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1.
Nat Commun ; 12(1): 1423, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33658509

RESUMEN

In the mammalian hippocampus, adult-born granule cells (abGCs) contribute to the function of the dentate gyrus (DG). Disruption of the DG circuitry causes spontaneous recurrent seizures (SRS), which can lead to epilepsy. Although abGCs contribute to local inhibitory feedback circuitry, whether they are involved in epileptogenesis remains elusive. Here, we identify a critical window of activity associated with the aberrant maturation of abGCs characterized by abnormal dendrite morphology, ectopic migration, and SRS. Importantly, in a mouse model of temporal lobe epilepsy, silencing aberrant abGCs during this critical period reduces abnormal dendrite morphology, cell migration, and SRS. Using mono-synaptic tracers, we show silencing aberrant abGCs decreases recurrent CA3 back-projections and restores proper cortical connections to the hippocampus. Furthermore, we show that GABA-mediated amplification of intracellular calcium regulates the early critical period of activity. Our results demonstrate that aberrant neurogenesis rewires hippocampal circuitry aggravating epilepsy in mice.


Asunto(s)
Epilepsia/fisiopatología , Hipocampo/fisiopatología , Neurogénesis/fisiología , Animales , Calcio/metabolismo , Clozapina/análogos & derivados , Clozapina/farmacología , Modelos Animales de Enfermedad , Electroencefalografía , Epilepsia del Lóbulo Temporal/fisiopatología , Femenino , Ratones Endogámicos C57BL , Ratones Transgénicos , Neurogénesis/efectos de los fármacos , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Neuronas/patología , Pilocarpina/farmacología , Retroviridae/genética , Convulsiones/fisiopatología , Ácido gamma-Aminobutírico/metabolismo
2.
Nat Commun ; 12(1): 1539, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33750784

RESUMEN

Vagus nerve stimulation (VNS) is thought to affect neural activity by recruiting brain-wide release of neuromodulators. VNS is used in treatment-resistant epilepsy, and is increasingly being explored for other disorders, such as depression, and as a cognitive enhancer. However, the promise of VNS is only partially fulfilled due to a lack of mechanistic understanding of the transfer function between stimulation parameters and neuromodulatory response, together with a lack of biosensors for assaying stimulation efficacy in real time. We here develop an approach to VNS in head-fixed mice on a treadmill and show that pupil dilation is a reliable and convenient biosensor for VNS-evoked cortical neuromodulation. In an 'optimal' zone of stimulation parameters, current leakage and off-target effects are minimized and the extent of pupil dilation tracks VNS-evoked basal-forebrain cholinergic axon activity in neocortex. Thus, pupil dilation is a sensitive readout of the moment-by-moment, titratable effects of VNS on brain state.


Asunto(s)
Pupila/fisiología , Nervio Vago/fisiología , Animales , Encéfalo , Corteza Cerebelosa/fisiología , Epilepsia/fisiopatología , Femenino , Locus Coeruleus/patología , Masculino , Ratones , Ratones Endogámicos C57BL , Estimulación del Nervio Vago , Vigilia/fisiología
3.
Nat Commun ; 12(1): 1027, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33589639

RESUMEN

Sleep spindles facilitate memory consolidation in the cortex during mammalian non-rapid eye movement sleep. In rodents, phase-locked firing during spindles may facilitate spike-timing-dependent plasticity by grouping pre-then-post-synaptic cell firing within ~25 ms. Currently, microphysiological evidence in humans for conditions conducive for spike-timing-dependent plasticity during spindles is absent. Here, we analyze field potentials and unit firing from middle/upper layers during spindles from 10 × 10 microelectrode arrays at 400 µm pitch in humans. We report strong tonic and phase-locked increases in firing and co-firing within 25 ms during spindles, especially those co-occurring with down-to-upstate transitions. Co-firing, spindle co-occurrence, and spindle coherence are greatest within ~2 mm, and high co-firing of units on different contacts depends on high spindle coherence between those contacts. Spindles propagate at ~0.28 m/s in distinct patterns, with correlated cell co-firing sequences. Spindles hence organize spatiotemporal patterns of neuronal co-firing in ways that may provide pre-conditions for plasticity during non-rapid eye movement sleep.


Asunto(s)
Potenciales de Acción/fisiología , Corteza Cerebral/fisiología , Consolidación de la Memoria/fisiología , Plasticidad Neuronal/fisiología , Neuronas/fisiología , Sueño REM/fisiología , Adulto , Corteza Cerebral/anatomía & histología , Electrodos Implantados , Electroencefalografía , Epilepsia/patología , Epilepsia/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuronas/citología , Técnicas Estereotáxicas
4.
Nat Commun ; 12(1): 1080, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33597538

RESUMEN

Clinicians have long been interested in functional brain monitoring, as reversible functional losses often precedes observable irreversible structural insults. By characterizing neonatal functional cerebral networks, resting-state functional connectivity is envisioned to provide early markers of cognitive impairments. Here we present a pioneering bedside deep brain resting-state functional connectivity imaging at 250-µm resolution on human neonates using functional ultrasound. Signal correlations between cerebral regions unveil interhemispheric connectivity in very preterm newborns. Furthermore, fine-grain correlations between homologous pixels are consistent with white/grey matter organization. Finally, dynamic resting-state connectivity reveals a significant occurrence decrease of thalamo-cortical networks for very preterm neonates as compared to control term newborns. The same method also shows abnormal patterns in a congenital seizure disorder case compared with the control group. These results pave the way to infants' brain continuous monitoring and may enable the identification of abnormal brain development at the bedside.


Asunto(s)
Encéfalo/diagnóstico por imagen , Corteza Cerebral/diagnóstico por imagen , Epilepsia/diagnóstico por imagen , Sustancia Gris/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Algoritmos , Encéfalo/fisiopatología , Corteza Cerebral/fisiopatología , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Femenino , Sustancia Gris/fisiopatología , Humanos , Recién Nacido , Recien Nacido Prematuro , Imagen por Resonancia Magnética/métodos , Masculino , Modelos Neurológicos , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/fisiopatología , Ultrasonografía Doppler/métodos , Sustancia Blanca/fisiopatología
5.
J Stroke Cerebrovasc Dis ; 30(4): 105656, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33571877

RESUMEN

OBJECTIVES: Post-stroke complications affect stroke survivors across the world, although data on them are limited. We conducted a questionnaire survey to examine the real-world state and issues regarding post-stroke complications in Japan, which represents a super-aged society. MATERIALS AND METHODS: In 2018, a nationwide multi-center questionnaire survey was conducted in the top 500 Japanese hospitals regarding the number of stroke patients treated. Three questionnaires regarding post-stroke complications were mailed to the doctors responsible for stroke management. RESULTS: Responses were obtained from 251 hospitals (50.2%). The chief doctors responsible for stroke management answered the questionnaires. The number of stroke patients in the departments of neurology and neurosurgery was 338.3 ± 195.3 and 295.8 ± 121.8. Hospitals were classified using the categories secondary (n =142) and tertiary hospitals (n = 106); most hospitals were acute hospitals. Dementia was the most common complication (30.9%), followed by dysphagia (29.3%), and apathy (16.3%). Dementia was thought to be more common by neurologists than neurosurgeons, while apathy and bladder-rectal disorder were thought to be more common by neurosurgeons than neurologists (p = 0.001). The most difficult complication to treat was dysphagia (40.4%), followed by dementia (33.9%), epilepsy (4.1%), and fall (4.1%). Dementia was considered to lack clinical evidence regarding treatment (32.8%), followed by dysphagia (25.3%), and epilepsy (14.1%). Epilepsy was considered to lack clinical evidence among hospitals with a larger number of stroke cases (p = 0.044). CONCLUSION: This study revealed the current state and issues regarding post-stroke complications in Japan. Clinicians should be aware of the importance of post-stroke complications, although data on them remain unsatisfactory.


Asunto(s)
Afasia/epidemiología , Demencia/epidemiología , Epilepsia/epidemiología , Accidente Cerebrovascular/epidemiología , Accidentes por Caídas , Apatía , Afasia/fisiopatología , Afasia/terapia , Demencia/psicología , Demencia/terapia , Epilepsia/fisiopatología , Epilepsia/terapia , Encuestas de Atención de la Salud , Humanos , Japón/epidemiología , Salud Mental , Neurólogos , Neurocirujanos , Enfermedades del Recto/epidemiología , Especialización , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/terapia , Enfermedades de la Vejiga Urinaria/epidemiología
6.
Sci Data ; 8(1): 9, 2021 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-33446665

RESUMEN

We present an electrophysiological dataset collected from the amygdalae of nine participants attending a visual dynamic stimulation of emotional aversive content. The participants were patients affected by epilepsy who underwent preoperative invasive monitoring in the mesial temporal lobe. Participants were presented with dynamic visual sequences of fearful faces (aversive condition), interleaved with sequences of neutral landscapes (neutral condition). The dataset contains the simultaneous recording of intracranial EEG (iEEG) and neuronal spike times and waveforms, and localization information for iEEG electrodes. Participant characteristics and trial information are provided. We technically validated this dataset and provide here the spike sorting quality metrics and the spectra of iEEG signals. This dataset allows the investigation of amygdalar response to dynamic aversive stimuli at multiple spatial scales, from the macroscopic EEG to the neuronal firing in the human brain.


Asunto(s)
Amígdala del Cerebelo/fisiopatología , Emociones , Epilepsia/fisiopatología , Adulto , Amígdala del Cerebelo/fisiología , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana Edad
7.
J Stroke Cerebrovasc Dis ; 30(4): 105629, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33497937

RESUMEN

BACKGROUND: Limb Shaking Syndrome (LSS) is usually associated with internal carotid occlusion. There are few reported-cases in context of middle cerebral artery stenosis. METHODS: We presented LSS in a patient with middle cerebral artery stenosis disease. RESULTS: The patient was a 62-year-old man, smoker, with high blood pressure who suffered left hemifacial and limbs myoclonus. He was initially diagnosed with focal seizures and he started antiepileptic treatment. However, he repeated the episodes. The electroencephalogram showed no abnormalities, and a vascular study with ultrasounds and angio-MRI evidenced severe middle cerebral stenosis. Finally, a diagnosis of Limb Shaking Syndrome was established and he started antiplatelet and high dose lipid-lowering treatment. CONCLUSION: Not all abnormal movements are due to epileptic seizures. When we evaluate a patient with vascular risk factors it is important to perform a complete vascular study to discard not only critical carotid stenosis but also intracranial disease.


Asunto(s)
Infarto de la Arteria Cerebral Media/complicaciones , Ataque Isquémico Transitorio/complicaciones , Temblor/etiología , Errores Diagnósticos , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Humanos , Hipolipemiantes/uso terapéutico , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Infarto de la Arteria Cerebral Media/fisiopatología , Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/tratamiento farmacológico , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Recurrencia , Síndrome , Resultado del Tratamiento , Temblor/diagnóstico , Temblor/fisiopatología
8.
Arch Biochem Biophys ; 699: 108763, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33460581

RESUMEN

MicroRNAs (miRNAs) are small non-coding highly conserved RNA molecules that can act as master regulators of gene expression in a sequence-specific manner either by translation repression or mRNA degradation, influencing a wide range of biologic processes that are essential for the maintenance of cellular homeostasis. Chronic pediatric diseases are the leading cause of death worldwide among children and the recent evidence indicates that aberrant miRNA expression significantly contributes to the development of chronic pediatric diseases. This review focuses on the role of miRNAs in five major chronic pediatric diseases including bronchial asthma, congenital heart diseases, cystic fibrosis, type 1 diabetes mellitus, and epilepsy, and their potential use as novel biomarkers for the diagnosis and prognosis of these disorders.


Asunto(s)
Asma/fisiopatología , Fibrosis Quística/fisiopatología , Diabetes Mellitus Tipo 1/fisiopatología , Epilepsia/fisiopatología , Cardiopatías Congénitas/fisiopatología , MicroARNs/fisiología , Asma/diagnóstico , Asma/metabolismo , Biomarcadores/sangre , Biomarcadores/metabolismo , Enfermedad Crónica , Fibrosis Quística/diagnóstico , Fibrosis Quística/metabolismo , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/metabolismo , Epilepsia/diagnóstico , Epilepsia/metabolismo , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/metabolismo , Humanos , MicroARNs/sangre , MicroARNs/metabolismo , Pediatría , Pronóstico
9.
Neurology ; 96(9): 439-448, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33408149

RESUMEN

For the past 2 decades, high-frequency oscillations (HFOs) have been enthusiastically studied by the epilepsy community. Emerging evidence shows that HFOs harbor great promise to delineate epileptogenic brain areas and possibly predict the likelihood of seizures. Investigations into HFOs in clinical epilepsy have advanced from small retrospective studies relying on visual identification and correlation analysis to larger prospective assessments using automatic detection and prediction strategies. Although most studies have yielded promising results, some have revealed significant obstacles to clinical application of HFOs, thus raising debate about the reliability and practicality of HFOs as clinical biomarkers. In this review, we give an overview of the current state of HFO research and pinpoint the conceptual and methodological issues that have hampered HFO translation. We highlight recent insights gained from long-term data, high-density recordings, and multicenter collaborations and discuss the open questions that need to be addressed in future research.


Asunto(s)
Electroencefalografía , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Biomarcadores , Ondas Encefálicas , Humanos , Convulsiones/fisiopatología
10.
Neuroimage ; 228: 117652, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33359347

RESUMEN

EEG-correlated fMRI analysis is widely used to detect regional BOLD fluctuations that are synchronized to interictal epileptic discharges, which can provide evidence for localizing the ictal onset zone. However, the typical, asymmetrical and mass-univariate approach cannot capture the inherent, higher order structure in the EEG data, nor multivariate relations in the fMRI data, and it is nontrivial to accurately handle varying neurovascular coupling over patients and brain regions. We aim to overcome these drawbacks in a data-driven manner by means of a novel structured matrix-tensor factorization: the single-subject EEG data (represented as a third-order spectrogram tensor) and fMRI data (represented as a spatiotemporal BOLD signal matrix) are jointly decomposed into a superposition of several sources, characterized by space-time-frequency profiles. In the shared temporal mode, Toeplitz-structured factors account for a spatially specific, neurovascular 'bridge' between the EEG and fMRI temporal fluctuations, capturing the hemodynamic response's variability over brain regions. By analyzing interictal data from twelve patients, we show that the extracted source signatures provide a sensitive localization of the ictal onset zone (10/12). Moreover, complementary parts of the IOZ can be uncovered by inspecting those regions with the most deviant neurovascular coupling, as quantified by two entropy-like metrics of the hemodynamic response function waveforms (9/12). Hence, this multivariate, multimodal factorization provides two useful sets of EEG-fMRI biomarkers, which can assist the presurgical evaluation of epilepsy. We make all code required to perform the computations available at https://github.com/svaneynd/structured-cmtf.


Asunto(s)
Mapeo Encefálico/métodos , Encéfalo/diagnóstico por imagen , Electroencefalografía/métodos , Epilepsia/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adulto , Encéfalo/fisiopatología , Epilepsia/fisiopatología , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Imagen Multimodal/métodos , Acoplamiento Neurovascular/fisiología
11.
Epilepsy Behav ; 115: 107682, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33342709

RESUMEN

OBJECTIVE: To perform a systematic review and meta-analysis to summarize and quantitatively evaluate the electroencephalogram (EEG) findings in patients with coronavirus disease 2019 (COVID-19). METHODS: The MEDLINE, CENTRAL, and ClinicalTrials.Gov databases were comprehensively assessed and searched for observational studies with EEG findings in patients with COVID-19. Pooled proportions of EEG findings with 95% confidence intervals (CIs) were assessed using a random effects model. The quality of assessment for each study, heterogeneity between the studies, and publication bias were also evaluated. RESULTS: In total, 12 studies with 308 patients were included in the meta-analysis. Abnormal background activity and generalized slowing in the pooled proportions were common findings among the patients with COVID-19 (96.1% [95% CI: 89.4-99.9]; I2 = 60%; p < 0.01 and 92.3% [95% CI: 81.2-99.3]; I2 = 74%; p < 0.01, respectively). The proportion of patients with epileptiform discharges (EDs) was 20.3% ([95% CI: 9.85-32.9]; I2 = 78%; p < 0.01). The proportion of EDs varied between patients with a history of epilepsy or seizures (59.5% [95% CI: 33.9-83.2]; I2 = 0%; p = 0.49) and patients without them (22.4% [95% CI: 10.4-36.4]; I2 = 46%; p = 0.07). The findings of seizures and status epilepticus on EEG were observed in 2.05% ([95% CI: 0.02-6.04]; I2 = 39%; p = 0.08) and 0.80% ([95% CI: 0.00.-3.69]; I2 = 28%; p = 0.17) of the patients, respectively. CONCLUSION: The proportion of abnormal background activity in patients with COVID-19 was high (96.1%). Epileptiform discharges were present in 20.3% of the cases and the proportion varied between people who had a history of epilepsy/seizure and those who did not. However, the proportion of seizures and status epilepticus on EEG was low (2.05% and 0. 80%, respectively).


Asunto(s)
/epidemiología , Electroencefalografía/métodos , Epilepsia/epidemiología , Epilepsia/fisiopatología , Ensayos Clínicos como Asunto/métodos , Humanos
12.
Ann Neurol ; 89(3): 573-586, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33325057

RESUMEN

OBJECTIVE: We aimed to characterize the phenotypic spectrum and functional consequences associated with variants in the gene GABRB2, coding for the γ-aminobutyric acid type A (GABAA ) receptor subunit ß2. METHODS: We recruited and systematically evaluated 25 individuals with variants in GABRB2, 17 of whom are newly described and 8 previously reported with additional clinical data. Functional analysis was performed using a Xenopus laevis oocyte model system. RESULTS: Our cohort of 25 individuals from 22 families with variants in GABRB2 demonstrated a range of epilepsy phenotypes from genetic generalized epilepsy to developmental and epileptic encephalopathy. Fifty-eight percent of individuals had pharmacoresistant epilepsy; response to medications targeting the GABAergic pathway was inconsistent. Developmental disability (present in 84%) ranged from mild intellectual disability to severe global disability; movement disorders (present in 44%) included choreoathetosis, dystonia, and ataxia. Disease-associated variants cluster in the extracellular N-terminus and transmembrane domains 1-3, with more severe phenotypes seen in association with variants in transmembrane domains 1 and 2 and the allosteric binding site between transmembrane domains 2 and 3. Functional analysis of 4 variants in transmembrane domains 1 or 2 (p.Ile246Thr, p.Pro252Leu, p.Ile288Ser, p.Val282Ala) revealed strongly reduced amplitudes of GABA-evoked anionic currents. INTERPRETATION: GABRB2-related epilepsy ranges broadly in severity from genetic generalized epilepsy to developmental and epileptic encephalopathies. Developmental disability and movement disorder are key features. The phenotypic spectrum is comparable to other GABAA receptor-encoding genes. Phenotypic severity varies by protein domain. Experimental evidence supports loss of GABAergic inhibition as the mechanism underlying GABRB2-associated neurodevelopmental disorders. ANN NEUROL 2021;89:573-586.


Asunto(s)
Epilepsia/fisiopatología , Trastornos del Movimiento/fisiopatología , Trastornos del Neurodesarrollo/fisiopatología , Receptores de GABA-A/genética , Adolescente , Adulto , Animales , Ataxia/genética , Ataxia/fisiopatología , Atetosis/genética , Atetosis/fisiopatología , Niño , Preescolar , Corea/genética , Corea/fisiopatología , Estudios de Cohortes , Discapacidades del Desarrollo/genética , Discapacidades del Desarrollo/fisiopatología , Epilepsia Refractaria/genética , Epilepsia Refractaria/fisiopatología , Distonía/genética , Distonía/fisiopatología , Epilepsia/genética , Femenino , Genotipo , Humanos , Discapacidad Intelectual/genética , Discapacidad Intelectual/fisiopatología , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/genética , Mutación Missense , Trastornos del Neurodesarrollo/genética , Oocitos , Técnicas de Placa-Clamp , Fenotipo , Dominios Proteicos/genética , Xenopus laevis , Adulto Joven
13.
J Nerv Ment Dis ; 209(3): 196-202, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33315796

RESUMEN

ABSTRACT: Psychogenic nonepileptic seizures (PNES) represent management challenges, especially if associated with epilepsy. We aimed to evaluate patients with mixed epilepsy (true and PNES) and compare them with pure epilepsy to identify predictors of psychogenic seizures. This study included 40 patients with pure epilepsy and 40 patients with mixed epilepsy matched in age and sex. Patients underwent neurological assessment, semistructured psychiatric clinical interview, and video electroencephalogram monitoring. We found that unemployment, divorce, and seizure frequency were higher in mixed epilepsy, as well as history of family dysfunction, child adversity, and depressive and dissociative disorders. Both groups were similar regarding family history for seizures and personality dysfunction scores. Family dysfunction, child adversity, and depressive disorders were predictors of PNES. We recommend early evaluation for social instability, family dysfunction, child adversity, and depressive disorders in epileptic patients with higher seizure frequency to avoid misdiagnosis of false drug-resistant epilepsy and enhance proper management.


Asunto(s)
Epilepsia/diagnóstico , Trastornos Psicofisiológicos/diagnóstico , Convulsiones/etiología , Adulto , Trastornos Disociativos/diagnóstico , Trastornos Disociativos/fisiopatología , Electroencefalografía/métodos , Epilepsia/fisiopatología , Femenino , Humanos , Entrevista Psicológica , Masculino , Pruebas Neuropsicológicas , Inventario de Personalidad , Trastornos Psicofisiológicos/fisiopatología , Trastornos Psicofisiológicos/terapia , Convulsiones/diagnóstico , Convulsiones/fisiopatología
14.
Rev. neurol. (Ed. impr.) ; 71(10): 377-386, 16 nov., 2020. tab
Artículo en Español | IBECS | ID: ibc-198073

RESUMEN

Los trastornos del movimiento y de la conducta durante el sueño pueden tener un impacto en la calidad del sueño del paciente y dar lugar a síntomas diurnos. En estos grupos de enfermedades se incluyen entidades como el síndrome de piernas inquietas, los movimientos periódicos de las piernas y las parasomnias del sueño de movimientos oculares rápidos (REM) y no REM. El conocimiento de sus características clínicas y nociones sobre su manejo es de gran importancia para el neurólogo y especialista en sueño por su frecuencia e impacto en la calidad del sujeto. Con frecuencia, estos pacientes son referidos a dichos especialistas, y es relevante conocer que ciertos trastornos del sueño pueden asociarse a otras enfermedades neurológicas


Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as restless legs syndrome, periodic leg movements, and REM and NREM parasomnias. The knowledge of their clinical features and management is of utmost importance for the neurologist and sleep specialist. Frequently, these patients are referred to such specialists and it is relevant to know that certain sleep disorders may be associated with other neurological conditions


Asunto(s)
Humanos , Adulto , Trastornos del Movimiento/fisiopatología , Trastornos del Sueño-Vigilia/fisiopatología , Síndrome de las Piernas Inquietas/fisiopatología , Parasomnias del Sueño REM/fisiopatología , Sueños/fisiología , Epilepsia/fisiopatología
15.
Nat Commun ; 11(1): 5240, 2020 10 16.
Artículo en Inglés | MEDLINE | ID: mdl-33067457

RESUMEN

Spoken language, both perception and production, is thought to be facilitated by an ensemble of predictive mechanisms. We obtain intracranial recordings in 37 patients using depth probes implanted along the anteroposterior extent of the supratemporal plane during rhythm listening, speech perception, and speech production. These reveal two predictive mechanisms in early auditory cortex with distinct anatomical and functional characteristics. The first, localized to bilateral Heschl's gyri and indexed by low-frequency phase, predicts the timing of acoustic events. The second, localized to planum temporale only in language-dominant cortex and indexed by high-gamma power, shows a transient response to acoustic stimuli that is uniquely suppressed during speech production. Chronometric stimulation of Heschl's gyrus selectively disrupts speech perception, while stimulation of planum temporale selectively disrupts speech production. This work illuminates the fundamental acoustic infrastructure-both architecture and function-for spoken language, grounding cognitive models of speech perception and production in human neurobiology.


Asunto(s)
Corteza Auditiva/fisiopatología , Epilepsia/fisiopatología , Estimulación Acústica , Adulto , Corteza Auditiva/diagnóstico por imagen , Mapeo Encefálico , Epilepsia/diagnóstico por imagen , Epilepsia/psicología , Femenino , Humanos , Lenguaje , Imagen por Resonancia Magnética , Masculino , Habla , Percepción del Habla , Adulto Joven
16.
Epileptic Disord ; 22(5): 548-554, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33095171

RESUMEN

The coronavirus SARS-CoV-2 disease (COVID-19) pandemic affects availability and performance of neurophysiological diagnostic methods, including EEG. Our objective was to outline the current situation regarding EEG-based investigations across Europe. A web-based survey was distributed to centres within the European Reference Network on rare and complex epilepsies (ERN EpiCARE). Responses were collected between April 9 and May 15, 2020. Results were analysed with Microsoft Excel, Python Pandas and SciPy. Representants from 47 EpiCARE centres from 22 countries completed the survey. At the time of completing the survey, inpatient video-EEGs had been stopped or restricted in most centres (61.7% vs. 36.2% for adults, and 38.3% vs. 53.2% for children). Invasive investigations and epilepsy surgery were similarly affected. Acute EEGs continued to be performed, while indications for outpatient EEGs were limited and COVID-19 triage put in place. The strictness of measures varied according to extent of the outbreak in a given country. The results indicate a profound impact of COVID-19 on neurophysiological diagnostics, especially inpatient video-EEGs, invasive investigations, and epilepsy surgery. The COVID-19 pandemic may hamper care for patients in need of EEG-based investigations, particularly patients with seizure disorders. ERN EpiCARE will work on recommendations on how to rapidly adapt to such situations in order to alleviate consequences for our patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Electroencefalografía , Pandemias , Neumonía Viral/epidemiología , Adulto , Niño , Continuidad de la Atención al Paciente , Prestación de Atención de Salud , Electroencefalografía/estadística & datos numéricos , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Europa (Continente)/epidemiología , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Utilización de Procedimientos y Técnicas , Triaje , Grabación en Video/estadística & datos numéricos
17.
Medicine (Baltimore) ; 99(44): e22965, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126368

RESUMEN

To figure out which diagnosis is more suitable and which antiepileptic drugs are more sensitive to epileptic negative myoclonus (ENM) as the first seizure type in atypical benign epilepsy with centrotemporal spikes.We reviewed the electroencephalogram (EEG) database of Linyi People's Hospital Affiliated to Shandong University and medical records of patients with ENM onset. The characteristics of epileptic seizures, onset age, treatment process, growth and development history, past disease history, family history, degree of mental deterioration, cranial imaging, and video-EEG were studied retrospectively and followed up.There were 4 cases with ENM onset and 1 with continuous ENM, 3 males and 1 female. The onset age was from 2 years 3 months to 8 years 7 months. The cranial magnetic resonance imaging (MRI) and developmental quotient, as well as the family, personal, and past disease history, were normal. Frequent falls and drops were the main clinical manifestations. Five months after the onset of ENM, case 1 had focal seizures in sleep. ENM was the first and only manifestation in all the other 3 children. Discharges of interictal EEG were in bilateral rolandic areas, especially in midline areas (Cz, Pz), electrical status epilepticus in sleep was found in 3 cases. One child was sensitive to levetiracetam, the other 3 were sensitive to clonazepam.ENM can affect the upper or lower extremities. ENM as the first or only symptom was a special phenomenon in benign epilepsy with centrotemporal spikes (BECTS) variants. Ignorance of midline spikes mainly in Cz or Pz in BECTS might lead to missed diagnosis of ENM. Whether benzodiazepines are viable as a choice of BECTS variants with electrical status epilepticus in sleep when ENM is the first symptom still needs a large sample evidence-based observation.


Asunto(s)
Epilepsia/diagnóstico , Mioclonía/diagnóstico , Convulsiones/diagnóstico , Niño , Preescolar , Electroencefalografía , Epilepsia/fisiopatología , Femenino , Humanos , Masculino , Mioclonía/fisiopatología , Convulsiones/fisiopatología
18.
Niger J Clin Pract ; 23(10): 1437-1442, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047703

RESUMEN

Background: Cardiac autonomic neuropathy (CAN) resulting from seizures has been implicated in sudden unexpected death in epilepsy in persons with epilepsy (PWE), however, there are no previous studies of CAN in PWE from Nigeria. Objectives: This study sought to determine the frequency and pattern of CAN in adult PWE in a tertiary hospital in South-western Nigeria and to determine the relationship between seizure variables and CAN. Methods: A cross-sectional study of 80 adult PWE and 80 matched controls aged between 18 and 60 years was carried out between March 2012 and June 2013 at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Demographic and clinical data were obtained from all the study participants. Anxiety was excluded using the Hamilton Anxiety Scale. Those with conditions that could affect autonomic function, such as chronic renal failure, heart failure, Parkinson's disease, diabetes mellitus, anxiety, and psychiatric disorders and pregnant women were excluded. Five bedside cardiovascular reflex tests were performed on each subject after baseline heart rate and blood pressure (BP) had been recorded. Results: The mean age of onset of epilepsy was 19 ± 10 years, whereas the mean duration of epilepsy was 10 ± 8 years. The mean seizure frequency was 14 ± 30 per month (median three seizures per month). Of the 80 patients evaluated, 42 (52.5%) had CAN, whereas none of the controls had CAN. Majority (69%) of the PWE with CAN had purely parasympathetic dysfunction, whereas 3% had purely sympathetic dysfunction and 10% had combined autonomic dysfunction. The PWE in this study had significantly lower tilt ratios and diastolic BP change with Isometric Hand grip as well as significantly higher systolic BP change on standing than the controls. Patients who had more than four seizures per month had higher odds of CAN than those with less frequent seizures (odds ratio 0.275, P value 0.023). Also, patients who had received treatment for less than 10 years were found to have greater odds of CAN than those who had received treatment for a longer period (odds ratio 11.676, P value 0.046). Conclusion: CAN is common in adult PWE in South-Western Nigeria and the major predictors are short duration of treatment and frequent seizure episodes. Routine screening of these patients may help with early detection of autonomic dysfunction and provide an opportunity for intervention.


Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/epidemiología , Sistema Nervioso Autónomo/fisiopatología , Epilepsia/fisiopatología , Corazón/fisiopatología , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Enfermedades del Sistema Nervioso Autónomo/etiología , Presión Sanguínea/fisiología , Estudios de Casos y Controles , Estudios Transversales , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Femenino , Fuerza de la Mano/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Postura/fisiología , Embarazo , Factores de Riesgo , Convulsiones , Centros de Atención Terciaria , Adulto Joven
19.
Epilepsy Behav ; 112: 107396, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32911299

RESUMEN

BACKGROUND: The aim of this study was to have a better understanding of the influence of the coronavirus disease 2019 (COVID-19) pandemic in people with epilepsy (PWE) and to assess whether there have been changes in seizure control during the current COVID-19 outbreak, exploring the possible causes thereof. METHODS: This is an observational, retrospective study based on prospective data collection of 100 successive patients who attended an epilepsy outpatient clinic either face-to-face or telephonically during the months of the COVID-19 outbreak and national state of emergency. RESULTS: One hundred patients were included, 52% women, mean age 42.4 years. During the COVID-19 period, 27% of the patients presented an increase of >50% of seizure frequency. An increase of stress/anxiety (odds ratios (OR): 5.78; p = 0.008) and a prior higher seizure frequency (OR: 12.4; p = 0.001) were associated with worsening of seizures. Other risk factors were exacerbation of depression, sleep deprivation, less physical activity, and history of epilepsy surgery. Three patients had status epilepticus (SE) and one a cluster of seizures. Likewise, 9% of patients improved their seizure control. Reduction in stress/anxiety (OR: 0.05; p = 0.03) and recent adjustment of antiepileptics (OR: 0.07; p = 0.01) acted as protecting factors. CONCLUSIONS: A high proportion of PWE suffered a significant worsening of their seizure control during the months of the COVID-19 pandemic. Emotional distress due to home confinement was the main factor for the change in seizure control. Promoting physical activity and adequate sleep may minimize the potential impact of the pandemic in PWE. Ensuring correct follow-up can prevent decompensation in those PWE at high risk.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Ansiedad/fisiopatología , Infecciones por Coronavirus , Epilepsia/fisiopatología , Pandemias , Neumonía Viral , Estrés Psicológico/fisiopatología , Adolescente , Adulto , Ansiedad/psicología , Betacoronavirus , Depresión/fisiopatología , Depresión/psicología , Progresión de la Enfermedad , Epilepsia/tratamiento farmacológico , Epilepsia/psicología , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Convulsiones/fisiopatología , Privación de Sueño/fisiopatología , España , Estado Epiléptico/fisiopatología , Estrés Psicológico/psicología
20.
PLoS Comput Biol ; 16(9): e1008206, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32986695

RESUMEN

The International League Against Epilepsy (ILAE) groups seizures into "focal", "generalized" and "unknown" based on whether the seizure onset is confined to a brain region in one hemisphere, arises in several brain region simultaneously, or is not known, respectively. This separation fails to account for the rich diversity of clinically and experimentally observed spatiotemporal patterns of seizure onset and even less so for the properties of the brain networks generating them. We consider three different patterns of domino-like seizure onset in Idiopathic Generalized Epilepsy (IGE) and present a novel approach to classification of seizures. To understand how these patterns are generated on networks requires understanding of the relationship between intrinsic node dynamics and coupling between nodes in the presence of noise, which currently is unknown. We investigate this interplay here in the framework of domino-like recruitment across a network. In particular, we use a phenomenological model of seizure onset with heterogeneous coupling and node properties, and show that in combination they generate a range of domino-like onset patterns observed in the IGE seizures. We further explore the individual contribution of heterogeneous node dynamics and coupling by interpreting in-vitro experimental data in which the speed of onset can be chemically modulated. This work contributes to a better understanding of possible drivers for the spatiotemporal patterns observed at seizure onset and may ultimately contribute to a more personalized approach to classification of seizure types in clinical practice.


Asunto(s)
Epilepsia/clasificación , Convulsiones/clasificación , Animales , Electroencefalografía , Epilepsia/fisiopatología , Humanos , Ratones , Modelos Biológicos , Convulsiones/fisiopatología
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