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1.
Brain Imaging Behav ; 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34478055

RESUMO

Unilateral temporal lobe epilepsy (TLE) is the most common type of focal epilepsy characterized by foci in the unilateral temporal lobe grey matters of regions such as the hippocampus. However, it remains unclear how the functional features of white matter are altered in TLE. In the current study, resting-state functional magnetic resonance imaging (fMRI) was performed on 71 left TLE (LTLE) patients, 79 right TLE (RTLE) patients and 47 healthy controls (HC). Clustering analysis was used to identify fourteen white matter networks (WMN). The functional connectivity (FC) was calculated among WMNs and between WMNs and grey matter. Furthermore, the FC laterality of hemispheric WMNs was assessed. First, both patient groups showed decreased FCs among WMNs. Specifically, cerebellar white matter illustrated decreased FCs with the cerebral superficial WMNs, implying a dysfunctional interaction between the cerebellum and the cerebral cortex in TLE. Second, the FCs between WMNs and the ipsilateral hippocampus (grey matter foci) were also reduced in patient groups, which may suggest insufficient functional integration in unilateral TLE. Interestingly, RTLE showed more severe abnormalities of white matter FCs, including links to the bilateral hippocampi and temporal white matter, than LTLE. Taken together, these findings provide functional evidence of white matter abnormalities, extending the understanding of the pathological mechanism of white matter impairments in unilateral TLE.

2.
Neuroreport ; 32(14): 1223-1228, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34406991

RESUMO

OBJECTIVES: To assess the cognitive impairment in patients with type 2 diabetes mellitus (T2DM) using mismatch negativity (MMN) and to explore the relationship between cognitive impairment and diabetic peripheral neuropathy (DPN). METHODS: Sixty-six T2DM patients and 40 healthy controls were included. For each participant, mini-mental state examination (MMSE) was applied to assess the general cognitive function and MMN was elicited. T2DM patients were divided into two subgroups: subgroup DPN-, patients without DPN; subgroup DPN+, patients with DPN. The MMSE scores, MMN amplitudes and latencies were compared between the T2DM group and the control group using univariate analysis of variance procedures, and also among the controls, subgroup DPN- and subgroup DPN+. Pearson's correlation coefficients (r) were used to analyze potential confounding clinical factors associated with MMN. RESULTS: T2DM patients had significantly lower MMSE scores compared with controls (23.25 ± 2.86 vs. 27.15 ± 1.83; P < 0.01), whereas those of the two subgroups were not significantly different. Both subgroup DPN+ and DPN- had longer latencies and lower amplitudes of MMN than the controls. The latencies of MMN were significantly longer in subgroup DPN+ compared with subgroup DPN-. The latency of MMN was positively correlated with the duration of the disease. CONCLUSION: Cognitive decline exists in patients with T2DM irrespective of the presence of DPN. Patients with DPN may have more severe cognitive dysfunction than those without DPN. MMN may be a promising tool for evaluating cognitive function.

3.
Neuroimage Clin ; 31: 102714, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34102537

RESUMO

OBJECTIVE: To explore the structural and functional reorganization of contralateral hippocampus in patients with unilateral mesial temporal lobe epilepsy (mTLE) who achieved seizure-freedom after anterior temporal lobectomy (ATL). METHODS: We obtained high-resolution structural MRI and resting-state functional MRI data in 28 unilateral mTLE patients and 29 healthy controls. Patients were scanned before and three and 24 months after surgery while controls were scanned only once. Hippocampal gray matter volume (GMV) and functional connectivity (FC) were assessed. RESULTS: No obvious GMV changes were observed in contralateral hippocampus before and after successful surgery. Before surgery, ipsilateral hippocampus showed increased FC with ipsilateral insula (INS) and temporoparietal junction (TPJ), but decreased FC with widespread bilateral regions, as well as contralateral hippocampus. After successful ATL, contralateral hippocampus showed: (1) decreased FC with ipsilateral INS at three months follow-up, without further changes; (2) decreased FC with ipsilateral TPJ, postcentral gyrus and rolandic operculum at three months, with an obvious increase at 24 months follow-up; (3) increased FC with bilateral medial prefrontal cortex (MPFC) and superior frontal gyrus (SFG) at three months follow-up, without further changes. CONCLUSIONS: Successful ATL may not lead to an obvious structural reorganization in contralateral hippocampus. Surgical manipulation may lead to a transient FC reduction of contralateral hippocampus. Increased FC between contralateral hippocampus and bilateral MPFC and SFG may be related to postoperative functional remodeling.


Assuntos
Epilepsia do Lobo Temporal , Lobectomia Temporal Anterior , Epilepsia do Lobo Temporal/diagnóstico por imagem , Epilepsia do Lobo Temporal/cirurgia , Substância Cinzenta , Hipocampo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética
4.
Brain Topogr ; 34(4): 525-536, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33973138

RESUMO

Epilepsy and depression were proposed to facilitate each other reciprocally through common neurobiological anomalies, especially the prefrontal-limbic-subcortical abnormalities. Yet neuroimaging patterns of higher-order cognitive networks and neuroanatomical correlates were rarely compared in temporal lobe epilepsy patients with (TLE-D) and without depression (TLE-N). We collected T1-weighted structural and resting-state functional MRI data from 20 TLE-D, 31 TLE-N and 20 healthy controls (HCs) and performed analyses including hippocampal volume (HCV), cortical thickness, gray matter volume (GMV) and whole-brain functional network connectivity (FNC) across three groups. Imaging differences were related to clinical and psychological measurements. TLE-D demonstrated disrupted functional role of subcortical (SUB) and higher-order cognitive networks compared to TLE-N and HCs. In TLE-D, GMV in the right supplementary motor area (SMA) and FNC between the dorsal attention (DAN) and SUB were attenuated compared to TLE-N and HCs, FNC between SUB and the visual network (VIS) decreased compared to HCs. GMV in the right SMA was negatively correlated with depression severity and some symptoms. Combined, explicit emotion regulation may be impaired in TLE-D. Meanwhile, compared to HCs, TLE-N showed smaller HCVs, TLE-D and TLE-N showed smaller GMV in the medial orbital frontal gyrus and right hippocampus and hippocampal gyrus, possibly implying predisposition of epileptic activities to co-morbid depression. Our findings suggest distinct anatomical and FNC patterns in TLE-D and TLE-N. More than prefrontal-limbic-subcortical anomalies, disrupted higher-order cognitive network may contribute to depression in TLE, providing new potential treatment targets for depression and calling attention to relation between cognitive dysfunction and co-morbid depression.


Assuntos
Epilepsia do Lobo Temporal , Depressão/diagnóstico por imagem , Epilepsia do Lobo Temporal/diagnóstico por imagem , Hipocampo , Humanos , Imageamento por Ressonância Magnética , Lobo Temporal
5.
Microb Pathog ; 155: 104899, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33894293

RESUMO

OBJECTIVE: The aim of this study was to investigate the composition of the intestinal microbiota and its association with fecal short chain fatty acids (SCFAs) in children with drug refractory epilepsy (DRE) before and after treatment with a ketogenic diet (KD). METHODS: Herein, we conducted a cross-sectional study of 12 children with DRE and 12 matched healthy controls to compare the changes in fecal microbiomes and SCFAs. Disease cohort also underwent analysis before and after 6 months of KD treatment. RESULTS: A higher microbial alpha diversity and a significant increase in Actinobacteria at the phylum level and Enterococcus, Anaerostipes, Bifidobacterium, Bacteroides, and Blautia at the genus level were observed in the children with DRE. The abundance of the eight epileptic-associated genera was reversed after six months of KD treatment with decreases in Bifidobacterium, Akkermansia, Enterococcaceae and Actinomyces and increases in Subdoligranulum, Dialister, Alloprevotella (p < 0.05). In particular, we identified some taxa that were more prevalent in patients with an inadequate response to KD than in those with an adequate response. Further, a significant correlation was observed between the change in the microbiome genera after KD treatment. The SCFA content in the fecal after 6 months of KD treatment increased and was highly correlated with the gut bacteria. SIGNIFICANCES: Dysbiosis of the microbiome could be involved in the pathogenesis of DRE in children, which can be relieved by a KD to a large extent. Gut microbiota and microbial metabolism could contribute to the antiseizure effect of KD.


Assuntos
Dieta Cetogênica , Epilepsia , Microbioma Gastrointestinal , Criança , Estudos Transversais , Disbiose , Fezes , Humanos
6.
Acta Neurol Scand ; 143(3): 261-270, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33058145

RESUMO

OBJECTIVES: To explore the dynamic changes of gray matter volume and intrinsic brain activity following anterior temporal lobectomy (ATL) in patients with unilateral mesial temporal lobe epilepsy (mTLE) who achieved seizure-free for 2 years. MATERIALS AND METHODS: High-resolution T1-weighted MRI and resting-state functional MRI data were obtained in ten mTLE patients at five serial timepoints: before surgery, 3, 6, 12, and 24 months after surgery. The gray matter volume (GMV) and amplitude of low-frequency fluctuations (ALFF) were compared among the five scans to depict the dynamic changes after ATL. RESULTS: After successful ATL, GMV decreased in several ipsilateral brain regions: ipsilateral insula, thalamus, and putamen showed gradual gray matter atrophy from 3 to 24 months, while ipsilateral superior temporal gyrus, middle temporal gyrus, inferior temporal gyrus, middle occipital gyrus, inferior occipital gyrus, caudate nucleus, lingual gyrus, and fusiform gyrus showed significant GMV decrease at 3 months follow-up, without further changes. Ipsilateral insula showed gradual ALFF decrease from 3 to 24 months after surgery. Ipsilateral superior temporal gyrus showed ALFF decrease at 3 months follow-up, without further changes. Ipsilateral thalamus and cerebellar vermis showed obvious ALFF increase after surgery. CONCLUSIONS: Surgical resection may lead to a short-term reduction of gray matter volume and intrinsic brain activity in neighboring regions, while the progressive gray matter atrophy may be due to possible intrinsic mechanism of mTLE. Dynamic ALFF changes provide evidence that disrupted focal spontaneous activities were reorganized after successful surgery.


Assuntos
Lobectomia Temporal Anterior/métodos , Epilepsia do Lobo Temporal/patologia , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/cirurgia , Substância Cinzenta/patologia , Adulto , Atrofia/patologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Adulto Jovem
7.
Front Microbiol ; 11: 517797, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33042045

RESUMO

Objective: To explore the structure and composition of the fecal microbiota of patients with epilepsy. Methods: Variations in the fecal microbiota between patients with epilepsy and healthy controls (HCs) from the same household were investigated and validated by utilizing 16S ribosomal RNA sequencing in two independent cohorts [exploration cohort (N = 55 patients and N = 46 HCs) and validation cohort (N = 13 patients and N = 10 HCs)]. Results: The alpha diversity indexes of the specimens from patients with epilepsy were much lower than those from the HCs (p < 0.05). The structure and composition of the fecal microbiota differed between patients with different clinical prognoses and between patients and HCs (Adonis: p < 0.05). Microbiome alterations in patients with epilepsy included increases in Actinobacteria and Verrucomicrobia and decreases in Proteobacteria at the phylum level and increases in Prevotella_9, Blautia, Bifidobacterium, and others at the genus level [linear discriminant analysis (LDA): 3.5] Patients with drug-resistant epilepsy showed enrichment of bacterial taxa in Actinobacteria, Verrucomicrobia, and Nitrospirae and the genera Blautia, Bifidobacterium, Subdoligranulum, Dialister, and Anaerostipes (Kruskal-Wallis test: p < 0.05). Analysis of gut microbiome indicated predictive ability for disease diagnosis, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.97 (95% CI, 0.84-0.98). Applying the model to our validation cohort resulted in an AUC of 0.96 (95% CI, 0.75-0.97). Notably, the model could distinguish drug-resistant from drug-sensitive epilepsy (AUC = 0.85, 95% CI: 0.69-0.94). Conclusion: Patients with epilepsy exhibit substantial alterations of fecal microbiota composition, and specific gut commensal strains are altered depending on different clinical phenotypes and thus could serve as potential biomarkers for disease diagnosis.

8.
Medicine (Baltimore) ; 99(20): e19940, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443294

RESUMO

The aim of this study was to investigate the demographic, clinical, and electrophysiological characteristics of postictal generalized electroencephalography (EEG) suppression (PGES), thereby facilitating the recognition of PGES and providing clues regarding its risk factors, pathophysiology, and relationship with sudden unexpected death in epilepsy patients (SUDEP).We retrospectively reviewed 237 generalized convulsive seizures (GCSs) in 126 patients during long-term video-EEG (VEEG) recordings. The associations of PGES and prolonged PGES (duration >20 seconds) with person- and seizure-specific variables were evaluated independently using SPSS software.Eighty patients (63.5%, 80/126) exhibited PGES after 127 GCSs (53.6%, 127/237) with an average PGES duration of 41.31 ±â€Š24.03 seconds. The tonic phase was significantly prolonged in patients with PGES and prolonged PGES. PGES was independently associated with ictal semiology, which was attributable to the different proportions of GCS type 1. After seizure termination, patients with PGES had a higher percentage of postictal unresponsiveness and immobility, including oropharyngeal immobility. Between prolonged and short-duration PGES, the former was more likely to phase out gradually followed by immediate body movement, whereas the latter tended to have an abrupt, evoked termination followed by delayed body movement.Prolonged tonic duration, GCS type 1, postictal unresponsiveness, and immobility were more prone to occur with PGES, which might imply that hyperactivation of inhibitory neural networks underlies the pathophysiology of PGES and subsequent SUDEP. Any form of periictal bedside care, whether it constitutes effective medical intervention or not, is advisable due to its possible contribution to the interruption of PGES. Regardless of the PGES termination pattern, the neural network resuscitation process was progressive.


Assuntos
Encéfalo/fisiopatologia , Eletroencefalografia , Convulsões/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
9.
J Neuroimmunol ; 344: 577243, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32417596

RESUMO

This study was to investigate whether autoimmune encephalitis is associated with the human leukocyte antigen (HLA) genotypes in Chinese Han population. We compared and analyzed the HLA genotypes of 101 patients with autoimmune encephalitis (77 anti-NMDAR, 11 anti-LGI1 and 13 anti-GABABR antibody, respectively) to the 200 healthy control groups. Our results showed that the DRB1*03:01 or DQB1*02:01 allele and the extended DRB1*03:01 ~ DQB1*02:01 haplotype represented the strong susceptibility locus for anti-LGI1 encephalitis (OR = 18.84, 95% CI = 5.01-70.89, Pc = 0.004; OR = 18.84, 95% CI = 5.01-70.89, Pc = 0.004; OR = 18.84, 95% CI = 5.01-70.89, Pc = 0.001). Additionally, the DRB1*08:03 ~ DQB1*06:01 or B*08:01 ~ C*07:02 haplotype was likely to be associated with anti-LGI1 encephalitis (OR = 10.23, 95% CI = 2.87-36.42, Pc = 0.039; OR = 74.62, 95% CI = 6.97-799.06, Pc = 0.043). No statistically significant differences were found for HLA association between patients with anti-NMDAR or anti-GABABR encephalitis and healthy controls. These results indicated that HLA subtypes were only associated with anti-LGI1 encephalitis.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Encefalite/diagnóstico , Encefalite/genética , Cadeias beta de HLA-DQ/genética , Cadeias HLA-DRB1/genética , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/genética , Peptídeos e Proteínas de Sinalização Intracelular/genética , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
10.
Front Med ; 14(5): 630-641, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31912429

RESUMO

Mesial temporal lobe epilepsy (mTLE), the most common type of focal epilepsy, is associated with functional and structural brain alterations. Machine learning (ML) techniques have been successfully used in discriminating mTLE from healthy controls. However, either functional or structural neuroimaging data are mostly used separately as input, and the opportunity to combine both has not been exploited yet. We conducted a multimodal ML study based on functional and structural neuroimaging measures. We enrolled 37 patients with left mTLE, 37 patients with right mTLE, and 74 healthy controls and trained a support vector ML model to distinguish them by using each measure and the combinations of the measures. For each single measure, we obtained a mean accuracy of 74% and 69% for discriminating left mTLE and right mTLE from controls, respectively, and 64% when all patients were combined. We achieved an accuracy of 78% by integrating functional data and 79% by integrating structural data for left mTLE, and the highest accuracy of 84% was obtained when all functional and structural measures were combined. These findings suggest that combining multimodal measures within a single model is a promising direction for improving the classification of individual patients with mTLE.


Assuntos
Epilepsia do Lobo Temporal , Epilepsia do Lobo Temporal/diagnóstico por imagem , Lateralidade Funcional , Neuroimagem Funcional , Hipocampo , Humanos , Aprendizado de Máquina , Imageamento por Ressonância Magnética
12.
Sci Rep ; 9(1): 18473, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31804610

RESUMO

Periventricular nodular heterotopia (PNH) is a neural migration disorder which often presents clinically with seizures. However, the underlying functional neural basis of PNH is still unclear. We aimed to explore the underlying pathological mechanism of PNH by combining both whole brain functional connectivity (FC) and seed-based FC analyses. We utilized resting-state fMRI to measure functional connectivity strength (FCS) in 38 patients with PNH-related epilepsy and 38 control subjects. The regions with FCS alterations were selected as seeds in the following FC analyses. Pearson correlation analyses were performed to explore associations between these functional neural correlates and clinical features. In comparison with controls, PNH patients showed lower FCS in bilateral insula (P < 0.05, family wise error (FWE) correction), higher FC in the default mode network and lower FC in the fronto-limbic-cerebellar circuits (P < 0.05, FWE correction). Pearson correlation analyses revealed that FCS in bilateral insula was negatively correlated with the epilepsy duration (P < 0.05); medial prefronto-insular connectivity was negatively correlated with Hamilton Anxiety Scale (P < 0.05) and cerebellar-insular connectivity was also negatively correlated with Hamilton Depression Scale (P < 0.05). Using the resting-state FCS analytical approach, we identified significant insular hypoactivation in PNH patients, which suggests that the insula might represent the cortical hub of the whole-brain networks in this condition. Additionally, disruption of resting state FC in large-scale neural networks pointed to a connectivity-based neuropathological process in PNH.


Assuntos
Cerebelo/fisiopatologia , Epilepsia/fisiopatologia , Lobo Frontal/fisiopatologia , Sistema Límbico/fisiopatologia , Heterotopia Nodular Periventricular/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Cerebelo/diagnóstico por imagem , Criança , Conectoma/métodos , Epilepsia/etiologia , Feminino , Lobo Frontal/diagnóstico por imagem , Humanos , Sistema Límbico/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Heterotopia Nodular Periventricular/diagnóstico , Heterotopia Nodular Periventricular/fisiopatologia , Descanso/fisiologia , Fatores de Tempo , Adulto Jovem
13.
Acta Neurol Scand ; 140(6): 414-421, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31483852

RESUMO

OBJECTIVES: To evaluate the long-term cognitive or neuropsychiatric outcomes and potential risk factors associated with prolonged cognitive deficits or neuropsychiatric symptoms in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. METHODS: In this cohort follow-up study, patients with a definitive diagnosis of anti-NMDAR encephalitis from the inpatient of West China Hospital between June 2012 and December 2017 were included and underwent a prospective cognitive and neuropsychiatric assessment every 3 months by cognitive impairment rating scale, Neuropsychiatric Inventory (NPI) and/or Montreal Cognitive Assessment. RESULTS: Up to 97.5% patients had severe cognitive deficits and neuropsychiatric symptoms in acute phase. Decreasing proportion of patients with prolonged cognitive deficits was observed and time dependent. At 2 years' follow-up, 7.8% of patients with cognitive deficits were unable to complete some previous activities or return to work. The risk factors associated with persistent cognitive deficits included age of disease onset over 40 years old (HR, 1.77; 95% CI, 1.11-2.82; P = .01) and with clinical relapses (HR, 2.22; 95% CI, 1.21-4.09; P = .02). The predictors of prolonged neuropsychiatric symptoms included clinical relapses (HR, 2.79; 95% CI, 1.21-6.43; P = .02). Among the 12 neuropsychiatric symptoms of NPI, irritability was shown as the most prevalent and persistent. CONCLUSIONS: Combined cognitive and neuropsychiatric assessment and intervention are essential elements of comprehensive care of anti-NMDAR encephalitis.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/psicologia , Disfunção Cognitiva/etiologia , Adolescente , Adulto , China , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
14.
Ann Clin Transl Neurol ; 6(9): 1771-1781, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31448571

RESUMO

OBJECTIVE: To explore the diversity and composition of the fecal microbiota in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. METHODS: We enrolled 10 patients in the acute stage with naïve treatment, seven patients with relapse, 13 patients without relapse in the remission phase, and 12 paired healthy controls. The fecal microbiota in different groups was compared by 16S ribosomal DNA (rDNA) gene pyrosequencing. RESULTS: Prominent dysbiosis in the gut microbiome of patients with anti-NMDAR encephalitis was found. Our primary findings showed that the overall species richness (alpha diversity indexes) of the microbiota was higher in patients than in controls (P < 0.05). Distance-based community analysis revealed that the microbiota differed substantially within all subgroups of patients and controls (P < 0.05). The relative abundance of species heatmap showed a tendency toward depletion for some commensal genera, such as Prevotella_6, Bifidobacterium, Faecalibacterium, and other short-chain fatty acid (SCFA)-producing bacteria. Additionally, our results showed that all subgroups had a distinct bacterial species, with an increase in the genus Fusobacterium in the acute phase group and the genera Streptococcus and Parabacteroides in patients with relapse. However, the genus Bacteroides was very abundant in patients without relapse. Although the findings regarding the Firmicutes/Bacteroidetes (F/B) ratios across the four comparison groups were not statistically significant, the F/B ratio gradually increased in patients from the acute phase group (0.87), to the disease remission group with relapse (1.06), to the group without relapse (1.28), to the healthy group (1.63). INTERPRETATION: Patients with anti-NMDAR encephalitis exhibit a substantial alteration in fecal microbiota composition.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/microbiologia , Disbiose/microbiologia , Microbioma Gastrointestinal/fisiologia , Adolescente , Adulto , Fezes/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S , Adulto Jovem
15.
Epilepsia Open ; 4(1): 85-91, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30868118

RESUMO

Objective: The use of multidisciplinary teams (MDTs) is a global trend in disease management, while China is still at the exploratory stage MDTs. We aimed to summarize our experience and assess the impact of MDT use in managing patients with epilepsy and optimizing their seizure outcomes. Methods: Our MDT is staffed with skilled epileptologists, electroencephalography experts, neurosurgeons, child neurologists, radiologists, and psychiatrists. The MDT discussion has been carried out once or twice a week since 2013. We reviewed our consecutive patients discussed at our MDT from March 2013 to December 2017. The detailed clinical characteristics, suggestions, and follow-up data were collected and analyzed. Results: A total of 1088 patients (604 male, 484 female) were included in this study. The median age at MDT discussion was 21 years (range 10 months to 79 years). Three hundred eighty-seven patients (35.6%) were younger than18 years of age. The median age at seizure onset was 12 years (range 2 days to 77 years). Most patients (80.4%) had at least one seizure per month and most (77%) took 2 or more antiepileptic drugs. A total of 70.6% of patients reached the standard of drug-resistant epilepsy and 74.2% of brain magnetic resonance imaging (MRI) studies detected positive findings. After detailed MDT discussion, 18 patients were diagnosed as having nonepileptic diseases, including psychogenic nonepileptic seizure, syncope, sleep disorder, paroxysmal kinesigenic dyskinesia, withdrawal symptom, and cerebral palsy. Three hundred eighty-two patients (35.1%) were suitable for resective surgery. Among the postoperative patients successfully followed up for more than 1 year, 72.7% (136/187) received favorable outcomes (Engel class I). The seizure-free rate was 78.6% after temporal lobe surgery and 58.9% after extratemporal surgery. Significance: Epilepsy management can be optimized through MDT discussion to attain accurate diagnosis and favorable seizure outcomes. There is still room for MDT improvement in resource-limited countries.

16.
Epilepsy Behav ; 94: 47-51, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30884407

RESUMO

PURPOSE AND METHODS: Persons with epilepsy (PWE) remain completely and permanently prohibited from driving in China currently. Previous studies have shown that a considerable proportion of PWE with uncontrolled seizures in China continue to drive motor vehicles. Discrepancy between Chinese policy and driving practices for PWE is potentially concerning. We conducted a preliminary online electronic questionnaire (e-questionnaire) survey among neurologists in China aiming to explore neurologists' attitudes toward the issue of driving among PWE. RESULTS: A total of 358 neurologists completed the e-questionnaire with a response rate of 75.8%. 50.3% of neurologists stated that they knew the driving restriction law in China. With respect to reporting of cases to relevant driving authorities, 82.4% of neurologists never directly report PWE, and 90.8% consider that it is PWE's responsibility to report themselves. 87.4% of physicians surveyed indicated that the lack of clearly-articulated guidelines is a major impediment to their routine discussions of driving fitness for PWE. Subgroup analysis indicated that 76.2% of epileptologists were of the opinion that persons with well-controlled epilepsy should be allowed to drive versus 56.2% of general neurologists (P < 0.05). CONCLUSION: Currently, neurologists in China have a low awareness of the legal driving restriction for PWE and have highly varying practices with respect to counseling PWE about driving. According to our preliminary results, a clearly-articulated published national document for medical fitness for driving in China is necessary in order to standardize physicians' practices.


Assuntos
Atitude do Pessoal de Saúde , Condução de Veículo , Epilepsia/complicações , Neurologistas/psicologia , Convulsões/complicações , Adulto , Condução de Veículo/psicologia , China , Aconselhamento , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inquéritos e Questionários
17.
Epilepsia ; 60(2): 246-254, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30653664

RESUMO

OBJECTIVE: To explore the real-time effects of interictal epileptiform discharges (IEDs) on hippocampus and amygdala functional connectivity (FC) in unilateral temporal lobe epilepsy (TLE). METHODS: Patients with unilateral TLE were recruited and underwent simultaneous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) scanning. Simultaneous EEG was used to define the prespike (10 s before spike) and postspike (10 s after spike) periods. Dynamic FC analysis was applied using the left/right hippocampus and amygdala separately as a seed region to map the network alterations after IED occurrence. RESULTS: A total of 261 IED events (133 left, 128 right) from 21 patients with unilateral TLE (10 left, 11 right) were analyzed. Left IEDs had a greater influence on the hippocampus-seeded networks, whereas right IEDs affected the amygdala-seeded networks more. Left IEDs disconnected the ipsilateral hippocampus and the default mode network, which might be related to cognitive impairment in TLE. The reward-emotion network (more of the prefrontal-limbic system) and visual network also showed FC changes after left IEDs. The reward-emotion network (more of the reward system) was coactivated after right IEDs, indicating a possible mechanism of forced normalization. SIGNIFICANCE: This study directly linked the disrupted functional networks in TLE to epileptic activities and offered a unique tool for future research to investigate mechanisms of comorbidities in TLE.


Assuntos
Tonsila do Cerebelo/fisiopatologia , Eletroencefalografia , Epilepsia do Lobo Temporal/fisiopatologia , Hipocampo/fisiopatologia , Imageamento por Ressonância Magnética , Adolescente , Adulto , Disfunção Cognitiva/fisiopatologia , Eletroencefalografia/métodos , Epilepsia/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Lobo Temporal/fisiopatologia
18.
Neuroimage Clin ; 21: 101631, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30553761

RESUMO

OBJECTIVES: To explore the dynamic changes of white matters following anterior temporal lobectomy (ATL) in mesial temporal lobe epilepsy (MTLE) patients who achieved seizure-free at two-year follow-up. METHODS: Diffusion tensor imaging (DTI) was obtained in ten MTLE patients at five serial time points: before surgery, three months, six months, 12 months and 24 months after surgery, as well as in 11 age- and sex-matched healthy controls at one time point. Regions with significant postoperative fractional anisotropy (FA) changes and their dynamic changes were confirmed by comparing all preoperative and postoperative data using Tract-Based Spatial Statistics (TBSS). RESULTS: After successful ATL, significant FA changes were found in widespread ipsilateral and contralateral white matter regions (P <.05, FWE correction). Ipsilateral external capsule, cingulum, superior corona radiate, body of corpus callosum, inferior longitudinal fasciculus, optic radiation and contralateral inferior cerebellar peduncle, inferior longitudinal fasciculus showed significant FA decrease at three months after surgery, without further changes. Ipsilateral superior cerebellar peduncle and contralateral corpus callosum, anterior corona radiate, external capsule, optic radiation showed significant FA decrease at three months follow up but increase later. Ipsilateral cerebral peduncle and contralateral middle cerebellar peduncle showed significant FA decrease at three months follow up, with further decrease after that. While ipsilateral posterior limb of internal capsule, retrolenticular part of internal capsule and contralateral posterior corona radiate showed significant FA increase after surgery. CONCLUSIONS: FA changes after successful ATL presented as four distinct patterns, reflecting different structural adaptions following epilepsy surgery. Some FA increases indicated the reversibility of preoperative diffusion abnormalities and the possibility of structural reorganization, especially in the contralateral hemisphere.


Assuntos
Imagem de Tensor de Difusão/tendências , Epilepsia do Lobo Temporal/diagnóstico por imagem , Epilepsia do Lobo Temporal/cirurgia , Cuidados Pós-Operatórios/tendências , Substância Branca/diagnóstico por imagem , Substância Branca/cirurgia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Adulto Jovem
19.
Sci Rep ; 8(1): 5689, 2018 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-29632387

RESUMO

The aim of the current study was to find the epileptic focus and examine its causal relationship to other brain regions in children with new-onset benign childhood epilepsy with centrotemporal spikes (BECTS). Resting-state functional magnetic resonance imaging (fMRI) was performed in 66 children with BECTS and 37 matched control children. We compared the amplitude of low frequency fluctuation (ALFF) signals between the two groups to find the potential epileptogenic zone (EZ), then used Granger causality analysis (GCA) to explore the causal effects of EZ on the whole brain. Children with BECTS had significantly increased ALFF in the right Broca's area, and decreased ALFF in bilateral fusiform gyrus. The patients also showed increased driving effect from the EZ in Broca's area to the right prefrontal lobe, and decreased effects to the frontal lobe and posterior parts of the language network. The causal effect on left Wernicke's area negatively correlated with verbal IQ (VIQ) score. Our research on new-onset BECTS patients illustrates a possible compensatory mechanism in the language network at early stages of BECTS, and the negative correlation of GCA and VIQ suggest the disturbance of epileptiform activity on language. These findings shed light on the mechanisms of and language dysfunction in BECTS.


Assuntos
Mapeamento Encefálico/métodos , Epilepsia Rolândica/diagnóstico por imagem , Epilepsia Rolândica/psicologia , Lobo Temporal/diagnóstico por imagem , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Escalas de Wechsler
20.
Seizure ; 56: 78-87, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29454194

RESUMO

PURPOSE: This study is intended to provide an overview of diagnostic and treatment services for patients with psychogenic nonepileptic seizures (PNES) across China. METHODS: Using a questionnaire devised by the PNES Task Force of Neuropsychiatry Commission of the International League Against Epilepsy (ILAE), we conducted a survey among Chinese health professionals at the Sixth Advanced International Course: Clinical Epileptology. Descriptive analyses were performed. RESULTS: Responses from 102 eligible clinicians were analysed. Responses were received from urban areas in 20 provinces/municipalities around China. Most respondents were neurologists. The results showed that hospitals in urban China were mostly well-equipped, and that health professionals' understanding of PNES largely reflected current international expert opinion. However, many of the participants would not actually make the diagnosis, and most provided neither follow-up nor treatment (especially psychotherapy) for patients with PNES. Only about one third of the patients diagnosed with PNES were estimated to receive at least one appointment for psychological treatment. In the opinion of the respondents, tacit trauma (neglect and stress) play an important role in the development of PNES. The main obstacles to patients with PNES accessing health services for their condition were thought to be lack of knowledge or awareness among health professionals, patients and society. CONCLUSION: Despite good access to equipment, diagnostic and treatment services for patients with PNES in China are currently deficient. Education programs about PNES with different target groups, and more effective referral and social security systems emerge as particular development needs from this survey.


Assuntos
Gerenciamento Clínico , Ocupações em Saúde , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/terapia , Convulsões/diagnóstico , Convulsões/terapia , Adulto , China , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicofisiológicos/complicações , Transtornos Psicofisiológicos/epidemiologia , Convulsões/epidemiologia , Inquéritos e Questionários , População Urbana , Adulto Jovem
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