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Deciphering temporal gene expression dynamics during epilepsy development using a rat model of focal neocortical epilepsy. 利用大鼠局灶性新皮质癫痫模型解读癫痫发生过程中的时态基因表达动态。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1111/epi.18169
Bao-Luen Chang, Matthew C Walker, Dimitri M Kullmann, Stephanie Schorge

Objective: Epilepsy involves significant changes in neural cells during epileptogenesis. Although the molecular mechanism of epileptogenesis remains obscure, changes in gene regulation play a crucial role in the evolution of epilepsy. This study aimed to compare changes in a subset of specific genes during epilepsy development, focusing on the period after the first spontaneous seizure, to identify critical time windows for targeting different regulators.

Methods: Using a rat model of acquired focal neocortical epilepsy induced by tetanus toxin, we characterized gene expression at acute, subacute, and chronic stages (48-72 h, 2 weeks, and 30 days after first spontaneous seizure, respectively), focusing on genes' potential contribution to epilepsy progression.

Results: We observed dynamic changes in the expression of these genes throughout the period after the first spontaneous seizure. Astrocytic reactions primarily occur early, before epilepsy is well established. Changes in Mtor (mammalian target of rapamycin) and Rest (repressor element 1 silencing transcription factor) signaling pathways are highly dynamic and correlated with the progression of epilepsy development. Ccl2 (chemokine C-C-motif ligand) is upregulated at the chronic stage, indicating activation of the neuroinflammatory pathway. Finally, Gabra5 (γ-aminobutyric acidergic signaling) is downregulated at the late stage after epilepsy is established. Surprisingly, changes in the expression of specific genes are linked to the time since the first seizure, rather than seizure frequency or duration.

Significance: These results suggest that the regulation of specific genes is essentially stage-dependent during the development of epilepsy, highlighting the importance of targeting specific genes at appropriate stages of epilepsy development.

目的:癫痫涉及癫痫发生过程中神经细胞的重大变化。虽然癫痫发生的分子机制仍不清楚,但基因调控的变化在癫痫的演变中起着至关重要的作用。本研究旨在比较癫痫发生过程中特定基因子集的变化,重点关注首次自发性癫痫发作后的时期,以确定针对不同调控因子的关键时间窗口:方法:我们利用破伤风毒素诱导的大鼠获得性局灶性新皮质癫痫模型,描述了急性、亚急性和慢性阶段(分别为首次自发癫痫发作后48-72小时、2周和30天)的基因表达,重点研究了基因对癫痫进展的潜在贡献:结果:我们观察到这些基因的表达在首次自发癫痫发作后的整个阶段都发生了动态变化。星形胶质细胞的反应主要发生在早期,即癫痫确立之前。Mtor(哺乳动物雷帕霉素靶标)和Rest(抑制因子1沉默转录因子)信号通路的变化是高度动态的,并与癫痫的发展进程相关。Ccl2(趋化因子 C-C-motif 配体)在慢性阶段上调,表明神经炎症通路被激活。最后,Gabra5(γ-氨基丁酸能信号)在癫痫形成后的晚期出现下调。令人惊讶的是,特定基因表达的变化与首次癫痫发作后的时间有关,而不是与癫痫发作频率或持续时间有关:这些结果表明,在癫痫的发展过程中,特定基因的调控基本上是阶段性的,这凸显了在癫痫发展的适当阶段靶向特定基因的重要性。
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引用次数: 0
Transition from pediatric to adult care system in patients with complex epilepsies: Necker model for transition evaluated on 70 consecutive patients. 复杂癫痫患者从儿科到成人护理系统的过渡:对 70 名连续患者进行评估的内克尔过渡模式。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1111/epi.18178
Rima Nabbout, Agathe Molimard, Giovanna Scorrano, Melodie Aubart, Delphine Breuillard, Morgane Delaune, Giulia Barcia, Nicole Chemaly, Marie-Anne Barthez, Isabelle Desguerre

Objective: Complex epilepsies such as epileptic and developmental encephalopathies require multidisciplinary care throughout life. A coordinated transition program is therefore essential to provide optimal support for patients leaving pediatric for adult care. The aim of this study is to describe and evaluate our transition program for complex epilepsies, focusing on the last step in this program, that is, the multidisciplinary transition day hospital (MTDH).

Methods: We performed a retrospective observational study including patients with complex epilepsies who underwent the full steps of the transition program at Necker-Enfants Malades Hospital between May 2021 and June 2023, with a follow-up until February 2024. We described the cohort and detailed the interventions performed during the MTDH including medical, medicosocial, educational, daily life abilities, and laboratory and imaging assessments with the participation of one member of the adult team. We evaluated two indicators of our program: (1) the "adult first clinic attendance rate," defined by the percentage of patients attending their first adult clinic; and (2) the "return rate," defined by the percentage of patients who requested a pediatric encounter after their transfer.

Results: Our cohort included 70 patients with a mean age of 19.1 years (interquartile range = 16.3-19.5). Eighty percent had an epilepsy syndrome diagnosis; 72.8% were treated with three or more antiseizure medications. All patients had their appointment at the adult clinic within 6 months of the day hospital, and only two families requested a pediatric encounter after the transfer.

Significance: The transition program is key for an optimal transfer of patients with complex epilepsies to adult care. It requires a comprehensive multidisciplinary approach and provides a complete summary of the medical record. Our program secures a smooth landing in adult care and is a promising model to better manage the challenging transition process, especially in patients with complex epilepsy.

目的:癫痫和发育性脑病等复杂性癫痫需要多学科终身护理。因此,协调的过渡计划对于为离开儿科转入成人护理的患者提供最佳支持至关重要。本研究旨在描述和评估我们针对复杂性癫痫的过渡项目,重点是该项目中的最后一步,即多学科过渡日间医院(MTDH):我们进行了一项回顾性观察研究,研究对象包括2021年5月至2023年6月期间在Necker-Enfants Malades医院接受完整过渡项目的复杂性癫痫患者,随访至2024年2月。我们对队列进行了描述,并详细介绍了MTDH期间实施的干预措施,包括医疗、社会医疗、教育、日常生活能力以及实验室和影像评估,成人团队的一名成员也参与其中。我们对项目的两个指标进行了评估:(1)"成人首次就诊率",即首次就诊的成人患者比例;(2)"回访率",即转院后要求儿科就诊的患者比例:我们的队列中有 70 名患者,平均年龄为 19.1 岁(四分位数间距 = 16.3-19.5)。80%的患者确诊为癫痫综合征;72.8%的患者接受过三种或三种以上的抗癫痫药物治疗。所有患者都在日间医院就诊后 6 个月内预约了成人门诊,只有两个家庭在转院后要求儿科就诊:转院计划是将复杂癫痫患者最佳转入成人护理的关键。它需要综合的多学科方法,并提供完整的病历摘要。我们的方案可确保患者顺利转入成人医疗机构,是更好地管理具有挑战性的转院过程(尤其是复杂性癫痫患者)的一种可行模式。
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引用次数: 0
Long-term characterization of behavior phenotypes in children with seizures: Analytic approach matters. 癫痫发作儿童行为表型的长期特征:分析方法很重要。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1111/epi.18176
Karina Morales, Danielle Harvey, David Dunn, Jana Jones, Anna Byars, Joan Austin, Bruce Hermann, Temitayo Oyegbile-Chidi

Objective: Behavioral problems in children with new onset epilepsies have been well established in the literature. More recently, the literature indicates the presence of unique behavioral patterns or phenotypes in youth with epilepsy that vary significantly in vulnerability and resilience to behavioral problems. This study contrasts the interpretation of behavioral risk as inferred from cross-sectional versus latent group analytic perspectives, as well as the presence, consistency, stability, and progression of behavioral phenotypes in youth with new onset epilepsy and sibling controls over 3 years.

Methods: Three hundred twelve participants (6-16 years old) were recruited within 6 weeks of their first recognized seizure along with 223 unaffected siblings. Each child's behavior was recorded by parents and teachers frequently over 36 months using the Child Behavior Checklist (CBCL), and each child completed self-report measures of depression symptoms over 36 months. Measures were evaluated cross-sectionally and longitudinally to identify clusters with prototypical behavioral trajectories.

Results: Cross-sectional analyses exhibited a pattern of generalized and undifferentiated behavioral problems compared to sibling controls at baseline and prospectively. In contrast, latent trajectory modeling identified three distinct behavior phenotype clusters across all raters (parents, teachers, and youth) over baseline and longitudinal assessments. CBCL Cluster 1 (~30% of youth with epilepsy) exhibited behavior similar to/better than controls, Cluster 2 (~50%) exhibited moderate behavior issues, and Cluster 3 (~20%) exhibited the most pronounced/problematic behavior, falling into Achenbach's clinically relevant behavior range. Behavior within clusters remained stable and consistent. Teachers' and children's behavior assessments corresponded to these cluster groupings consistently over 36 months. Predictors of cluster membership include seizure syndrome type and social determinants of health.

Significance: This study demonstrates the varying public health perspectives of behavioral risk in youth with epilepsy that result as a function of analytic approach as well as the presence of distinct latent behavioral trajectory phenotypes over time in youth with new onset epilepsy.

目的:新发癫痫儿童的行为问题已在文献中得到充分证实。最近,有文献表明,青少年癫痫患者存在独特的行为模式或表型,这些行为模式或表型在行为问题的易感性和抗逆性方面存在显著差异。本研究对比了从横断面角度和潜在群体分析角度推断出的行为风险解释,以及新发癫痫青少年和兄弟姐妹对照组 3 年中行为表型的存在、一致性、稳定性和进展情况:在首次确认癫痫发作后 6 周内招募了 312 名参与者(6-16 岁)以及 223 名未受影响的兄弟姐妹。每个孩子的行为都由家长和老师在36个月内使用儿童行为检查表(CBCL)进行频繁记录,每个孩子都在36个月内完成了抑郁症状的自我报告测量。对测量结果进行了横向和纵向评估,以确定具有典型行为轨迹的群组:横断面分析显示,与基线和前瞻性的同胞对照组相比,儿童的行为问题具有普遍性和不确定性。与此相反,通过潜在轨迹建模,在基线和纵向评估中,所有评分者(家长、教师和青少年)都发现了三个不同的行为表型群组。CBCL 第 1 组(约 30% 的癫痫青少年)表现出与对照组相似/优于对照组的行为,第 2 组(约 50%)表现出中等程度的行为问题,第 3 组(约 20%)表现出最明显/有问题的行为,属于 Achenbach 的临床相关行为范围。群组内的行为保持稳定和一致。在 36 个月内,教师和儿童的行为评估与这些群组分组一致。群组成员资格的预测因素包括癫痫综合征类型和健康的社会决定因素:这项研究表明,不同的分析方法会导致对青少年癫痫患者行为风险的不同公共卫生观点,而且随着时间的推移,在新发癫痫患者中存在不同的潜在行为轨迹表型。
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引用次数: 0
Cerebellar transcranial magnetic stimulation to treat drug-resistant epilepsy: A randomized, controlled, crossover clinical trial. 小脑经颅磁刺激治疗耐药性癫痫:随机对照交叉临床试验。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-08 DOI: 10.1111/epi.18168
Yuan-Yuan Wang, Lei Ma, Xiao-Jing Shi, Yu Liu, Dian-Wei Wu, Jian-Min Hao, Xiu-Xiu Leng, Lang Jin, Fang Yuan, Zhong-Qing Sun, Jing-Jing Zhao, Ling Wang, Lei Shang, Duo-Lao Wang, Chang-Geng Song, Wen Jiang

Objective: Epilepsy is one of the most prevalent brain diseases. Approximately one third of patients consistently experience drug-resistant epilepsy (DRE), a condition where seizures persist despite the use of antiseizure medications. Exploration of new therapies for DRE is urgently needed. In this single-center, randomized, sham-controlled, crossover clinical trial (NCT05042726), we aimed to investigate the effectiveness and safety of transcranial magnetic continuous theta burst stimulation (cTBS) targeting the cerebellum to treat DRE.

Methods: Patients with DRE for ≥2 years and a seizure frequency of ≥2 seizures per month were enrolled and randomized 1:1 to receive active stimulation followed by sham stimulation or vice versa. The bilateral cerebellum was targeted by navigated cTBS focusing on the cerebellar dentate nucleus, once daily on workdays for 2 weeks. The primary outcomes were the percentage of seizure reduction and 50% responder rate in the per-protocol population within 2 months after treatment.

Results: Forty-four patients were enrolled and randomized; 18 patients in the active stimulation-first group and 20 in the sham stimulation-first group were included in the final analysis. Active cTBS significantly reduced seizures compared to sham stimulation (difference in percentage of seizure reduction between treatments = 25%, 95% confidence interval [CI] = 5%-46%, p = .018). The 50% responder rate after active stimulation was significantly higher than that after sham stimulation (difference in 50% responder rate between treatments = 24%, 95% CI = 11%-40%, p = .029). Adverse events occasionally occurred during active stimulation (moderate headache in 5% of patients, tinnitus in 3% of patients, dizziness in 3% of patients) but resolved spontaneously within days after treatment completion.

Significance: This trial suggested that cTBS targeting the cerebellum was effective and well tolerated in the treatment of DRE. Further studies are warranted to confirm its effectiveness and mechanism.

目的:癫痫是最常见的脑部疾病之一。约有三分之一的患者会持续出现耐药性癫痫(DRE),即使用抗癫痫药物后癫痫仍持续发作。探索治疗 DRE 的新疗法迫在眉睫。在这项单中心、随机、假对照、交叉临床试验(NCT05042726)中,我们旨在研究针对小脑的经颅磁连续θ脉冲刺激(cTBS)治疗DRE的有效性和安全性:入选的 DRE 患者病程≥2 年且每月发作频率≥2 次,按 1:1 随机分配接受主动刺激后再接受假刺激或反之。双侧小脑以小脑齿状核为中心进行导航式 cTBS 刺激,工作日每天一次,持续 2 周。主要结果是治疗后 2 个月内癫痫发作减少的百分比和按协议人群中 50% 的应答率:结果:44 名患者入组并进行了随机分组;18 名先接受主动刺激组和 20 名先接受假刺激组的患者被纳入最终分析。与假刺激相比,主动 cTBS 能明显减少癫痫发作(治疗间癫痫发作减少百分比差异 = 25%,95% 置信区间 [CI] = 5%-46%, p = .018)。主动刺激后的 50% 应答率明显高于假刺激后的 50% 应答率(不同治疗间的 50% 应答率差异 = 24%,95% 置信区间 [CI] = 11%-40%,p = .029)。在主动刺激过程中偶尔会出现不良反应(5% 的患者出现中度头痛,3% 的患者出现耳鸣,3% 的患者出现头晕),但在治疗结束后数天内即可自行缓解:这项试验表明,以小脑为靶点的 cTBS 治疗眩晕症有效且耐受性良好。有必要进行进一步研究,以确认其有效性和机制。
{"title":"Cerebellar transcranial magnetic stimulation to treat drug-resistant epilepsy: A randomized, controlled, crossover clinical trial.","authors":"Yuan-Yuan Wang, Lei Ma, Xiao-Jing Shi, Yu Liu, Dian-Wei Wu, Jian-Min Hao, Xiu-Xiu Leng, Lang Jin, Fang Yuan, Zhong-Qing Sun, Jing-Jing Zhao, Ling Wang, Lei Shang, Duo-Lao Wang, Chang-Geng Song, Wen Jiang","doi":"10.1111/epi.18168","DOIUrl":"https://doi.org/10.1111/epi.18168","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy is one of the most prevalent brain diseases. Approximately one third of patients consistently experience drug-resistant epilepsy (DRE), a condition where seizures persist despite the use of antiseizure medications. Exploration of new therapies for DRE is urgently needed. In this single-center, randomized, sham-controlled, crossover clinical trial (NCT05042726), we aimed to investigate the effectiveness and safety of transcranial magnetic continuous theta burst stimulation (cTBS) targeting the cerebellum to treat DRE.</p><p><strong>Methods: </strong>Patients with DRE for ≥2 years and a seizure frequency of ≥2 seizures per month were enrolled and randomized 1:1 to receive active stimulation followed by sham stimulation or vice versa. The bilateral cerebellum was targeted by navigated cTBS focusing on the cerebellar dentate nucleus, once daily on workdays for 2 weeks. The primary outcomes were the percentage of seizure reduction and 50% responder rate in the per-protocol population within 2 months after treatment.</p><p><strong>Results: </strong>Forty-four patients were enrolled and randomized; 18 patients in the active stimulation-first group and 20 in the sham stimulation-first group were included in the final analysis. Active cTBS significantly reduced seizures compared to sham stimulation (difference in percentage of seizure reduction between treatments = 25%, 95% confidence interval [CI] = 5%-46%, p = .018). The 50% responder rate after active stimulation was significantly higher than that after sham stimulation (difference in 50% responder rate between treatments = 24%, 95% CI = 11%-40%, p = .029). Adverse events occasionally occurred during active stimulation (moderate headache in 5% of patients, tinnitus in 3% of patients, dizziness in 3% of patients) but resolved spontaneously within days after treatment completion.</p><p><strong>Significance: </strong>This trial suggested that cTBS targeting the cerebellum was effective and well tolerated in the treatment of DRE. Further studies are warranted to confirm its effectiveness and mechanism.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Eating habits and behaviors in children with Dravet syndrome: A case-control study. 德雷维综合征患儿的饮食习惯和行为:病例对照研究
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-06 DOI: 10.1111/epi.18179
Alexandra Laliberté, Lyna Siafa, Arij Soufi, Christelle Dassi, Sophie J Russ-Hall, Ingrid E Scheffer, Kenneth A Myers

This study evaluated food preferences and eating behaviors of individuals with Dravet syndrome. Patients diagnosed with Dravet syndrome were recruited, as well as a control group composed of siblings of patients with epilepsy (any form). The Food Preference Questionnaire and the Child Eating Behavior Questionnaire were completed by caregivers along with two open-ended questions regarding eating challenges. Seventy-eight participants (45 with Dravet syndrome and 33 controls) were included. Compared to controls, mean scores for food preference were lower for fruits (p = .000099), meats and fish (p = .00094), and snacks (p = .000027) in Dravet syndrome. People with Dravet syndrome also had less emotional overeating (p = .0085) and food enjoyment (p = .0012), but more slowness in eating (p = .00021) and food fussiness (p = .0064). In a subgroup analysis of only pediatric (age <18 years) patients, similar results were observed for both food preferences and eating habits. In qualitative data, caregivers most commonly reported difficulties with fixation on specific foods. This study demonstrates specific food preferences and challenging eating behaviors in individuals with Dravet syndrome. These data provide potential avenues for nutritional interventions and behavioral therapies to increase the quality of life of patients and their families.

本研究评估了德雷维综合征患者的食物偏好和饮食行为。研究人员招募了被确诊患上德拉维特综合征的患者,以及由癫痫患者(任何形式)的兄弟姐妹组成的对照组。照顾者填写了食物偏好问卷和儿童进食行为问卷,以及两个有关进食挑战的开放式问题。研究共纳入 78 名参与者(45 名患有德雷维综合征,33 名为对照组)。与对照组患者相比,患有本病的患者对水果(p = .000099)、肉类和鱼类(p = .00094)以及零食(p = .000027)的食物偏好平均得分较低。此外,患有本病的人情绪暴饮暴食(p = .0085)和享受食物(p = .0012)的情况较少,但进食缓慢(p = .00021)和对食物大惊小怪(p = .0064)的情况较多。在一项分组分析中,只有儿童(年龄
{"title":"Eating habits and behaviors in children with Dravet syndrome: A case-control study.","authors":"Alexandra Laliberté, Lyna Siafa, Arij Soufi, Christelle Dassi, Sophie J Russ-Hall, Ingrid E Scheffer, Kenneth A Myers","doi":"10.1111/epi.18179","DOIUrl":"10.1111/epi.18179","url":null,"abstract":"<p><p>This study evaluated food preferences and eating behaviors of individuals with Dravet syndrome. Patients diagnosed with Dravet syndrome were recruited, as well as a control group composed of siblings of patients with epilepsy (any form). The Food Preference Questionnaire and the Child Eating Behavior Questionnaire were completed by caregivers along with two open-ended questions regarding eating challenges. Seventy-eight participants (45 with Dravet syndrome and 33 controls) were included. Compared to controls, mean scores for food preference were lower for fruits (p = .000099), meats and fish (p = .00094), and snacks (p = .000027) in Dravet syndrome. People with Dravet syndrome also had less emotional overeating (p = .0085) and food enjoyment (p = .0012), but more slowness in eating (p = .00021) and food fussiness (p = .0064). In a subgroup analysis of only pediatric (age <18 years) patients, similar results were observed for both food preferences and eating habits. In qualitative data, caregivers most commonly reported difficulties with fixation on specific foods. This study demonstrates specific food preferences and challenging eating behaviors in individuals with Dravet syndrome. These data provide potential avenues for nutritional interventions and behavioral therapies to increase the quality of life of patients and their families.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Imaging blood-brain barrier dysfunction in drug-resistant epilepsy: A multi-center feasibility study. 耐药性癫痫的血脑屏障功能障碍成像:多中心可行性研究
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-06 DOI: 10.1111/epi.18145
Nir Cafri, Sheida Mirloo, Daniel Zarhin, Lyna Kamintsky, Yonatan Serlin, Laith Alhadeed, Ilan Goldberg, Mark A Maclean, Ben Whatley, Ilia Urman, Colin P Doherty, Chris Greene, Claire Behan, Declan Brennan, Matthew Campbell, Chris Bowen, Gal Ben-Arie, Ilan Shelef, Britta Wandschneider, Matthias Koepp, Alon Friedman, Felix Benninger

Objective: Blood-brain barrier dysfunction (BBBD) has been linked to various neurological disorders, including epilepsy. This study aims to utilize dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to identify and compare brain regions with BBBD in patients with epilepsy (PWE) and healthy individuals.

Methods: We scanned 50 drug-resistant epilepsy (DRE) patients and 58 control participants from four global specialized epilepsy centers using DCE-MRI. The presence and extent of BBBD were analyzed and compared between PWE and healthy controls.

Results: Both greater brain volume and higher number of brain regions with BBBD were significantly present in PWE compared to healthy controls (p < 10-7). No differences in total brain volume with BBBD were observed in patients diagnosed with either focal seizures or generalized epilepsy, despite variations in the affected regions. Overall brain volume with BBBD did not differ in PWE with MRI-visible lesions compared with non-lesional cases. BBBD was observed in brain regions suspected to be related to the onset of seizures in 82% of patients (n = 39) and was typically identified in, adjacent to, and/or in the same hemisphere as the suspected epileptogenic lesion (n = 10).

Significance: These findings are consistent with pre-clinical studies that highlight the role of BBBD in the development of DRE and identify microvascular stabilization as a potential therapeutic strategy.

目的:血脑屏障功能障碍(BBBD)与包括癫痫在内的多种神经系统疾病有关。本研究旨在利用动态对比增强磁共振成像(DCE-MRI)来识别和比较癫痫患者(PWE)和健康人存在血脑屏障功能障碍的脑区:我们使用 DCE-MRI 扫描了来自全球四个专业癫痫中心的 50 名耐药性癫痫 (DRE) 患者和 58 名对照组参与者。方法:我们使用 DCE-MRI 扫描了来自全球四个专业癫痫中心的 50 名耐药性癫痫患者和 58 名对照组参与者,分析并比较了 PWE 和健康对照组之间 BBBD 的存在和程度:结果:与健康对照组相比,PWE 患者的脑容量更大,具有 BBBD 的脑区数量更多(p -7)。在被诊断为局灶性癫痫发作或全身性癫痫的患者中,尽管受影响的区域不同,但未观察到伴有BBBD的总脑容量存在差异。与无病变病例相比,有磁共振成像可见病灶的PWE患者有BBBD的总脑容量没有差异。82%的患者(n = 39)在怀疑与癫痫发作有关的脑区观察到了BBBD,并且通常在怀疑致痫病灶(n = 10)所在、邻近和/或同一半球中发现:这些研究结果与临床前研究一致,临床前研究强调了 BBBD 在 DRE 发病中的作用,并将稳定微血管确定为一种潜在的治疗策略。
{"title":"Imaging blood-brain barrier dysfunction in drug-resistant epilepsy: A multi-center feasibility study.","authors":"Nir Cafri, Sheida Mirloo, Daniel Zarhin, Lyna Kamintsky, Yonatan Serlin, Laith Alhadeed, Ilan Goldberg, Mark A Maclean, Ben Whatley, Ilia Urman, Colin P Doherty, Chris Greene, Claire Behan, Declan Brennan, Matthew Campbell, Chris Bowen, Gal Ben-Arie, Ilan Shelef, Britta Wandschneider, Matthias Koepp, Alon Friedman, Felix Benninger","doi":"10.1111/epi.18145","DOIUrl":"10.1111/epi.18145","url":null,"abstract":"<p><strong>Objective: </strong>Blood-brain barrier dysfunction (BBBD) has been linked to various neurological disorders, including epilepsy. This study aims to utilize dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to identify and compare brain regions with BBBD in patients with epilepsy (PWE) and healthy individuals.</p><p><strong>Methods: </strong>We scanned 50 drug-resistant epilepsy (DRE) patients and 58 control participants from four global specialized epilepsy centers using DCE-MRI. The presence and extent of BBBD were analyzed and compared between PWE and healthy controls.</p><p><strong>Results: </strong>Both greater brain volume and higher number of brain regions with BBBD were significantly present in PWE compared to healthy controls (p < 10<sup>-7</sup>). No differences in total brain volume with BBBD were observed in patients diagnosed with either focal seizures or generalized epilepsy, despite variations in the affected regions. Overall brain volume with BBBD did not differ in PWE with MRI-visible lesions compared with non-lesional cases. BBBD was observed in brain regions suspected to be related to the onset of seizures in 82% of patients (n = 39) and was typically identified in, adjacent to, and/or in the same hemisphere as the suspected epileptogenic lesion (n = 10).</p><p><strong>Significance: </strong>These findings are consistent with pre-clinical studies that highlight the role of BBBD in the development of DRE and identify microvascular stabilization as a potential therapeutic strategy.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Histopathological substrate of increased T2 signal in the anterior temporal lobe white matter in temporal lobe epilepsy associated with hippocampal sclerosis. 与海马硬化相关的颞叶癫痫前颞叶白质中 T2 信号增加的组织病理学基础。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-06 DOI: 10.1111/epi.18162
Ricardo C Wainberg, William Alves Martins, Francine H de Oliveira, Eliseu Paglioli, Ricardo Paganin, Ricardo Soder, Rafael Paglioli, Thomas M Frigeri, Matteo Baldisseroto, André Palmini

Objective: This study was undertaken to analyze the histology underlying increased T2 signal intensity (iT2SI) in anterior temporal lobe white matter (aTLWM) epilepsy due to hippocampal sclerosis (TLE/HS).

Methods: Twenty-three patients were included: 16 with increased T2 signal in the aTLWM and seven with HS only. Magnetic resonance imaging (MRI) findings were consistent across two neuroradiologists (kappa = .89, p < .001). Quantification of neuronal cells, astrocytes, oligodendrocytes, and vacuolization in the white matter of temporal lobe specimens was performed by immunohistochemistry (neuronal nuclear antigen, glial fibrillary acidic protein, oligodendrocyte transcription factor, and basic myelin protein, respectively). Surgical specimens from TLE/HS patients with and without iT2SI in the aTLWM were compared. Samples of aTLWM were divided into three groups, according to MRI features: G1 = samples of iT2SI, G2 = samples with normal T2 signal intensity from patients without white matter imaging abnormalities, and G3 = samples with normal T2 signal intensity adjacent to areas with iT2SI.

Results: Patients with increased T2 signal had a significantly younger age at epilepsy onset (p < .035). Histological analysis revealed a higher percentage of vacuolar area in these patients (p < .004) along with a lower number of ectopic neurons (p = .042). No significant differences were found in astrocyte or oligodendrocyte counts among groups.

Significance: A higher proportion of vacuoles in regions with iT2SI may be the histopathologic substrate of this signal alteration in the white matter of the temporal lobe in patients with TLE/HS. This method of quantifying vacuoles using digital image analysis proved reliable and cost-effective.

研究目的本研究旨在分析海马硬化导致的前颞叶白质(aTLWM)癫痫(TLE/HS)T2信号强度增加(iT2SI)的组织学基础:纳入23名患者:方法:共纳入23名患者:16名aTLWM中T2信号增高的患者和7名仅患有HS的患者。两名神经放射学专家的磁共振成像(MRI)结果一致(kappa = .89,p 结果:T2信号增高的患者的T2信号比TLE/HS患者的T2信号高:T2信号增高的患者癫痫发病年龄明显较小(p 有意义:iT2SI区域空泡比例较高可能是TLE/HS患者颞叶白质信号改变的组织病理学基础。事实证明,这种利用数字图像分析量化空泡的方法既可靠又经济。
{"title":"Histopathological substrate of increased T2 signal in the anterior temporal lobe white matter in temporal lobe epilepsy associated with hippocampal sclerosis.","authors":"Ricardo C Wainberg, William Alves Martins, Francine H de Oliveira, Eliseu Paglioli, Ricardo Paganin, Ricardo Soder, Rafael Paglioli, Thomas M Frigeri, Matteo Baldisseroto, André Palmini","doi":"10.1111/epi.18162","DOIUrl":"10.1111/epi.18162","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to analyze the histology underlying increased T2 signal intensity (iT2SI) in anterior temporal lobe white matter (aTLWM) epilepsy due to hippocampal sclerosis (TLE/HS).</p><p><strong>Methods: </strong>Twenty-three patients were included: 16 with increased T2 signal in the aTLWM and seven with HS only. Magnetic resonance imaging (MRI) findings were consistent across two neuroradiologists (kappa = .89, p < .001). Quantification of neuronal cells, astrocytes, oligodendrocytes, and vacuolization in the white matter of temporal lobe specimens was performed by immunohistochemistry (neuronal nuclear antigen, glial fibrillary acidic protein, oligodendrocyte transcription factor, and basic myelin protein, respectively). Surgical specimens from TLE/HS patients with and without iT2SI in the aTLWM were compared. Samples of aTLWM were divided into three groups, according to MRI features: G1 = samples of iT2SI, G2 = samples with normal T2 signal intensity from patients without white matter imaging abnormalities, and G3 = samples with normal T2 signal intensity adjacent to areas with iT2SI.</p><p><strong>Results: </strong>Patients with increased T2 signal had a significantly younger age at epilepsy onset (p < .035). Histological analysis revealed a higher percentage of vacuolar area in these patients (p < .004) along with a lower number of ectopic neurons (p = .042). No significant differences were found in astrocyte or oligodendrocyte counts among groups.</p><p><strong>Significance: </strong>A higher proportion of vacuoles in regions with iT2SI may be the histopathologic substrate of this signal alteration in the white matter of the temporal lobe in patients with TLE/HS. This method of quantifying vacuoles using digital image analysis proved reliable and cost-effective.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-term neuroplasticity in language networks after anterior temporal lobe resection. 前颞叶切除术后语言网络的长期神经可塑性。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-06 DOI: 10.1111/epi.18147
Maria Sablik, Marine N Fleury, Lawrence P Binding, David P Carey, Giovanni d'Avossa, Sallie Baxendale, Gavin P Winston, John S Duncan, Meneka K Sidhu

Objective: Anterior temporal lobe resection (ATLR) is an effective treatment for drug-resistant temporal lobe epilepsy (TLE), although language deficits may occur after both left and right ATLR. Functional reorganization of the language network has been observed in the ipsilateral and contralateral hemispheres within 12 months after ATLR, but little is known of longer-term plasticity effects. Our aim was to examine the plasticity of language functions up to a decade after ATLR, in relation to cognitive profiles.

Methods: We examined 24 TLE patients (12 left [LTLE]) and 10 controls across four time points: pre-surgery, 4 months, 12 months, and ~9 years post-ATLR. Participants underwent standard neuropsychological assessments (naming, phonemic, and categorical fluency tests) and a verbal fluency functional magnetic resonance imaging (fMRI) task. Using a flexible factorial design, we analyzed longitudinal fMRI activations from 12 months to ~9 years post-ATLR, relative to controls, with separate analyses for people with hippocampal sclerosis (HS). Change in cognitive profiles was correlated with the long-term change in fMRI activations to determine the "efficiency" of reorganized networks.

Results: LTLE patients had increased long-term engagement of the left extra-temporal and contralateral temporal regions, with better language performance linked to bilateral activation. Those with HS exhibited more widespread bilateral activations. RTLE patients showed plasticity in the left extra-temporal regions, with better language outcomes associated with these areas. Both groups of patients achieved cognitive stability over 9 years, with more than 50% of LTLE patients improving. Older age, longer epilepsy duration, and lower pre-operative cognitive reserve negatively affected long-term language performance.

Significance: Neuroplasticity continues for up to ~9 years post-epilepsy surgery in LTLE and RTLE, with effective language recovery linked to bilateral engagement of temporal and extra-temporal regions. This adaptive reorganization is associated with improved cognitive outcomes, challenging the traditional view of localized surgery effects. These findings emphasize the need for early intervention, tailored pre-operative counseling, and the potential for continued cognitive gains with extended post-ATLR rehabilitation.

目的:前颞叶切除术(ATLR)是治疗耐药性颞叶癫痫(TLE)的有效方法,但左右颞叶切除术后都可能出现语言障碍。在ATLR术后12个月内,同侧和对侧大脑半球都观察到了语言网络的功能重组,但对长期的可塑性影响却知之甚少。我们的目的是研究 ATLR 后十年内语言功能的可塑性与认知特征的关系:我们对 24 名 TLE 患者(12 名左侧患者 [LTLE])和 10 名对照组患者进行了检查,共分为四个时间点:ATLR 术前、术后 4 个月、术后 12 个月和术后约 9 年。受试者接受了标准的神经心理学评估(命名、音位和分类流利性测试)和言语流利性功能磁共振成像(fMRI)任务。我们采用灵活的因子设计,分析了ATLR后12个月至约9年期间相对于对照组的纵向fMRI激活情况,并对海马硬化症(HS)患者进行了单独分析。认知概况的变化与fMRI激活的长期变化相关联,以确定重组网络的 "效率":结果:LTLE 患者左侧颞外和对侧颞区的长期参与度增加,语言能力的提高与双侧激活有关。HS患者则表现出更广泛的双侧激活。RTLE患者的左侧颞外区域表现出可塑性,语言成绩的提高与这些区域有关。两组患者的认知能力在9年内都趋于稳定,其中超过50%的LTLE患者的认知能力有所改善。年龄越大、癫痫持续时间越长、术前认知储备越低,对长期语言表现的影响越不利:LTLE和RTLE患者在癫痫手术后的神经可塑性可持续长达约9年,语言的有效恢复与颞区和颞外区的双侧参与有关。这种适应性重组与认知结果的改善有关,挑战了手术局部效应的传统观点。这些发现强调了早期干预、量身定制的术前咨询的必要性,以及通过延长ATLR术后康复来继续提高认知能力的潜力。
{"title":"Long-term neuroplasticity in language networks after anterior temporal lobe resection.","authors":"Maria Sablik, Marine N Fleury, Lawrence P Binding, David P Carey, Giovanni d'Avossa, Sallie Baxendale, Gavin P Winston, John S Duncan, Meneka K Sidhu","doi":"10.1111/epi.18147","DOIUrl":"10.1111/epi.18147","url":null,"abstract":"<p><strong>Objective: </strong>Anterior temporal lobe resection (ATLR) is an effective treatment for drug-resistant temporal lobe epilepsy (TLE), although language deficits may occur after both left and right ATLR. Functional reorganization of the language network has been observed in the ipsilateral and contralateral hemispheres within 12 months after ATLR, but little is known of longer-term plasticity effects. Our aim was to examine the plasticity of language functions up to a decade after ATLR, in relation to cognitive profiles.</p><p><strong>Methods: </strong>We examined 24 TLE patients (12 left [LTLE]) and 10 controls across four time points: pre-surgery, 4 months, 12 months, and ~9 years post-ATLR. Participants underwent standard neuropsychological assessments (naming, phonemic, and categorical fluency tests) and a verbal fluency functional magnetic resonance imaging (fMRI) task. Using a flexible factorial design, we analyzed longitudinal fMRI activations from 12 months to ~9 years post-ATLR, relative to controls, with separate analyses for people with hippocampal sclerosis (HS). Change in cognitive profiles was correlated with the long-term change in fMRI activations to determine the \"efficiency\" of reorganized networks.</p><p><strong>Results: </strong>LTLE patients had increased long-term engagement of the left extra-temporal and contralateral temporal regions, with better language performance linked to bilateral activation. Those with HS exhibited more widespread bilateral activations. RTLE patients showed plasticity in the left extra-temporal regions, with better language outcomes associated with these areas. Both groups of patients achieved cognitive stability over 9 years, with more than 50% of LTLE patients improving. Older age, longer epilepsy duration, and lower pre-operative cognitive reserve negatively affected long-term language performance.</p><p><strong>Significance: </strong>Neuroplasticity continues for up to ~9 years post-epilepsy surgery in LTLE and RTLE, with effective language recovery linked to bilateral engagement of temporal and extra-temporal regions. This adaptive reorganization is associated with improved cognitive outcomes, challenging the traditional view of localized surgery effects. These findings emphasize the need for early intervention, tailored pre-operative counseling, and the potential for continued cognitive gains with extended post-ATLR rehabilitation.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Machine learning for forecasting initial seizure onset in neonatal hypoxic-ischemic encephalopathy. 预测新生儿缺氧缺血性脑病初期发作的机器学习。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-04 DOI: 10.1111/epi.18163
Danilo Bernardo, Jonathan Kim, Marie-Coralie Cornet, Adam L Numis, Aaron Scheffler, Vikram R Rao, Edilberto Amorim, Hannah C Glass

Objective: This study was undertaken to develop a machine learning (ML) model to forecast initial seizure onset in neonatal hypoxic-ischemic encephalopathy (HIE) utilizing clinical and quantitative electroencephalogram (QEEG) features.

Methods: We developed a gradient boosting ML model (Neo-GB) that utilizes clinical features and QEEG to forecast time-dependent seizure risk. Clinical variables included cord blood gas values, Apgar scores, gestational age at birth, postmenstrual age (PMA), postnatal age, and birth weight. QEEG features included statistical moments, spectral power, and recurrence quantification analysis (RQA) features. We trained and evaluated Neo-GB on a University of California, San Francisco (UCSF) neonatal HIE dataset, augmenting training with publicly available neonatal electroencephalogram (EEG) datasets from Cork University and Helsinki University Hospitals. We assessed the performance of Neo-GB at providing dynamic and static forecasts with diagnostic performance metrics and incident/dynamic area under the receiver operating characteristic curve (iAUC) analyses. Model explanations were performed to assess contributions of QEEG features and channels to model predictions.

Results: The UCSF dataset included 60 neonates with HIE (30 with seizures). In subject-level static forecasting at 30 min after EEG initiation, baseline Neo-GB without time-dependent features had an area under the receiver operating characteristic curve (AUROC) of .76 and Neo-GB with time-dependent features had an AUROC of .89. In time-dependent evaluation of the initial seizure onset within a 24-h seizure occurrence period, dynamic forecast with Neo-GB demonstrated median iAUC = .79 (interquartile range [IQR] .75-.82) and concordance index (C-index) = .82, whereas baseline static forecast at 30 min demonstrated median iAUC = .75 (IQR .72-.76) and C-index = .69. Model explanation analysis revealed that spectral power, PMA, RQA, and cord blood gas values made the strongest contributions in driving Neo-GB predictions. Within the most influential EEG channels, as the preictal period advanced toward eventual seizure, there was an upward trend in broadband spectral power.

Significance: This study demonstrates an ML model that combines QEEG with clinical features to forecast time-dependent risk of initial seizure onset in neonatal HIE. Spectral power evolution is an early EEG marker of seizure risk in neonatal HIE.

研究目的本研究旨在开发一种机器学习(ML)模型,利用临床和定量脑电图(QEEG)特征预测新生儿缺氧缺血性脑病(HIE)的初始癫痫发作:我们开发了一种梯度提升 ML 模型(Neo-GB),利用临床特征和 QEEG 预测随时间变化的癫痫发作风险。临床变量包括脐带血气值、Apgar 评分、胎龄、经后年龄 (PMA)、产后年龄和出生体重。QEEG 特征包括统计矩、频谱功率和复发量化分析 (RQA) 特征。我们在加州大学旧金山分校(UCSF)的新生儿 HIE 数据集上对 Neo-GB 进行了训练和评估,并利用科克大学和赫尔辛基大学医院公开提供的新生儿脑电图(EEG)数据集对训练进行了补充。我们通过诊断性能指标和接收器工作特征曲线下的事件/动态面积(iAUC)分析,评估了 Neo-GB 在提供动态和静态预测方面的性能。对模型进行了解释,以评估 QEEG 特征和通道对模型预测的贡献:加州大学旧金山分校的数据集包括 60 名患有 HIE 的新生儿(30 名患有癫痫发作)。在脑电图开始后 30 分钟的受试者级静态预测中,无时间依赖特征的基线 Neo-GB 的接收器操作特征曲线下面积 (AUROC) 为 0.76,而有时间依赖特征的 Neo-GB 的接收器操作特征曲线下面积 (AUROC) 为 0.89。在对 24 小时发作发生期内的初始发作进行时间依赖性评估时,使用 Neo-GB 进行动态预测的中位 iAUC = .79(四分位距 [IQR] .75-.82)和一致性指数 (C-index) = .82,而 30 分钟的基线静态预测的中位 iAUC = .75(四分位距 [IQR] .72-.76)和 C-index = .69。模型解释分析表明,频谱功率、PMA、RQA 和脐带血气体值对 Neo-GB 预测的贡献最大。在最有影响力的脑电图通道中,随着发作前期向最终发作的推进,宽带频谱功率呈上升趋势:本研究展示了一种结合 QEEG 和临床特征的多重多重模式,可预测新生儿 HIE 中随时间变化的初始癫痫发作风险。频谱功率演变是新生儿 HIE 癫痫发作风险的早期脑电图标记。
{"title":"Machine learning for forecasting initial seizure onset in neonatal hypoxic-ischemic encephalopathy.","authors":"Danilo Bernardo, Jonathan Kim, Marie-Coralie Cornet, Adam L Numis, Aaron Scheffler, Vikram R Rao, Edilberto Amorim, Hannah C Glass","doi":"10.1111/epi.18163","DOIUrl":"https://doi.org/10.1111/epi.18163","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to develop a machine learning (ML) model to forecast initial seizure onset in neonatal hypoxic-ischemic encephalopathy (HIE) utilizing clinical and quantitative electroencephalogram (QEEG) features.</p><p><strong>Methods: </strong>We developed a gradient boosting ML model (Neo-GB) that utilizes clinical features and QEEG to forecast time-dependent seizure risk. Clinical variables included cord blood gas values, Apgar scores, gestational age at birth, postmenstrual age (PMA), postnatal age, and birth weight. QEEG features included statistical moments, spectral power, and recurrence quantification analysis (RQA) features. We trained and evaluated Neo-GB on a University of California, San Francisco (UCSF) neonatal HIE dataset, augmenting training with publicly available neonatal electroencephalogram (EEG) datasets from Cork University and Helsinki University Hospitals. We assessed the performance of Neo-GB at providing dynamic and static forecasts with diagnostic performance metrics and incident/dynamic area under the receiver operating characteristic curve (iAUC) analyses. Model explanations were performed to assess contributions of QEEG features and channels to model predictions.</p><p><strong>Results: </strong>The UCSF dataset included 60 neonates with HIE (30 with seizures). In subject-level static forecasting at 30 min after EEG initiation, baseline Neo-GB without time-dependent features had an area under the receiver operating characteristic curve (AUROC) of .76 and Neo-GB with time-dependent features had an AUROC of .89. In time-dependent evaluation of the initial seizure onset within a 24-h seizure occurrence period, dynamic forecast with Neo-GB demonstrated median iAUC = .79 (interquartile range [IQR] .75-.82) and concordance index (C-index) = .82, whereas baseline static forecast at 30 min demonstrated median iAUC = .75 (IQR .72-.76) and C-index = .69. Model explanation analysis revealed that spectral power, PMA, RQA, and cord blood gas values made the strongest contributions in driving Neo-GB predictions. Within the most influential EEG channels, as the preictal period advanced toward eventual seizure, there was an upward trend in broadband spectral power.</p><p><strong>Significance: </strong>This study demonstrates an ML model that combines QEEG with clinical features to forecast time-dependent risk of initial seizure onset in neonatal HIE. Spectral power evolution is an early EEG marker of seizure risk in neonatal HIE.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distinct comorbidity phenotypes among post-9/11 Veterans with epilepsy are linked to diverging outcomes and mortality risks. 9/11事件后退伍军人癫痫患者不同的合并症表型与不同的治疗结果和死亡风险有关。
IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-02 DOI: 10.1111/epi.18170
Mary Jo Pugh, Heidi Munger Clary, Madeleine Myers, Eamonn Kennedy, Megan Amuan, Alicia A Swan, Sidney Hinds, W Curt LaFrance, Hamada Altalib, Alan Towne, Amy Henion, Abigail White, Christine Baca, Chen-Pin Wang

Objective: To investigate phenotypes of comorbidity before and after an epilepsy diagnosis in a national cohort of post-9/11 Service Members and Veterans and explore phenotypic associations with mortality.

Methods: Among a longitudinal cohort of Service Members and Veterans receiving care in the Veterans Health Administration (VHA) from 2002 to 2018, annual diagnoses for 26 conditions associated with epilepsy were collected over 5 years, ranging from 2 years prior to 2 years after the year of first epilepsy diagnosis. Latent class analysis (LCA) was used to identify probabilistic comorbidity phenotypes with distinct health trajectories. Descriptive statistics were used to describe the characteristics of each phenotype. Fine and Gray cause-specific survival models were used to measure mortality outcomes for each phenotype up to 2021.

Results: Six distinct phenotypes were identified: (1) relatively healthy, (2) post-traumatic stress disorder, (3) anxiety and depression, (4) chronic disease, (5) bipolar/substance use disorder, and (6) polytrauma. Accidents were the most common cause of death overall, followed by suicide/mental health and cancer, respectively. Each phenotype exhibited unique associations with mortality and cause of death, highlighting the differential impact of comorbidity patterns on patient outcomes.

Significance: By delineating clinically meaningful epilepsy comorbidity phenotypes, this study offers a framework for clinicians to tailor interventions. Moreover, these data support systems of care that facilitate treatment of epilepsy and comorbidities within an interdisciplinary health team that allows continuity of care. Targeting treatment toward patients with epilepsy who present with specific heightened risks could help mitigate adverse outcomes and enhance overall patient care.

目的调查9/11后军人和退伍军人全国队列中癫痫诊断前后的合并症表型,并探讨表型与死亡率的关联:在2002年至2018年期间接受退伍军人健康管理局(VHA)护理的军人和退伍军人纵向队列中,收集了与癫痫相关的26种疾病的年度诊断,诊断时间为首次癫痫诊断年之前2年至之后2年,历时5年。潜类分析(LCA)用于识别具有不同健康轨迹的概率合并症表型。描述性统计用于描述每种表型的特征。使用 Fine 和 Gray 病因特异性生存模型来测量每个表型直到 2021 年的死亡率结果:结果:确定了六种不同的表型:结果:确定了六种不同的表型:(1) 相对健康;(2) 创伤后应激障碍;(3) 焦虑和抑郁;(4) 慢性疾病;(5) 躁郁症/药物使用障碍;(6) 多重创伤。事故是最常见的死亡原因,其次分别是自杀/精神疾病和癌症。每种表型都与死亡率和死因有独特的关联,凸显了合并症模式对患者预后的不同影响:本研究通过划分具有临床意义的癫痫合并症表型,为临床医生提供了一个量身定制干预措施的框架。此外,这些数据还支持在跨学科医疗团队内促进癫痫和合并症治疗的护理系统,从而实现护理的连续性。对具有特定高风险的癫痫患者进行针对性治疗,有助于减轻不良后果并加强对患者的整体护理。
{"title":"Distinct comorbidity phenotypes among post-9/11 Veterans with epilepsy are linked to diverging outcomes and mortality risks.","authors":"Mary Jo Pugh, Heidi Munger Clary, Madeleine Myers, Eamonn Kennedy, Megan Amuan, Alicia A Swan, Sidney Hinds, W Curt LaFrance, Hamada Altalib, Alan Towne, Amy Henion, Abigail White, Christine Baca, Chen-Pin Wang","doi":"10.1111/epi.18170","DOIUrl":"https://doi.org/10.1111/epi.18170","url":null,"abstract":"<p><strong>Objective: </strong>To investigate phenotypes of comorbidity before and after an epilepsy diagnosis in a national cohort of post-9/11 Service Members and Veterans and explore phenotypic associations with mortality.</p><p><strong>Methods: </strong>Among a longitudinal cohort of Service Members and Veterans receiving care in the Veterans Health Administration (VHA) from 2002 to 2018, annual diagnoses for 26 conditions associated with epilepsy were collected over 5 years, ranging from 2 years prior to 2 years after the year of first epilepsy diagnosis. Latent class analysis (LCA) was used to identify probabilistic comorbidity phenotypes with distinct health trajectories. Descriptive statistics were used to describe the characteristics of each phenotype. Fine and Gray cause-specific survival models were used to measure mortality outcomes for each phenotype up to 2021.</p><p><strong>Results: </strong>Six distinct phenotypes were identified: (1) relatively healthy, (2) post-traumatic stress disorder, (3) anxiety and depression, (4) chronic disease, (5) bipolar/substance use disorder, and (6) polytrauma. Accidents were the most common cause of death overall, followed by suicide/mental health and cancer, respectively. Each phenotype exhibited unique associations with mortality and cause of death, highlighting the differential impact of comorbidity patterns on patient outcomes.</p><p><strong>Significance: </strong>By delineating clinically meaningful epilepsy comorbidity phenotypes, this study offers a framework for clinicians to tailor interventions. Moreover, these data support systems of care that facilitate treatment of epilepsy and comorbidities within an interdisciplinary health team that allows continuity of care. Targeting treatment toward patients with epilepsy who present with specific heightened risks could help mitigate adverse outcomes and enhance overall patient care.</p>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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