scholarly journals Multimodal connectome biomarkers of cognitive and affective dysfunction in the common epilepsies

2021 ◽  
Author(s):  
raul rodriguez-cruces ◽  
Jessica Royer ◽  
Sara Lariviere ◽  
Danielle S Bassett ◽  
Lorenzo Caciagli ◽  
...  
Keyword(s):  
Future Research ◽  
Drug Resistant ◽  
Cortical Circuits ◽  
Idiopathic Generalized Epilepsy ◽  
Behavioral Challenges ◽  
Cognitive Domains ◽  
The Common ◽  
Neurological Conditions ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy

Epilepsy is one of the most common chronic neurological conditions, traditionally defined as a disorder of recurrent seizures. Cognitive and affective dysfunctions are increasingly recognized as core disease dimensions and can affect patient wellbeing sometimes more than the seizures themselves. Connectome- based approaches hold immense promise for revealing mechanisms that contribute to dysfunction, and to identify biomarkers. Our review discusses emerging multimodal neuroimaging and connectomics studies that highlight network substrates of cognitive/affective dysfunction in the common epilepsies. We first overview work in drug-resistant epilepsy syndromes i.e., temporal lobe epilepsy related to mesiotemporal sclerosis (TLE) and extratemporal epilepsy (ETE) related to malformations of cortical development. While these are traditionally conceptualized as ‘focal’ epilepsies, many patients present with broad structural and functional anomalies. Moreover, the extent of distributed changes contributes to difficulties in multiple cognitive domains as well as affective-behavioral challenges. We will also review work in idiopathic generalized epilepsy (IGE), a class of generalized epilepsy syndromes that involve subcortico-cortical circuits. Overall, neuroimaging and network neuroscience studies point to both shared and syndrome specific connectome signatures of dysfunction across TLE, ETE, and IGE. Lastly, we point to current gaps in the literature and formulate recommendations for future research.

scholarly journals Efficacy of Vagal Nerve Stimulation for Drug-Resistant Epilepsy: Is it the Stimulation or Medication?

2017 ◽  
Vol 44 (5) ◽  
pp. 532-537 ◽  
Author(s):  
Jaylynn Arcand ◽  
Karen Waterhouse ◽  
Lizbeth Hernandez-Ronquillo ◽  
Aleksander Vitali ◽  
Jose F. Tellez-Zenteno
Keyword(s):  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Drug Resistant ◽  
Idiopathic Generalized Epilepsy ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy ◽  
Seizure Classification

AbstractBackground: Vagus nerve stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug-resistant epilepsy, although modification of antiepileptic drugs (AEDs) during VNS treatment could explain the improvement in patients. Methods: We retrospectively assessed the efficacy of VNS in 30 adult patients with epilepsy treated with >6 months of follow-up. The criteria for implantation were the following: (1) not a candidate for resective epilepsy surgery, (2) drug-resistant epilepsy, (3) impairment of quality of life, (4) no other option of treatment, and (5) patients with idiopathic generalized epilepsy who fail to be controlled with appropriate AEDs. We assessed sociodemographics, seizure etiology, seizure classification, and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50% seizure improvement from baseline. Results: Thirty patients (females, 18; males, 12; age, 35.1±13.3 years) were included. After 6, 12, 24, and 36 months of follow-up, the response rates were: 13/30 (43%), 13/27 (48%), 9/22 (41%), and 8/16 (50%), respectively; none was seizure free. Fifty-seven percent, 33%, 59%, and 81% of patients had changes of medication type or dose at 6, 12, 24, and 36 months respectively. In the majority of patients, the change of medication consisted of an increase in the dose of AEDs. Conclusions: Our study shows that VNS is an effective therapy, although significant changes in medications were done along with the therapy; therefore, the real effect of VNS could be controversial.

Depressive disorder in a boy with drug resistant idiopathic generalized epilepsy

2012 ◽  
Vol 24 (2) ◽  
pp. 191-192
Author(s):  
I. Leo⁎ ◽  
D. Cordelli ◽  
V. Gentile ◽  
A. Barbieri ◽  
V. Marchiani ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Drug Resistant ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy

scholarly journals Cannabis Treatment in Children with Epilepsy: Practices of Canadian Neurologists

2020 ◽  
Vol 47 (4) ◽  
pp. 511-518 ◽  
Author(s):  
Stephanie M. DeGasperis ◽  
Richard Webster ◽  
Daniela Pohl
Keyword(s):  
Online Survey ◽  
Focal Epilepsy ◽  
Poor Quality ◽  
Dravet Syndrome ◽  
Pediatric Epilepsy ◽  
Medical Cannabis ◽  
Idiopathic Generalized Epilepsy ◽  
Community Based ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy

ABSTRACT:Background:Medical cannabis has recently emerged as a treatment option for children with drug-resistant epilepsy. Despite the fact that many pediatric epilepsy patients across Canada are currently being treated with cannabis, little is known about the attitudes of neurologists toward cannabinoid treatment of children with epilepsy.Methods:A 21-item online survey was distributed via email to 148 pediatric neurologists working in hospitals and community clinics across Canada. Questions were related to clinical practice and demographics.Results:This survey achieved a response rate of 38% (56 Canadian neurologists). These neurologists were treating 668 pediatric epilepsy patients with cannabinoids. While 29% of neurologists did not support cannabis treatment in their patients, 34% prescribed cannabis, and 38% referred to another authorizing physician, mostly to community-based non-neurologists. The majority of neurologists considered cannabis for patients with Dravet syndrome (68%) and Lennox–Gastaut syndrome (64%) after an average of three failed anticonvulsants. Twenty-seven percent considered it for patients with idiopathic generalized epilepsy, and 18% for focal epilepsy. No neurologist used cannabis as a first-line treatment. All neurologists had at least one hesitation regarding cannabis treatment in pediatric epilepsy. The most common one was poor evidence (66%), followed by poor quality control (52%) and high cost (50%).Conclusions:The majority of Canadian pediatric neurologists consider using cannabis as a treatment for epilepsy in children. With many gaps in evidence and high patient-driven demand for cannabis therapy, this survey provides immediate information from the “wisdom of the crowd,” to aid neurologists until further evidence is available.

Using Generalized Polyspike Train to Predict Drug-Resistant Idiopathic Generalized Epilepsy

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Erin C. Conrad ◽  
Nanak Chugh ◽  
Taneeta M. Ganguly ◽  
James J. Gugger ◽  
Etsegenet F. Tizazu ◽  
...  
Keyword(s):  
Drug Resistant ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy

Electroclinical Phenotype-Genotype Homogeneity in Drug-Resistant “Generalized” Tonic-Clonic Seizures of Early Childhood

2020 ◽  
pp. 155005942095373
Author(s):  
Anis Jukkarwala ◽  
Ramshekhar N. Menon ◽  
E. R. Sunesh ◽  
Ashalatha Radhakrishnan
Keyword(s):  
Genetic Testing ◽  
Dravet Syndrome ◽  
Drug Resistant ◽  
Presurgical Evaluation ◽  
Epileptiform Discharges ◽  
Mri Scans ◽  
Clonic Seizures ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy

Purpose Children with refractory focal to bilateral tonic-clonic seizures, despite normal high-resolution imaging, are often not subjected to genetic tests due to the costs involved and instead undergo multimodality presurgical evaluation targeted at delineating a focal onset. The objective of this study was to ascertain genotype-phenotype correlations in this group of patients. Method An online hospital database search was conducted for children who presented in 2019 with drug-resistant epilepsy dominated by nonlateralizing focal-onset/rapid generalized (bilateral) tonic-clonic seizures (GTCS), subjected to presurgical evaluation and subsequent genetic testing due to absence of a clear focus hypothesis. Results Phenotypic homogeneity was apparent in 3 children who had onset in infancy with drug-resistant GTCS (predominantly unprovoked and occasionally fever provoked) and subsequent delayed development. 3-Tesla magnetic resonance imaging (MRI) scans were negative and video EEG documented a homogeneous pattern of multifocal and/or generalized epileptiform discharges with phenomenology favoring probable focal-onset/generalized-onset bilateral tonic-clonic seizures. All 3 tested positive for SCN1A gene variants (heterozygous missense substitution variants in 2 children, one of which was novel and a novel duplication in one that led to frameshift and premature truncation of the protein), suggestive of SCN1A-mediated epilepsy. This electroclinical profile constituted 3 out of 25 patients with SCN1A-epilepsy phenotypes at our center. Conclusions These cases suggest that children with early-onset drug-resistant “generalized” epilepsy are likely to have a genetic basis although the presentation may not be typical of Dravet syndrome. Hence, genetic testing for SCN1A variants is recommended in children with drug-resistant MRI negative focal-onset/generalized-onset bilateral tonic-clonic seizures before subjecting them to exhaustive presurgical workup and to guide appropriate treatment and prognostication.

scholarly journals Network-based atrophy modeling in the common epilepsies: A worldwide ENIGMA study

2020 ◽  
Vol 6 (47) ◽  
pp. eabc6457
Author(s):  
Sara Larivière ◽  
Raúl Rodríguez-Cruces ◽  
Jessica Royer ◽  
Maria Eugenia Caligiuri ◽  
Antonio Gambardella ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Strong Influence ◽  
Healthy Controls ◽  
Negative Effects ◽  
Idiopathic Generalized Epilepsy ◽  
Cross Sectional ◽  
Distinct Disease ◽  
The Common ◽  
Generalized Epilepsy

Epilepsy is increasingly conceptualized as a network disorder. In this cross-sectional mega-analysis, we integrated neuroimaging and connectome analysis to identify network associations with atrophy patterns in 1021 adults with epilepsy compared to 1564 healthy controls from 19 international sites. In temporal lobe epilepsy, areas of atrophy colocalized with highly interconnected cortical hub regions, whereas idiopathic generalized epilepsy showed preferential subcortical hub involvement. These morphological abnormalities were anchored to the connectivity profiles of distinct disease epicenters, pointing to temporo-limbic cortices in temporal lobe epilepsy and fronto-central cortices in idiopathic generalized epilepsy. Negative effects of age on atrophy further revealed a strong influence of connectome architecture in temporal lobe, but not idiopathic generalized, epilepsy. Our findings were reproduced across individual sites and single patients and were robust across different analytical methods. Through worldwide collaboration in ENIGMA-Epilepsy, we provided deeper insights into the macroscale features that shape the pathophysiology of common epilepsies.

scholarly journals Network-based atrophy modelling in the common epilepsies: a worldwide ENIGMA study

2020 ◽  
Author(s):  
Sara Larivière ◽  
Raúl Rodríguez-Cruces ◽  
Jessica Royer ◽  
Maria Eugenia Caligiuri ◽  
Antonio Gambardella ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Analytical Methods ◽  
Strong Influence ◽  
Healthy Controls ◽  
Idiopathic Generalized Epilepsy ◽  
Cross Sectional ◽  
Distinct Disease ◽  
The Common ◽  
Generalized Epilepsy

SUMMARYEpilepsy is increasingly conceptualized as a network disorder. In this cross-sectional mega-analysis, we integrated neuroimaging and connectome analysis to identify network associations with atrophy patterns in 1,021 adults with epilepsy compared to 1,564 healthy controls from 19 international sites. In temporal lobe epilepsy, areas of atrophy co-localized with highly interconnected cortical hub regions, whereas idiopathic generalized epilepsy showed preferential subcortical hub involvement. These morphological abnormalities were anchored to the connectivity profiles of distinct disease epicenters, pointing to temporo-limbic cortices in temporal lobe epilepsy and fronto-central cortices in idiopathic generalized epilepsy. Indices of progressive atrophy further revealed a strong influence of connectome architecture on disease progression in temporal lobe, but not idiopathic generalized, epilepsy. Our findings were reproduced across individual sites and single patients, and were robust across different analytical methods. Through worldwide collaboration in ENIGMA-Epilepsy, we provided novel insights into the macroscale features that shape the pathophysiology of common epilepsies.

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