to quantify EEG background variability independent from visual scoring of EEG epochs. Spectral variability was compared between groups and correlated with clinical outcome parameters and visual EEG patterns. RESULTS Quantitative assessment of spectral EEG variability (state space velocity) revealed significant differences between patients with poor and good outcome after cardiac arrest: Lower mean velocity in temporal electrodes (T4 and T5) was significantly associated with poor prognostic outcome (p<0.005) and correlated with independently identified visual EEG patterns such as generalized periodic discharges (p<0.02). Receiver operating characteristic (ROC) analysis confirmed the predictive value of lower state space velocity for poor clinical outcome after cardiac arrest (AUC 80.8, 70% sensitivity, 15% false positive rate). CONCLUSION Model-based quantitative EEG analysis (state space analysis) provides a novel, complementary marker for prognosis in postanoxic encephalopathy.
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Affiliation(s)
- Evdokia Efthymiou
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Roland Renzel
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
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Morawska MM, Moreira CG, Imbach LL, Burgi L, Valko P, Baumann A, Masneuf S, Schreglmann SR, Baumann CR, Noain D. 0276 SLEEP ENHANCEMENT ASSOCIATED WITH REDUCED ALPHA-SYNUCLEIN ACCUMULATION IN THE BRAIN CORTEX OF VESICULAR MONOAMINE TRANSPORTER 2 DEFICIENT MICE SUFFERING FROM INCREASED AROUSAL. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.275] [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: 11/14/2022] Open
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Baumann-Vogel H, Imbach LL, Sürücü O, Stieglitz L, Waldvogel D, Baumann CR, Werth E. The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients. Sleep 2017; 40:3079010. [DOI: 10.1093/sleep/zsx033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 11/12/2022] Open
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Imbach LL, Büchele F, Valko PO, Li T, Maric A, Stover JF, Bassetti CL, Mica L, Werth E, Baumann CR. Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized. Neurology 2016; 86:1945-9. [PMID: 27164676 DOI: 10.1212/wnl.0000000000002697] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study is a prospective, controlled clinical and electrophysiologic trial examining the chronic course of posttraumatic sleep-wake disturbances (SWD). METHODS We screened 140 patients with acute, first-ever traumatic brain injury of any severity and included 60 patients for prospective follow-up examinations. Patients with prior brain trauma, other neurologic or systemic disease, drug abuse, or psychiatric comorbidities were excluded. Eighteen months after trauma, we performed detailed sleep assessment in 31 participants. As a control group, we enrolled healthy individuals without prior brain trauma matched for age, sex, and sleep satiation. RESULTS In the chronic state after traumatic brain injury, sleep need per 24 hours was persistently increased in trauma patients (8.1 ± 0.5 hours) as compared to healthy controls (7.1 ± 0.7 hours). The prevalence of chronic objective excessive daytime sleepiness was 67% in patients with brain trauma compared to 19% in controls. Patients significantly underestimated excessive daytime sleepiness and sleep need, emphasizing the unreliability of self-assessments on SWD in trauma patients. CONCLUSIONS This study provides prospective, controlled, and objective evidence for chronic persistence of posttraumatic SWD, which remain underestimated by patients. These results have clinical and medicolegal implications given that SWD can exacerbate other outcomes of traumatic brain injury, impair quality of life, and are associated with public safety hazards.
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Affiliation(s)
- Lukas L Imbach
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland.
| | - Fabian Büchele
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - Philipp O Valko
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - Tongzhou Li
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - Angelina Maric
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - John F Stover
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - Claudio L Bassetti
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - Ladislav Mica
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - Esther Werth
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
| | - Christian R Baumann
- From the Departments of Neurology (L.L.I., F.B., P.O.V., T.L., A.M., E.W., C.R.B.) and Traumatology (J.F.S., L.M.), University Hospital Zurich; and Department of Neurology (C.L.B.), Inselspital Bern, Switzerland
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Imbach LL, Baumann-Vogel H, Baumann CR, Sürücü O, Hermsdörfer J, Sarnthein J. Adaptive grip force is modulated by subthalamic beta activity in Parkinson's disease patients. Neuroimage Clin 2015; 9:450-7. [PMID: 26594627 PMCID: PMC4596927 DOI: 10.1016/j.nicl.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/07/2015] [Accepted: 09/11/2015] [Indexed: 01/04/2023]
Abstract
Introduction Healthy subjects scale grip force to match the load defined by physical object properties such as weight, or dynamic properties such as inertia. Patients with Parkinson's disease (PD) show an elevated grip force in dynamic object handling, but temporal aspects of anticipatory grip force control are relatively preserved. In PD patients, beta frequency oscillatory activity in the basal ganglia is suppressed prior to externally paced movements. However, the role of the subthalamic nucleus (STN) in anticipatory grip force control is not known. Methods After implantation of deep brain stimulation (DBS) electrodes in the STN, PD patients performed adaptive and voluntary grip force tasks, while we recorded subthalamic local field potentials (LFP) and scalp EEG. Results During adaptive grip force control (Shake), we found event related desynchronization (ERD) in the beta frequency band, which was time-locked to the grip force. In contrast, during voluntary grip force control (Press) we recorded a biphasic ERD, corresponding to peak grip force and grip force release. Beta synchronization between STN and cortical EEG was reduced during adaptive grip force control. Conclusion The time-locked suppression of beta oscillatory activity in the STN is in line with previous reports of beta ERD prior to voluntary movements. Our results show that the STN is involved in anticipatory grip force control in PD patients. The difference in the phasic beta ERD between the two tasks and the reduction of cortico-subthalamic synchronization suggests that qualitatively different neuronal network states are involved in different grip force control tasks. Subthalamic nucleus is involved in anticipatory grip force control in PD patients. Subthalamic beta activity is the first derivative of grip force in a shaking task. Synchronization between STN and cortex is reduced during the shaking task.
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Affiliation(s)
- Lukas L Imbach
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland ; University of Zurich, Zurich, Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland ; University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland ; Neuroscience Center, University of Zurich and ETH Zurich, Zurich, Switzerland ; University of Zurich, Zurich, Switzerland
| | - Oguzkan Sürücü
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland ; University of Zurich, Zurich, Switzerland
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Georg-Brauchle-Ring 60/62, Technische Universität München, München D-80992, Germany
| | - Johannes Sarnthein
- Neuroscience Center, University of Zurich and ETH Zurich, Zurich, Switzerland ; Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland ; University of Zurich, Zurich, Switzerland
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Sommerauer M, Imbach LL, Jarallah M, Baumann CR, Valko PO. Diminished event-related cortical arousals and altered heart rate response in Parkinson's disease. Mov Disord 2015; 30:866-70. [DOI: 10.1002/mds.26165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 01/12/2015] [Accepted: 01/18/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michael Sommerauer
- Department of Neurology; University Hospital Zurich; Frauenklinikstrasse Zurich Switzerland
| | - Lukas L. Imbach
- Department of Neurology; University Hospital Zurich; Frauenklinikstrasse Zurich Switzerland
| | - Mohan Jarallah
- Department of Neurology; University Hospital Zurich; Frauenklinikstrasse Zurich Switzerland
| | - Christian R. Baumann
- Department of Neurology; University Hospital Zurich; Frauenklinikstrasse Zurich Switzerland
| | - Philipp O. Valko
- Department of Neurology; University Hospital Zurich; Frauenklinikstrasse Zurich Switzerland
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Imbach LL, Valko PO, Li T, Maric A, Symeonidou ER, Stover JF, Bassetti CL, Mica L, Werth E, Baumann CR. Increased sleep need and daytime sleepiness 6 months after traumatic brain injury: a prospective controlled clinical trial. Brain 2015; 138:726-35. [PMID: 25595147 PMCID: PMC4408434 DOI: 10.1093/brain/awu391] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/27/2014] [Accepted: 11/16/2014] [Indexed: 11/14/2022] Open
Abstract
Post-traumatic sleep-wake disturbances are common after acute traumatic brain injury. Increased sleep need per 24 h and excessive daytime sleepiness are among the most prevalent post-traumatic sleep disorders and impair quality of life of trauma patients. Nevertheless, the relation between traumatic brain injury and sleep outcome, but also the link between post-traumatic sleep problems and clinical measures in the acute phase after traumatic brain injury has so far not been addressed in a controlled and prospective approach. We therefore performed a prospective controlled clinical study to examine (i) sleep-wake outcome after traumatic brain injury; and (ii) to screen for clinical and laboratory predictors of poor sleep-wake outcome after acute traumatic brain injury. Forty-two of 60 included patients with first-ever traumatic brain injury were available for follow-up examinations. Six months after trauma, the average sleep need per 24 h as assessed by actigraphy was markedly increased in patients as compared to controls (8.3 ± 1.1 h versus 7.1 ± 0.8 h, P < 0.0001). Objective daytime sleepiness was found in 57% of trauma patients and 19% of healthy subjects, and the average sleep latency in patients was reduced to 8.7 ± 4.6 min (12.1 ± 4.7 min in controls, P = 0.0009). Patients, but not controls, markedly underestimated both excessive sleep need and excessive daytime sleepiness when assessed only by subjective means, emphasizing the unreliability of self-assessment of increased sleep propensity in traumatic brain injury patients. At polysomnography, slow wave sleep after traumatic brain injury was more consolidated. The most important risk factor for developing increased sleep need after traumatic brain injury was the presence of an intracranial haemorrhage. In conclusion, we provide controlled and objective evidence for a direct relation between sleep-wake disturbances and traumatic brain injury, and for clinically significant underestimation of post-traumatic sleep-wake disturbances by trauma patients.
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Affiliation(s)
- Lukas L Imbach
- 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Philipp O Valko
- 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Tongzhou Li
- 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Angelina Maric
- 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - John F Stover
- 2 Department of Traumatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Ladislav Mica
- 2 Department of Traumatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Esther Werth
- 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christian R Baumann
- 1 Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
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Imbach LL, Sommerauer M, Leuenberger K, Schreglmann SR, Maier O, Uhl M, Gassert R, Baumann CR. Dopamine-responsive pattern in tremor patients. Parkinsonism Relat Disord 2014; 20:1283-6. [PMID: 25260965 DOI: 10.1016/j.parkreldis.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/14/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Diagnosis and treatment of tremor are largely based on clinical assessment. Whereas in some patients tremor may respond to dopaminergic treatment, in general l-Dopa response to tremor varies considerably. The aim of this study was to predict l-Dopa response by accelerometry. METHODS We included 60 tremor patients and measured harmonic oscillations by accelerometry. In addition to neurological assessment, we performed l-Dopa challenge tests and the individual tremor response was compared to the amount of harmonic oscillations. RESULTS We found a strong correlation between harmonic oscillations and clinical l-Dopa response. Similarly, harmonic oscillations were significantly greater in patients with subjective tremor reduction upon l-Dopa administration. CONCLUSIONS We conclude that harmonic oscillations are a measure for l-Dopa response to tremor irrespective of the underlying disease. Because of the observational character of the study, any causal relation remains speculative. Nevertheless, we propose a novel, non-invasive approach to predict l-Dopa response in tremor patients.
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Affiliation(s)
- Lukas L Imbach
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.
| | - Michael Sommerauer
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Kaspar Leuenberger
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, CH-8092, Switzerland
| | - Sebastian R Schreglmann
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Oliver Maier
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, CH-8092, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
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Sürücü O, Baumann-Vogel H, Uhl M, Imbach LL, Baumann CR. Subthalamic deep brain stimulation versus best medical therapy for L-dopa responsive pain in Parkinson's disease. Pain 2013; 154:1477-9. [PMID: 23632230 DOI: 10.1016/j.pain.2013.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 01/03/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
Pain is a frequently observed non-motor symptom of patients with Parkinson's disease. In some patients, Parkinson's-related pain responds to dopaminergic treatment. In the present study, we aimed to elucidate whether subthalamic deep brain stimulation has a similar beneficial effect on pain in Parkinson's disease, and whether this effect can be predicted by a pre-operative l-dopa challenge test assessing pain severity. We prospectively analyzed 14 consecutive Parkinson's patients with severe pain who underwent subthalamic deep brain stimulation. In 8 of these patients, pain severity decreased markedly with high doses of l-dopa, irrespective of the type and localization of the pain symptoms. In these patients, subthalamic deep brain stimulation provided an even higher reduction of pain severity than did dopaminergic treatment, and the majority of this group was pain-free after surgery. This effect lasted for up to 41 months. In the remaining 6 patients, pain was not improved by dopaminergic treatment nor by deep brain stimulation. Thus, we conclude that pain relief following subthalamic deep brain stimulation is superior to that following dopaminergic treatment, and that the response of pain symptoms to deep brain stimulation can be predicted by l-dopa challenge tests assessing pain severity. This diagnostic procedure could contribute to the decision on whether or not a Parkinson's patient with severe pain should undergo deep brain stimulation for potential pain relief.
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Affiliation(s)
- Oguzkan Sürücü
- Department of Neurosurgery, University Hospital Zurich, Switzerland
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Abstract
Sleep is generally categorized into discrete stages based on characteristic electroencephalogram (EEG) patterns. This traditional approach represents sleep architecture in a static way, but it cannot reflect variations in sleep across time and across the cortex. To investigate these dynamic aspects of sleep, we analyzed sleep recordings in 14 healthy volunteers with a novel, frequency-based EEG analysis. This approach enabled comparison of sleep patterns with low inter-individual variability. We then implemented a new probability dependent, automatic classification of sleep states that agreed closely with conventional manual scoring during consolidated sleep. Furthermore, this analysis revealed a previously unrecognized, interhemispheric oscillation during rapid eye movement (REM) sleep. This quantitative approach provides a new way of examining the dynamic aspects of sleep, shedding new light on the physiology of human sleep.
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Affiliation(s)
- Lukas L Imbach
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
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Baumann CR, Imbach LL, Baumann-Vogel H, Uhl M, Sarnthein J, Sürücü O. Interleaving deep brain stimulation for a patient with both Parkinson's disease and essential tremor. Mov Disord 2012; 27:1700-1. [DOI: 10.1002/mds.25221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 08/10/2012] [Accepted: 08/30/2012] [Indexed: 11/09/2022] Open
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