Dynamic analysis of fMRI activation during epileptic spikes can help identify the seizure origin

Abstract

Objective

We use the dynamic electroencephalography–functional magnetic resonance imaging (EEG‐fMRI) method to incorporate variability in the amplitude and field of the interictal epileptic discharges (IEDs) into the fMRI analysis. We ask whether IED variability analysis can (a) identify additional activated brain regions during the course of IEDs, not seen in standard analysis; and (b) demonstrate the origin and spread of epileptic activity. We explore whether these functional changes recapitulate the structural connections and propagation of epileptic activity during seizures.

Methods

Seventeen patients with ...

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Interrater agreement on classification of photoparoxysmal electroencephalographic response

Abstract

Our goal was to assess the interrater agreement (IRA) of photoparoxysmal response (PPR) using the classification proposed by a task force of the International League Against Epilepsy (ILAE), and a simplified classification system proposed by our group. In addition, we evaluated IRA of epileptiform discharges (EDs) and the diagnostic significance of the electroencephalographic (EEG) abnormalities. We used EEG recordings from the European Reference Network (EpiCARE) and Standardized Computer‐based Organized Reporting of EEG (SCORE). Six raters independently scored EEG recordings from ...

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Seizures with paroxysmal arousals in sleep‐related hypermotor epilepsy (SHE): Dissecting epilepsy from NREM parasomnias

Abstract

Objective

Sleep‐related hypermotor epilepsy (SHE) is a focal epilepsy characterized by seizures occurring mostly during sleep, ranging from brief seizures with paroxysmal arousals (SPAs) to hyperkinetic seizures and ambulatory behaviors. SPAs are brief and stereotypic seizures representing the beginning of a major seizure. Distinguishing SPAs from disorders of arousal (DOAs) and their briefest episodes called simple arousal movements (SAMs) is difficult. We performed a characterization of SPAs and SAMs to identify video‐polysomnographic (VPSG) features that can contribute to the diagnosis of ...

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Value of 7T MRI and post‐processing in patients with nonlesional 3T MRI undergoing epilepsy presurgical evaluation

Abstract

Objective

Ultra‐high‐field 7‐Tesla (7T) magnetic resonance imaging (MRI) offers increased signal‐to‐noise and contrast‐to‐noise ratios, which may improve visualization of cortical malformations. We aim to assess the clinical value of in vivo structural 7T MRI and its post‐processing for the noninvasive identification of epileptic brain lesions in patients with pharmacoresistant epilepsy and nonlesional 3T MRI who are undergoing presurgical evaluation.

Methods

Sixty‐seven patients were included who had nonlesional 3T MRI by official radiology report. Epilepsy protocols were used for the 3T and 7T acquisitions. ...

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Efficacy and safety of Fenfluramine hydrochloride for the treatment of seizures in Dravet syndrome: A real‐world study

Abstract

Objective

Dravet syndrome (DS) is a drug‐resistant, infantile onset epilepsy syndrome with multiple seizure types and developmental delay. In recently published randomized controlled trials, fenfluramine (FFA) proved to be safe and effective in DS.

Methods

DS patients were treated with FFA in the Zogenix Early Access Program at four Italian pediatric epilepsy centers. FFA was administered as add‐on, twice daily at an initial dose of 0.2 mg/kg/d up to 0.7 mg/kg/d. Seizures were recorded in a diary. Adverse events and cardiac safety (with Doppler echocardiography) ...

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Seizure‐onset regions demonstrate high inward directed connectivity during resting‐state: An SEEG study in focal epilepsy

Abstract

Objective

In patients with medically refractory focal epilepsy, stereotactic‐electroencephalography (SEEG) can aid in localizing epileptogenic regions for surgical treatment. SEEG, however, requires long hospitalizations to record seizures, and ictal interpretation can be incomplete or inaccurate. Our recent work showed that non‐directed resting‐state analyses may identify brain regions as epileptogenic or uninvolved. Our present objective is to map epileptogenic networks in greater detail and more accurately identify seizure‐onset regions using directed resting‐state SEEG connectivity.

Methods

In 25 patients with focal epilepsy who underwent SEEG, ...

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Verbal memory dysfunction is associated with alterations in brain transcriptome in dominant temporal lobe epilepsy

Abstract

Objective

Memory dysfunction is prevalent in many neurological disorders and can have a significant negative impact on quality of life. The genetic contributions to memory impairment in epilepsy, particularly temporal lobe epilepsy (TLE), remain poorly understood. Here, we compare the brain transcriptome between TLE patients with and without verbal memory impairments to identify genes and signaling networks important for episodic memory.

Methods

Brain tissues were resected from 23 adults who underwent dominant temporal lobectomy for treatment of pharmacoresistant epilepsy. To control for potential ...

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Preictal variability of high‐frequency oscillation rates in refractory epilepsy

Abstract

Objective

High‐frequency oscillations (HFOs) have shown promising utility in the spatial localization of the seizure onset zone for patients with focal refractory epilepsy. Comparatively few studies have addressed potential temporal variations in HFOs, or their role in the preictal period. Here, we introduce a novel evaluation of the instantaneous HFO rate through interictal and peri‐ictal epochs to assess their usefulness in identifying imminent seizure onset.

Methods

Utilizing an automated HFO detector, we analyzed intracranial electroencephalographic data from 30 patients with refractory epilepsy undergoing ...

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Characterization of seizure susceptibility in Pcdh19 mice

Abstract

Objective

PCDH19‐related epilepsy is characterized by a distinctive pattern of X‐linked inheritance, where heterozygous females exhibit seizures and hemizygous males are asymptomatic. A cellular interference mechanism resulting from the presence of both wild‐type and mutant PCDH19 neurons in heterozygous patients or mosaic carriers of PCDH19 variants has been hypothesized. We aim to investigate seizure susceptibility and progression in the Pchd19 mouse model.

Methods

We assessed seizure susceptibility and progression in the Pcdh19 mouse model using three acute seizure induction paradigms. We first induced ...

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Reduced synaptic vesicle protein 2A binding in temporal lobe epilepsy: A [11C]UCB‐J positron emission tomography study

Abstract

Objective

In this positron emission tomography (PET) study with [11C]UCB‐J, we evaluated synaptic vesicle glycoprotein 2A (SV2A) binding, which is decreased in resected brain tissues from epilepsy patients, in subjects with temporal lobe epilepsy (TLE) and compared the regional binding pattern to [18F]fluorodeoxyglucose (FDG) uptake.

Methods

Twelve TLE subjects and 12 control subjects were examined. Regional [11C]UCB‐J binding potential (BP
ND) values were estimated using the centrum semiovale as a reference region. [18F]FDG uptake in TLE subjects was quantified using mean radioactivity values. ...

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