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Jeon S, Kim I, Na YR, Yong Hong K, Chang H, Kim SH, Jeong YJ, Chung JH, Kim SW. Multiple Injections of Adipose-Derived Stem Cells Improve Graft Survival in Human-to-Rat Skin Xenotransplantation through Immune Modulation. Tissue Eng Regen Med 2023; 20:905-919. [PMID: 37531072 PMCID: PMC10519904 DOI: 10.1007/s13770-023-00552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Adipose-derived stem cells (ADSCs) exert immunomodulatory effects in the treatment of transplant rejection. This study aimed to evaluate the effects of ADSCs on the skin graft survival in a human-to-rat xenograft transplantation model and to compare single and multiple injections of ADSCs. METHODS Full-thickness human skin xenografts were transplanted into the backs of Sprague-Dawley rats. The rats were injected subcutaneously on postoperative days 0, 3, and 5. The injections were as follows: triple injections of phosphate-buffered saline (PBS group), a single injection of ADSCs and double injections of PBS (ADSC × 1 group), and triple injections of ADSCs (ADSC × 3 group). The immunomodulatory effects of ADSCs on human skin xenografts were assessed. RESULTS Triple injections of ADSCs considerably delayed cell-mediated xenograft rejection compared with the PBS and ADSC × 1 groups. The vascularization and collagen type 1-3 ratios in the ADSC × 3 group were significantly higher than those in the other groups. In addition, intragraft infiltration of CD3-, CD4-, CD8-, and CD68-positive cells was reduced in the ADSC × 3 group. Furthermore, in the ADSC × 3 group, the expression levels of proinflammatory cytokine interferon-gamma (IFN-γ) were decreased and immunosuppressive prostaglandin E synthase (PGES) was increased in the xenograft and lymph node samples. CONCLUSION This study presented that triple injections of ADSCs appeared to be superior to a single injection in suppressing cell-mediated xenograft rejection. The immunomodulatory effects of ADSCs are associated with the downregulation of IFN-γ and upregulation of PGES in skin xenografts and lymph nodes.
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Affiliation(s)
- Sungmi Jeon
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Iljin Kim
- Department of Pharmacology and Program in Biomedical Science and Engineering, Inha University, Incheon, 22212, Republic of Korea
| | - Yi Rang Na
- Department of Microbiology and Immunology, and Institute of Endemic Disease, Seoul National University Medical College, Seoul, Republic of Korea
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyeok Chung
- Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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2
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Leitner DF, Devore S, Laze J, Friedman D, Mills JD, Liu Y, Janitz M, Anink JJ, Baayen JC, Idema S, van Vliet EA, Diehl B, Scott C, Thijs R, Nei M, Askenazi M, Sivathamboo S, O’Brien T, Wisniewski T, Thom M, Aronica E, Boldrini M, Devinsky O. Serotonin receptor expression in hippocampus and temporal cortex of temporal lobe epilepsy patients by postictal generalized electroencephalographic suppression duration. Epilepsia 2022; 63:2925-2936. [PMID: 36053862 PMCID: PMC9669210 DOI: 10.1111/epi.17400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prolonged postictal generalized electroencephalographic suppression (PGES) is a potential biomarker for sudden unexpected death in epilepsy (SUDEP), which may be associated with dysfunctional autonomic responses and serotonin signaling. To better understand molecular mechanisms, PGES duration was correlated to 5HT1A and 5HT2A receptor protein expression and RNAseq from resected hippocampus and temporal cortex of temporal lobe epilepsy patients with seizures recorded in preoperative evaluation. METHODS Analyses included 36 cases (age = 14-64 years, age at epilepsy onset = 0-51 years, epilepsy duration = 2-53 years, PGES duration = 0-93 s), with 13 cases in all hippocampal analyses. 5HT1A and 5HT2A protein was evaluated by Western blot and histologically in hippocampus (n = 16) and temporal cortex (n = 9). We correlated PGES duration to our previous RNAseq dataset for serotonin receptor expression and signaling pathways, as well as weighted gene correlation network analysis (WGCNA) to identify correlated gene clusters. RESULTS In hippocampus, 5HT2A protein by Western blot positively correlated with PGES duration (p = .0024, R2 = .52), but 5HT1A did not (p = .87, R2 = .0020). In temporal cortex, 5HT1A and 5HT2A had lower expression and did not correlate with PGES duration. Histologically, PGES duration did not correlate with 5HT1A or 5HT2A expression in hippocampal CA4, dentate gyrus, or temporal cortex. RNAseq identified two serotonin receptors with expression that correlated with PGES duration in an exploratory analysis: HTR3B negatively correlated (p = .043, R2 = .26) and HTR4 positively correlated (p = .049, R2 = .25). WGCNA identified four modules correlated with PGES duration, including positive correlation with synaptic transcripts (p = .040, Pearson correlation r = .52), particularly potassium channels (KCNA4, KCNC4, KCNH1, KCNIP4, KCNJ3, KCNJ6, KCNK1). No modules were associated with serotonin receptor signaling. SIGNIFICANCE Higher hippocampal 5HT2A receptor protein and potassium channel transcripts may reflect underlying mechanisms contributing to or resulting from prolonged PGES. Future studies with larger cohorts should assess functional analyses and additional brain regions to elucidate mechanisms underlying PGES and SUDEP risk.
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Affiliation(s)
- Dominique F. Leitner
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sasha Devore
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Juliana Laze
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Friedman
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - James D. Mills
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Yan Liu
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Michael Janitz
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasper J. Anink
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Johannes C. Baayen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Sander Idema
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Erwin A. van Vliet
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Catherine Scott
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Roland Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Maromi Nei
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Manor Askenazi
- Biomedical Hosting LLC, Arlington, MA, USA
- Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY, USA
| | - Shobi Sivathamboo
- Department of Neuroscience, Alfred Health, Central Clinical School, Melbourne, Victoria, Australia
- Department Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Terence O’Brien
- Department of Neuroscience, Alfred Health, Central Clinical School, Melbourne, Victoria, Australia
- Department Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Thomas Wisniewski
- Center for Cognitive Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Eleonora Aronica
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Maura Boldrini
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
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Xu Y, Liu Y, Li K, Miao S, Lv C, Wang C, Zhao J. Regulation of PGE 2 Pathway During Cerebral Ischemia Reperfusion Injury in Rat. Cell Mol Neurobiol 2021; 41:1483-1496. [PMID: 32621176 DOI: 10.1007/s10571-020-00911-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/22/2020] [Indexed: 01/14/2023]
Abstract
Stroke is an acute central nervous system disease with high morbidity and mortality rate. Cerebral ischemia reperfusion (I/R) injury is easily induced during the development or treatment of stroke and subsequently leads to more serious brain damage. Prostaglandin E2 (PGE2) is one of the most important inflammatory mediators in the brain and contributes to both physiological and pathophysiological functions. It may be upregulated and subsequently plays a key role in cerebral ischemia reperfusion injury. The synthesis and degradation of PGE2 is an extremely complex process, with multiple key stages and molecules. However, there are few comprehensive and systematic studies conducted to investigate the synthesis and degradation of PGE2 during cerebral I/R injury, which is what we want to demonstrate. In this study, qRT-PCR and immunoblotting demonstrated that the key enzymes in PGE2 synthesis, including COX-1, COX-2, mPGES-1 and mPGES-2, were upregulated during cerebral I/R injury, but 15-PGDH, the main PGE2 degradation enzyme, was downregulated. In addition, two of PGE2 receptors, EP3 and EP4, were also increased. Meanwhile, immunohistochemistry demonstrated the localization of these molecules in ischemic areas, including cortex, striatum and hippocampus, and reflected their expression patterns in different regions. Combining the results of PCR, Western blotting and immunohistochemistry, we can determine where the increase or decrease of these molecules occurs. Overall, these results further indicate a possible pathway that mediates enhanced production of PGE2, and thus that may impact production of inflammatory cytokines including IL-1β and TNF-α during cerebral I/R injury.
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Affiliation(s)
- Yunfei Xu
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, 410008, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Changsha, 410008, Hunan, China
| | - Ying Liu
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, 410008, Hunan, China.
- Sepsis Translational Medicine Key Lab of Hunan Province, Changsha, 410008, Hunan, China.
| | - Kexin Li
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, 410008, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Changsha, 410008, Hunan, China
| | - Shuying Miao
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Caihong Lv
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, 410008, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Changsha, 410008, Hunan, China
| | - Chunjiang Wang
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, 410008, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Changsha, 410008, Hunan, China
| | - Jie Zhao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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El Atrache R, Tamilia E, Amengual-Gual M, Mohammadpour Touserkani F, Yang Y, Wang X, Ufongene C, Sheehan T, Cantley S, Jackson M, Zhang B, Papadelis C, Sarkis RA, Loddenkemper T. Association between semiologic, autonomic, and electrographic seizure characteristics in children with generalized tonic-clonic seizures. Epilepsy Behav 2021; 122:108228. [PMID: 34388667 DOI: 10.1016/j.yebeh.2021.108228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Generalized tonic-clonic seizures (GTCS) are associated with elevated electrodermal activity (EDA) and postictal generalized electroencephalographic suppression (PGES), markers that may indicate sudden unexpected death in epilepsy (SUDEP) risk. This study investigated the association of GTCS semiology, EDA, and PGES in children with epilepsy. METHODS Patients admitted to the Boston Children's Hospital long-term video-EEG monitoring unit wore a sensor that records EDA. We selected patients with at least one GTCS and reviewed video-EEGs for semiology, tonic and clonic phase duration, total clinical seizure duration, electrographic onset, offset, and PGES. We grouped patients into three semiology classes: GTCS 1: bilateral symmetric tonic arm extension, GTCS 2: no specific tonic arm extension or flexion, GTCS 3: unilateral or asymmetrical arm extension, tonic arm flexion or posturing that does not fit into GTCS 1 or 2. We analyzed the correlation between semiology, EDA, and PGES, and measured the area under the curve (AUC) of the ictal EDA (seizure onset to one hour after), subtracting baseline EDA (one-hour seizure-free before seizure onset). Using generalized estimating equation (GEE) and linear regression, we analyzed all seizures and single episodes per patient. RESULTS We included 30 patients (median age 13.8 ± 3.6 years, 46.7% females) and 53 seizures. With GEE, GTCS 1 was associated with longer PGES duration compared to GTCS 2 (Estimate (β) = -26.32 s, 95% Confidence Interval (CI): -36.46 to -16.18, p < 0.001), and the presence of PGES was associated with greater EDA change (β = 429604 μS, 95% CI: 3550.96 to 855657.04, p = 0.048). With single-episode analysis, GTCS 1 had greater EDA change than GTCS 2 ((β = -601339 μS, 95% CI: -1167016.56 to -35661.44, p = 0.047). EDA increased with PGES presence (β = 637500 μS, 95% CI: 183571.84 to 1091428.16, p = 0.01) and duration (β = 16794 μS, 95% CI: 5729.8 to 27858.2, p = 0.006). Patients with GTCS 1 had longer PGES duration compared to GTCS 2 (β = -30.53 s, 95% CI: -44.6 to -16.46, p < 0.001) and GTCS 3 (β = -22.07 s, 95% CI: -38.95 to -5.19, p = 0.016). CONCLUSION In children with epilepsy, PGES correlates with greater ictal EDA. GTCS 1 correlated with longer PGES duration and may indirectly correlate with greater ictal EDA. Our study suggests potential applications in monitoring and preventing SUDEP in these patients.
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Affiliation(s)
- Rima El Atrache
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Eleonora Tamilia
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Marta Amengual-Gual
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fatemeh Mohammadpour Touserkani
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Yonghua Yang
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaofan Wang
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Claire Ufongene
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore Sheehan
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Cantley
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michele Jackson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christos Papadelis
- Laboratory of Children's Brain Dynamics, Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rani A Sarkis
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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5
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Zhao X, Vilella L, Zhu L, Rani MRS, Hampson JP, Hampson J, Hupp NJ, Sainju RK, Friedman D, Nei M, Scott C, Allen L, Gehlbach BK, Schuele S, Harper RM, Diehl B, Bateman LM, Devinsky O, Richerson GB, Zhang GQ, Lhatoo SD, Lacuey N. Automated Analysis of Risk Factors for Postictal Generalized EEG Suppression. Front Neurol 2021; 12:669517. [PMID: 34046007 PMCID: PMC8148040 DOI: 10.3389/fneur.2021.669517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Rationale: Currently, there is some ambiguity over the role of postictal generalized electro-encephalographic suppression (PGES) as a biomarker in sudden unexpected death in epilepsy (SUDEP). Visual analysis of PGES, known to be subjective, may account for this. In this study, we set out to perform an analysis of PGES presence and duration using a validated signal processing tool, specifically to examine the association between PGES and seizure features previously reported to be associated with visually analyzed PGES. Methods: This is a prospective, multicenter epilepsy monitoring study of autonomic and breathing biomarkers of SUDEP in adult patients with intractable epilepsy. We studied videoelectroencephalogram (vEEG) recordings of generalized convulsive seizures (GCS) in a cohort of patients in whom respiratory and vEEG recording were carried out during the evaluation in the epilepsy monitoring unit. A validated automated EEG suppression detection tool was used to determine presence and duration of PGES. Results: We studied 148 GCS in 87 patients. PGES occurred in 106/148 (71.6%) seizures in 70/87 (80.5%) of patients. PGES mean duration was 38.7 ± 23.7 (37; 1–169) seconds. Presence of tonic phase during GCS, including decerebration, decortication and hemi-decerebration, were 8.29 (CI 2.6–26.39, p = 0.0003), 7.17 (CI 1.29–39.76, p = 0.02), and 4.77 (CI 1.25–18.20, p = 0.02) times more likely to have PGES, respectively. In addition, presence of decerebration (p = 0.004) and decortication (p = 0.02), older age (p = 0.009), and hypoxemia duration (p = 0.03) were associated with longer PGES durations. Conclusions: In this study, we confirmed observations made with visual analysis, that presence of tonic phase during GCS, longer hypoxemia, and older age are reliably associated with PGES. We found that of the different types of tonic phase posturing, decerebration has the strongest association with PGES, followed by decortication, followed by hemi-decerebration. This suggests that these factors are likely indicative of seizure severity and may or may not be associated with SUDEP. An automated signal processing tool enables objective metrics, and may resolve apparent ambiguities in the role of PGES in SUDEP and seizure severity studies.
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Affiliation(s)
- Xiuhe Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Laura Vilella
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Liang Zhu
- Biostatistics and Epidemiology Research Design Core, Division of Clinical and Translational Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - M R Sandhya Rani
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Johnson P Hampson
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jaison Hampson
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Norma J Hupp
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Rup K Sainju
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Daniel Friedman
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Maromi Nei
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Catherine Scott
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, Institute of Neurology, University College London, London, United Kingdom
| | - Luke Allen
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, Institute of Neurology, University College London, London, United Kingdom
| | - Brian K Gehlbach
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Stephan Schuele
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ronald M Harper
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Beate Diehl
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, Institute of Neurology, University College London, London, United Kingdom
| | - Lisa M Bateman
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Orrin Devinsky
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - George B Richerson
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Guo-Qiang Zhang
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Samden D Lhatoo
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nuria Lacuey
- National Institute of Neurological Disorders and Stroke (NINDS) Center for Sudden Unexpected Death in Epilepsy (SUDEP) Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
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6
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Rabinovitch A, Thieberger R, Aviram I, Biton Y, Braunstein D. Origin of post-ictal and post-anesthesia adverse effects and possibly of SUDEP. Med Hypotheses 2021; 151:110591. [PMID: 33873149 DOI: 10.1016/j.mehy.2021.110591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/10/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
The origin of post-ictal malfunctions is debatable. We want to propose a novel idea of a cause of these adverse results occurring following epileptic seizures and anesthesia. Previously we have put forward the idea that epileptic seizures termination is caused by the function of the glymphatic system in the brain. A new measurement shows that this system can be much faster than what was estimated before. Moreover, the method enabling this speeding was actually measured in brains of epilepsy subjects. So, the main objection to our model is relegated. As a possible consequence of the glymphatic process, there can be an excess cleaning of the brain's interstitial fluid. We discuss possible adverse results of this process. This over-cleaning (that can, to a lower extent, occur also during anesthesia) which results post-ictally from the previous overexpression of fluid materials by the neurons during their seizure operation, can reduce ingredients essential for regular neuronal functioning, thereby leading to function reduction and EEG suppression which last until those materials are replenished. We argue that this ingredients' scarcity is the cause of post-ictal generalized EEG suppression (PGES), of post-ictal immobility (PI) and possibly of Sudden Unexpected Death in Epilepsy Patients (SUDEP). Similarly, such cleaning can lead to morbidity and even mortality problems following anesthesia. If our assumption is correct, this understanding of the process of the problems' origin can lead to a method to remedy them by judicial supplement of the lost materials.
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7
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Johnson M, Samudra N, Gallagher MJ, Abou-Khalil B, Nobis WP. Near SUDEP during bilateral stereo-EEG monitoring characterized by diffuse postictal EEG suppression. Epilepsia 2021; 62:e60-e64. [PMID: 33617691 DOI: 10.1111/epi.16852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in patients with refractory epilepsy. The pathophysiology of SUDEP is unknown. Postictal phenomena such as postconvulsive immobility (PI), postictal generalized electroencephalography (EEG) suppression (PGES), arousal deficits, cardiac arrhythmias, central apneas, and obstructive apneas due to laryngospasms have been suggested to contribute to SUDEP. We present, to our knowledge, the first case of a near-SUDEP event in a patient undergoing intracranial, stereotactic EEG (sEEG) monitoring. This case spotlights potential mediators of SUDEP, most notably the striking PGES and postictal apnea. The nature of the sEEG investigation illustrates the extent of cortical and subcortical postictal EEG suppression and showcases a transient return of cerebral activity likely to be missed on scalp-EEG recording. Critically, this case emphasizes the importance of continuous cardiorespiratory monitoring and underscores the importance of postictal arousal as a pathophysiological mechanism in SUDEP.
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Affiliation(s)
- Michael Johnson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niyatee Samudra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin J Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bassel Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William P Nobis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is a leading cause of premature death in patients with epilepsy. If timely assessment of SUDEP risk can be made, early interventions for optimized treatments might be provided. One of the biomarkers being investigated for SUDEP risk assessment is postictal generalized EEG suppression [postictal generalized EEG suppression (PGES)]. For example, prolonged PGES has been found to be associated with a higher risk for SUDEP. Accurate characterization of PGES requires correct identification of the end of PGES, which is often complicated due to signal noise and artifacts, and has been reported to be a difficult task even for trained clinical professionals. In this work we present a method for automatic detection of the end of PGES using multi-channel EEG recordings, thus enabling the downstream task of SUDEP risk assessment by PGES characterization. METHODS We address the detection of the end of PGES as a classification problem. Given a short EEG snippet, a trained model classifies whether it consists of the end of PGES or not. Scalp EEG recordings from a total of 134 patients with epilepsy are used for training a random forest based classification model. Various time-series based features are used to characterize the EEG signal for the classification task. The features that we have used are computationally inexpensive, making it suitable for real-time implementations and low-power solutions. The reference labels for classification are based on annotations by trained clinicians identifying the end of PGES in an EEG recording. RESULTS We evaluated our classification model on an independent test dataset from 34 epileptic patients and obtained an AUreceiver operating characteristic (ROC) (area under the curve) of 0.84. We found that inclusion of multiple EEG channels is important for better classification results, possibly owing to the generalized nature of PGES. Of among the channels included in our analysis, the central EEG channels were found to provide the best discriminative representation for the detection of the end of PGES. CONCLUSION Accurate detection of the end of PGES is important for PGES characterization and SUDEP risk assessment. In this work, we showed that it is feasible to automatically detect the end of PGES-otherwise difficult to detect due to EEG noise and artifacts-using time-series features derived from multi-channel EEG recordings. In future work, we will explore deep learning based models for improved detection and investigate the downstream task of PGES characterization for SUDEP risk assessment.
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Affiliation(s)
- Bishal Lamichhane
- Electrical and Computer Engineering Department, Rice University, 6100 Main St, Houston, TX USA
| | - Yejin Kim
- School of Biomedical Informatics, UT Health, 7000 Fannin St Suite 600, Houston, TX USA
| | - Santiago Segarra
- Electrical and Computer Engineering Department, Rice University, 6100 Main St, Houston, TX USA
| | - Guoqiang Zhang
- Department of Neurology, McGovern Medical School, UT Health, 6430 Fannin St, Houston, TX USA
| | - Samden Lhatoo
- Department of Neurology, McGovern Medical School, UT Health, 6430 Fannin St, Houston, TX USA
| | - Jaison Hampson
- Department of Neurology, McGovern Medical School, UT Health, 6430 Fannin St, Houston, TX USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, UT Health, 7000 Fannin St Suite 600, Houston, TX USA
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9
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Zhu C, Kim Y, Jiang X, Lhatoo S, Jaison H, Zhang GQ. A lightweight convolutional neural network for assessing an EEG risk marker for sudden unexpected death in epilepsy. BMC Med Inform Decis Mak 2020; 20:329. [PMID: 33357242 PMCID: PMC7758925 DOI: 10.1186/s12911-020-01310-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Convolutional neural network (CNN) has achieved state-of-art performance in many electroencephalogram (EEG) related studies. However, the application of CNN in prediction of risk factors for sudden unexpected death in epilepsy (SUDEP) remains as an underexplored area. It is unclear how the trade-off between computation cost and prediction power varies with changes in the complexity and depth of neural nets. METHODS The purpose of this study was to explore the feasibility of using a lightweight CNN to predict SUDEP. A total of 170 patients were included in the analyses. The CNN model was trained using clips with 10-s signals sampled from the original EEG. We implemented Hann function to smooth the raw EEG signal and evaluated its effect by choosing different strength of denoising filter. In addition, we experimented two variations of the proposed model: (1) converting EEG input into an "RGB" format to address EEG channels underlying spatial correlation and (2) incorporating residual network (ResNet) into the bottle neck position of the proposed structure of baseline CNN. RESULTS The proposed baseline CNN model with lightweight architecture achieved the best AUC of 0.72. A moderate noise removal step facilitated the training of CNN model by ensuring stability of performance. We did not observe further improvement in model's accuracy by increasing the strength of denoising filter. CONCLUSION Post-seizure slow activity in EEG is a potential marker for SUDEP, our proposed lightweight architecture of CNN achieved satisfying trade-off between efficiently identifying such biomarker and computational cost. It also has a flexible interface to be integrated with different variations in structure leaving room for further improvement of the model's performance in automating EEG signal annotation.
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Affiliation(s)
- Cong Zhu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yejin Kim
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiaoqian Jiang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Samden Lhatoo
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hampson Jaison
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Guo-Qiang Zhang
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
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10
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Petrucci AN, Joyal KG, Chou JW, Li R, Vencer KM, Buchanan GF. Post-ictal Generalized EEG Suppression is reduced by Enhancing Dorsal Raphe Serotonergic Neurotransmission. Neuroscience 2020; 453:206-221. [PMID: 33242541 DOI: 10.1016/j.neuroscience.2020.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 01/02/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. A proposed risk marker for SUDEP is the duration of post-ictal generalized EEG suppression (PGES). The mechanisms underlying PGES are unknown. Serotonin (5-HT) has been implicated in SUDEP pathophysiology. Seizures suppress activity of 5-HT neurons in the dorsal raphe nucleus (DRN). We hypothesized that suppression of DRN 5-HT neuron activity contributes to PGES and increasing 5-HT neurotransmission or stimulating the DRN before a seizure would decrease PGES duration. Adult C57BL/6J and Pet1-Cre mice received EEG/EMG electrodes, a bipolar stimulating/recording electrode in the right basolateral amygdala, and either a microdialysis guide cannula or an injection of adeno-associated virus (AAV) allowing expression of channelrhodopsin2 plus an optic fiber into the DRN. Systemic application of the selective 5-HT reuptake inhibitor citalopram (20 mg/kg) decreased PGES duration from seizures induced during wake (n = 23) and non-rapid eye movement (NREM) sleep (n = 13) whereas fluoxetine (10 mg/kg) pretreatment decreased PGES duration following seizures induced from wake (n = 11), but not NREM sleep (n = 9). Focal chemical (n = 6) or optogenetic (n = 8) stimulation of the DRN reduced PGES duration following seizures in kindled mice induced during wake. During PGES, animals exhibited immobility and suppression of EEG activity that was reduced by citalopram pretreatment. These results suggest 5-HT and the DRN may regulate PGES.
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Affiliation(s)
- Alexandra N Petrucci
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Department of Neurology, Carver College of Medicine, Carver College of Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States.
| | - Katelyn G Joyal
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Department of Neurology, Carver College of Medicine, Carver College of Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States.
| | - Jonathan W Chou
- Department of Neurology, Carver College of Medicine, Carver College of Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA 52242, United States.
| | - Rui Li
- Department of Neurology, Carver College of Medicine, Carver College of Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States.
| | - Kimberly M Vencer
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA 52242, United States
| | - Gordon F Buchanan
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Department of Neurology, Carver College of Medicine, Carver College of Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States.
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11
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Grigorovsky V, Jacobs D, Breton VL, Tufa U, Lucasius C, Del Campo JM, Chinvarun Y, Carlen PL, Wennberg R, Bardakjian BL. Delta-gamma phase-amplitude coupling as a biomarker of postictal generalized EEG suppression. Brain Commun 2020; 2:fcaa182. [PMID: 33376988 PMCID: PMC7750942 DOI: 10.1093/braincomms/fcaa182] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 07/06/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
Postictal generalized EEG suppression is the state of suppression of electrical activity at the end of a seizure. Prolongation of this state has been associated with increased risk of sudden unexpected death in epilepsy, making characterization of underlying electrical rhythmic activity during postictal suppression an important step in improving epilepsy treatment. Phase-amplitude coupling in EEG reflects cognitive coding within brain networks and some of those codes highlight epileptic activity; therefore, we hypothesized that there are distinct phase-amplitude coupling features in the postictal suppression state that can provide an improved estimate of this state in the context of patient risk for sudden unexpected death in epilepsy. We used both intracranial and scalp EEG data from eleven patients (six male, five female; age range 21–41 years) containing 25 seizures, to identify frequency dynamics, both in the ictal and postictal EEG suppression states. Cross-frequency coupling analysis identified that during seizures there was a gradual decrease of phase frequency in the coupling between delta (0.5–4 Hz) and gamma (30+ Hz), which was followed by an increased coupling between the phase of 0.5–1.5 Hz signal and amplitude of 30–50 Hz signal in the postictal state as compared to the pre-seizure baseline. This marker was consistent across patients. Then, using these postictal-specific features, an unsupervised state classifier—a hidden Markov model—was able to reliably classify four distinct states of seizure episodes, including a postictal suppression state. Furthermore, a connectome analysis of the postictal suppression states showed increased information flow within the network during postictal suppression states as compared to the pre-seizure baseline, suggesting enhanced network communication. When the same tools were applied to the EEG of an epilepsy patient who died unexpectedly, ictal coupling dynamics disappeared and postictal phase-amplitude coupling remained constant throughout. Overall, our findings suggest that there are active postictal networks, as defined through coupling dynamics that can be used to objectively classify the postictal suppression state; furthermore, in a case study of sudden unexpected death in epilepsy, the network does not show ictal-like phase-amplitude coupling features despite the presence of convulsive seizures, and instead demonstrates activity similar to postictal. The postictal suppression state is a period of elevated network activity as compared to the baseline activity which can provide key insights into the epileptic pathology.
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Affiliation(s)
| | - Daniel Jacobs
- Institute of Biomedical Engineering, University of Toronto, Canada
| | | | - Uilki Tufa
- Institute of Biomedical Engineering, University of Toronto, Canada
| | - Christopher Lucasius
- Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Canada
| | | | - Yotin Chinvarun
- Comprehensive Epilepsy Program and Neurology Unit, Phramongkutklao Hospital, Thailand
| | - Peter L Carlen
- Institute of Biomedical Engineering, University of Toronto, Canada.,Department of Physiology, University of Toronto, Canada.,Division of Neurology, Toronto Western Hospital, Canada
| | | | - Berj L Bardakjian
- Institute of Biomedical Engineering, University of Toronto, Canada.,Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Canada
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12
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Marchi A, Giusiano B, King M, Lagarde S, Trébuchon-Dafonseca A, Bernard C, Rheims S, Bartolomei F, McGonigal A. Postictal electroencephalographic (EEG) suppression: A stereo-EEG study of 100 focal to bilateral tonic-clonic seizures. Epilepsia 2018; 60:63-73. [PMID: 30565663 DOI: 10.1111/epi.14601] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We aimed to describe intracerebral aspects of postictal generalized electroencephalography suppression (PGES) following focal to bilateral tonic-clonic ("secondarily generalized tonic-clonic") seizures (GTCS) recorded using stereoelectroencephalographic (SEEG), and to correlate these with electroclinical features. METHODS Three independent observers scored semiologic and SEEG features. Patient and epilepsy characteristics were collected. Descriptive statistics and multivariate analysis were performed. The operational definition of PGES on SEEG used strict criteria (absence of visible signal at 20 μV/mm amplitude, in all readable channels). Postictal regional suppression (RS) was identified if only a subset of implanted electrodes showed absence of signal. RESULTS We evaluated 100 seizures in 52 patients. Interobserver agreement was good (κ 0.72 for clinical features and 0.73 for EEG features). PGES was present in 27 of 100 and RS without PGES present in 42 of 100 seizures. Region of RS included epileptogenic zone in 43 of 51 (86%). No effect of sampling (multilobar or bilateral exploration) was seen. Oral tonicity (mouth opening and/or tonic vocalization during the tonic phase of GTCS) was associated with the presence of PGES (P = 0.029; negative predictive value [NPV] 0.91). Bilateral upper limb extension during the tonic phase correlated with PGES (P = 0.041; NPV 0.85). Association of both oral tonicity and bilateral upper limb extension had a high NPV of 0.96. SIGNIFICANCE SEEG recordings confirm true absence of signal during postictal EEG suppression. PGES is unlikely when both upper limb extension and oral tonicity are absent. We hypothesize that bilateral tonic seizure discharge at bulbar level brainstem regions is associated with the production of oral signs and may relate to mechanisms of PGES.
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Affiliation(s)
- Angela Marchi
- Clinical Neurophysiology Department, Sainte Anne Hospital, AP-HP, Paris, France
| | - Bernard Giusiano
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France
| | - Mark King
- Department of Neurosciences, Alfred Hospital, Melbourne, Victoria, Australia
| | - Stanislas Lagarde
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Agnès Trébuchon-Dafonseca
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Christophe Bernard
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France
| | - Sylvain Rheims
- Lyon University, Claude Bernard University, Lyon, France.,Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Lyon, France.,Lyon's Neuroscience Research Center (INSERM U1028, CNRS 5292), Lyon, France
| | - Fabrice Bartolomei
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Aileen McGonigal
- Inserm, INS, Brain Dynamics Institute, Aix Marseille University, Marseille, France.,APHM, Clinical Neurophysiology, Timone Hospital, Marseille, France
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13
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Abstract
Eicosanoids, oxygenated metabolites of C20 polyunsaturated fatty acids (PUFAs), mediate fundamental physiological processes, including immune reactions and reproduction, in insects. Prostaglandins (PGs) make up one group of eicosanoids, of which PGE2 is a relatively well-known mediator in various insect taxa. While PG biosynthesis has been reported, the specific biosynthetic pathway for PGE2 is not known in insects. Here, we posed the hypothesis that Se-mPGES2 mediates biosynthesis of physiologically active PGE2 through its cognate protein. To test this hypothesis, we interrogated a transcriptome of the lepidopteran insect, Spodoptera exigua, to identify a candidate PGE2 synthase (Se-mPGES2) and analyzed its sequence and expression. Its predicted amino acid sequence contains a consensus thioredoxin homology sequence (Cys-x-x-Cys) responsible for catalytic activity along with an N-terminal membrane-associated hydrophobic domain and C-terminal cytosolic domain. It also shares sequence homology (36.5%) and shares almost overlapping three dimensional structures with a membrane-bound human PGES2 (mPGES2). Se-mPGES2 was expressed in all developmental stages with high peaks during the late larval instar and adult stages. Immune challenge significantly up-regulated its expression levels in hemocytes and fat body. Injecting double-stranded RNA (dsRNA) specific to Se-mPGES2 significantly impaired two cellular immune responses, hemocyte-spreading behavior and nodule formation following bacterial challenge. Humoral immunity was also significantly suppressed, registered as reduced phenoloxidase activity and antimicrobial peptide expression levels. The suppressed immune responses were reversed following PGE2, but not arachidonic acid (AA), treatments. RNAi treatments also reduced the egg-laying behavior of females. Control females mated with the RNAi-treated males led to substantially reduced egg-laying behavior, which was also reversed following PGE2 injections into females. These results strongly bolster our hypothesis that Se-mPGES2 acts in the biosynthesis of PGE2, a crucial biochemical signal mediating immune and reproductive physiology of S. exigua.
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Affiliation(s)
- Shabbir Ahmed
- Department of Plant Medicals, College of Natural Sciences, Andong National University, Andong, South Korea
| | - David Stanley
- Biological Control of Insects Research Laboratory, United States Department of Agriculture-Agricultural Research Service, Columbia, MO, United States
| | - Yonggyun Kim
- Department of Plant Medicals, College of Natural Sciences, Andong National University, Andong, South Korea
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14
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Jin L, Zhang Y, Wang XL, Zhang WJ, Liu YH, Jiang Z. Postictal apnea as an important mechanism for SUDEP: A near-SUDEP with continuous EEG-ECG-EMG recording. J Clin Neurosci 2017; 43:130-2. [PMID: 28576433 DOI: 10.1016/j.jocn.2017.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/22/2017] [Indexed: 11/22/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is one of the most frequent causes of death among patients with epilepsy. Most SUDEP or near-SUDEP are unwitnessed and not observed or recorded during video-EEG recording in epilepsy monitoring units. This report describes a young woman with post ictal apnea and generalized EEG suppression (PGES) after a secondary generalized tonic-clonic seizure (sGTCS). This was accompanied by bradycardia and then ventricular tachycardia (VT). But at the end of VT, the patient's breath recovered without any intervention, such as cardio-respiratory resuscitation. This case report with continuous EEG, EKG, EMG during near SUDEP may provide insights into the mechanism of action.
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15
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Kang JY, Rabiei AH, Myint L, Nei M. Equivocal significance of post-ictal generalized EEG suppression as a marker of SUDEP risk. Seizure 2017; 48:28-32. [PMID: 28380395 DOI: 10.1016/j.seizure.2017.03.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 01/31/2017] [Revised: 03/12/2017] [Accepted: 03/26/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Our objective was to determine the significance of PGES as a possible EEG marker of increased risk for SUDEP and explore factors that influence PGES. METHODS We identified 17 patients who died due to definite or probable SUDEP and 52 living control patients with drug resistant focal epilepsy who underwent EEG monitoring and least one seizure recorded on EEG. We reviewed 305 seizures on EEG and when available, on video, for presence or absence of PGES, the duration of PGES immediately after seizure end, seizure type, state seizure occurred (sleep vs. wake), tonic duration and time from seizure onset to initial nursing intervention. We noted that majority (93% in SUDEP group and 83% living controls) with PGES had additional brief bursts of suppression. We measured the time from the end of seizure to end of last brief suppression to determine the time to final PGES. RESULTS SUDEP patients had statistically significant shorter PGES duration compared to living controls (unadjusted: -32.8s, 95%CI[-54.5, -11.2], adjusted: -39.5s, 95% CI[-59.4, -19.6]). SUDEP status was associated with longer time to final PGES compare to living controls, but this was not statistically significant. Earlier nursing intervention was associated with shorter seizure duration. PGES occurred only after GCS. Time to nursing intervention, tonic duration or state did not have a statistically significant effect on PGES. CONCLUSIONS PGES is an equivocal marker of increased SUDEP risk. Earlier nursing intervention is associated with shorter seizure duration and may play a role in reducing risk of SUDEP.
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Affiliation(s)
- Joon Y Kang
- Johns Hopkins School of Medicine, United States.
| | | | - Leslie Myint
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | - Maromi Nei
- Thomas Jefferson University Hospital, United States
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16
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Wu S, Issa NP, Rose SL, Ali A, Tao JX. Impact of periictal nurse interventions on postictal generalized EEG suppression in generalized convulsive seizures. Epilepsy Behav 2016; 58:22-5. [PMID: 26994879 DOI: 10.1016/j.yebeh.2016.02.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/08/2016] [Accepted: 02/21/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The objective of this study was to determine the impact of periictal nurse interventions on postictal generalized EEG suppression (PGES) in generalized convulsive seizures (GCS). METHODS We retrospectively reviewed the video-EEG recordings of patients during long-term video-EEG monitoring. We compared the duration of seizures, seizure phases (tonic, clonic, and tonic-clonic phases), and the occurrence and duration of postictal generalized EEG suppression (PGES) in patients with and without periictal interventions (e.g., oxygen administration, suctioning, and repositioning). Statistical analyses were performed to determine the association between the seizure-related variables and the periictal interventions. RESULTS A total of 109 patients with 150 GCS were included in the study. Periictal interventions were provided in 122 GCS, of which, ictal administration of oxygen was provided in 29 GCS. The duration of PGES was significantly shortened in GCS with interventions when compared with those without interventions (p=0.003). However, the ictal administration of oxygen, assessed as an independent variable, did not influence the occurrence or duration of PGES. CONCLUSION Periictal interventions significantly shortened the duration of PGES, and may, as a consequence, reduce the risk of SUDEP. However, ictal administration of oxygen did not influence the occurrence or duration of PGES.
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Moseley BD, DeGiorgio CM. The SUDEP Risk Inventory: Association with postictal generalized EEG suppression. Epilepsy Res 2015; 117:82-4. [PMID: 26425830 DOI: 10.1016/j.eplepsyres.2015.09.006] [Citation(s) in RCA: 13] [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: 06/23/2015] [Revised: 08/18/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
To help identify patients at greatest risk for sudden unexpected death in epilepsy (SUDEP), screening inventories like the SUDEP-7 Inventory can be useful. In this study, we examined the strength of association between this inventory's risk factors and postictal generalized EEG suppression (PGES), a biomarker of SUDEP risk. We reanalyzed data from an epilepsy monitoring unit study of 37 children. We performed a 2 by 2 contingency table analysis to determine the association between "yes" responses on the inventory questions and PGES following >=1 seizure. Having a history of >3 generalized tonic-clonic seizures (GTCS) in the past year had the strongest association with PGES (Pearson chi-square p<0.001, Cramer's V=0.75). Having >=1 GTCS in the past year was also strongly associated with PGES (Pearson chi-square p<0.001, Cramer's V=0.636). Histories of >50 seizures of any type/month (Pearson chi-square p=0.14, Cramer's V=0.241) and intellectual disability (Pearson chi-square p=0.04, Cramer's V=0.337) were not as robustly associated with PGES. Current use of >=3 AEDs had the weakest association with PGES (Pearson chi-square p=0.66, Cramer's V=0.072). Given that all study patients had >=1 seizure per year and epilepsy durations <30 years, the strength of association with these questions and PGES could not be analyzed.
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Affiliation(s)
- Brian D Moseley
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA.
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Lee A, Ellman MB, Yan D, Kroin JS, Cole BJ, van Wijnen AJ, Im HJ. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene 2013; 527:440-7. [PMID: 23830938 PMCID: PMC3745800 DOI: 10.1016/j.gene.2013.05.069] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/27/2013] [Indexed: 01/19/2023]
Abstract
Osteoarthritis afflicts millions of individuals across the world resulting in impaired quality of life and increased health costs. To understand this disease, physicians have been studying risk factors, such as genetic predisposition, aging, obesity, and joint malalignment; however have been unable to conclusively determine the direct etiology. Current treatment options are short-term or ineffective and fail to address pathophysiological and biochemical mechanisms involved with cartilage degeneration and the induction of pain in arthritic joints. OA pain involves a complex integration of sensory, affective, and cognitive processes that integrate a variety of abnormal cellular mechanisms at both peripheral and central (spinal and supraspinal) levels of the nervous system Through studies examined by investigators, the role of growth factors and cytokines has increasingly become more relevant in examining their effects on articular cartilage homeostasis and the development of osteoarthritis and osteoarthritis-associated pain. Catabolic factors involved in both cartilage degradation in vitro and nociceptive stimulation include IL-1, IL-6, TNF-α, PGE2, FGF-2 and PKCδ, and pharmacologic inhibitors to these mediators, as well as compounds such as RSV and LfcinB, may potentially be used as biological treatments in the future. This review explores several biochemical mediators involved in OA and pain, and provides a framework for the understanding of potential biologic therapies in the treatment of degenerative joint disease in the future.
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Affiliation(s)
- Andrew Lee
- Department of Biochemistry, Rush University Medical Center, Chicago, IL 60612
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Michael B Ellman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Dongyao Yan
- Department of Biochemistry, Rush University Medical Center, Chicago, IL 60612
| | - Jeffrey S Kroin
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL 60612
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery & Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN 55905
| | - Hee-Jeong Im
- Department of Biochemistry, Rush University Medical Center, Chicago, IL 60612
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
- Department of Internal Medicine, Section of Rheumatology, Rush University Medical Center, Chicago, IL 60612
- Department of Bioengineering, University of Illinois, Chicago, IL 60612
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