Age-dependent semiology of frontal lobe seizures.

INTRODUCTION: Frontal lobe epilepsy is the second most frequent origin of focal epilepsy. Various studies have discussed localizing aspects of ictal signs in frontal lobe epilepsy; the effect of age on semiological manifestations has, however, not been analyzed so far. MATERIAL AND METHODS: We retrospectively analyzed video-documented semiological signs in a cohort of 122 consecutive patients aged 0-70 years (mean age: 24.9 years) with EEG/MR evidence for frontal lobe epilepsy undergoing video-EEG telemetry assessment between 1999 und 2016. RESULTS: In this patient cohort, most common etiologies were focal cortical dysplasia (48%) and tumors (16%). Most frequent ictal manifestations overall were impaired language comprehension (60.3%), unilateral tonic posturing (58.9%), unilateral cloni (46.6%), versive movements (44.5%), vocalization (42.5%) and impaired reactivity to non-verbal stimuli (40.4%). With increasing age, sign of four (p = 0.019), dystonic posturing (p = 0.026), changes in heart rate (p = 0.014) and impaired reactivity to non-verbal stimuli (p = 0.009) occurred significantly more frequently. In contrast, myoclonic components were significantly less frequent observed in the higher age group (p = 0.037). CONCLUSIONS: Frontal lobe seizures can be categorized into different behavioral manifestations related to involved symptomatic brain regions, including clonic, bilateral asymmetric tonic seizures and complex motor phenomena. In this cross-sectional study, we found age-related changes in the frequency of both, motor and non-motor semiological elements. Especially simple lateralized motor signs like dystonic posturing, sign of four and version were more common with increasing age. Age-dependent alterations in phenomenology may reflect maturation in connectivity and seizure propagation within and beyond the frontal lobe, and affect the localizing and lateralizing value of ictal phenomena.

RAIDD mutations underlie the pathogenesis of thin lissencephaly (TLIS).

Abnormal regulation of caspase-2-mediated neuronal cell death causes neurodegenerative diseases and defective brain development. PIDDosome is caspase-2 activating complex composed of PIDD, RAIDD, and caspase-2. Recent whole-exome sequencing study showed that the RAIDD mutations in the death domain (DD), including G128R, F164C, R170C, and R170H mutations, cause thin lissencephaly (TLIS) by reducing caspase-2-mediated neuronal apoptosis. Given that the molecular structure of the RAIDD DD:PIDD DD complex is available, in this study, we analyzed the molecular mechanisms underlying TLIS caused by the RAIDD TLIS variants by performing mutagenesis and biochemical assays.

Fetal cytomegalovirus infection.

Cytomegalovirus (CMV) congenital infection affects 0.7% of live births worldwide and is the leading cause of congenital neurological handicap of infectious origin. However, systematic screening for this infection has not been implemented in pregnancy or at birth in any country. This apparent paradox had been justified by persisting gaps in the knowledge of this congenital infection: uncertain epidemiological data, difficulty in the diagnosis of maternal infection, absence of validated prenatal prognostic markers, unavailability of an efficient vaccine and scarcity of data available on the treatment. However, in the last decade, new data have emerged towards better management of this congenital infection, including solid epidemiological data, good evidence for the accuracy of diagnosis of maternal CMV infection and good evidence for the feasibility of predicting the outcome of fetal infection by a combination of fetal imaging and fetal laboratory parameters. There is also some evidence that valaciclovir treatment of mothers carrying an infected fetus is feasible, safe and might be effective. This review provides an update on the evidence for diagnosis, prognosis and treatment of congenital infection in the antenatal period. These suggest a benefit to a proactive approach for prenatal congenital infections.

Congenital Zika Virus Infection: Beyond Neonatal Microcephaly.

IMPORTANCE: Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. OBJECTIVE: To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. DESIGN, SETTING, AND PARTICIPANTS: We observed 11 infants with congenital ZIKV infection from gestation to 6 months in the state of Paraíba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. MAIN OUTCOMES AND MEASURES: Description of the major lesions caused by ZIKV congenital infection. RESULTS: Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. CONCLUSIONS AND RELEVANCE: Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.

Citomegalia congénita y malformaciones corticales y subcorticales / Congenital cytomegalovirus infection and cortical/subcortical malformations

Introducción: La infección intrauterina por citomegalovirus es la más frecuente de las viriasis/parasitosis intrauterinas que afectan al sistema nervioso central y causan lesiones permanentes tanto en el córtex como en la sustancia blanca subcortical. Son escasos los estudios de resonancia magnética (RM) cerebral.Material y métodos: Seis pacientes (4M y 2V) fueron estudiados desde los primeros meses de vida para hacer el diagnóstico de citomegalia congénita e identificar la presencia de lesiones corticales y subcorticales, utilizando las necesarias secuencias de RM. Resultados: Los 6 pacientes mostraban malformaciones del desarrollo cortical (MDC) (esquisencefalia, polimicrogiria o lisencefalia-paquigiria) desde la época neonatal y alteraciones difusas de la sustancia blanca, que se mantuvieron con pocos cambios durante los dos primeros años y después se iban reduciendo de tamaño en forma de zonas de hiperseñal en T2, circunscritas a determinadas áreas y permanecían con pocos cambios durante algunos años más. Conclusión:La infección intrauterina por citomegalovirus causa lesiones en sustancia gris cortical, que consisten en MDC y en sustancia blanca subcortical. Estas últimas muestran aspecto cambiante, ya que aparecen como áreas difusas y amplias de hiperseñal, que se suelen interpretar como retraso en la mielinización, pero que también pueden ser causadas directamente por el virus de la citomegalia. Estas alteraciones de la sustancia blanca sufren cambios morfológicos a lo largo de los primeros años de vida, dejando atrofia cerebral. Las secuelas neurológicas que dejan estas alteraciones son severas y crónicas (AU)

Introduction: Intrauterine infection due to cytomegalovirus is the most common of the intrauterine viral/parasitic infections that affect the central nervous system and cause permanent lesions in the cortex as well as the subcortical white matter. Studies using brain magnetic resonance imaging (MRI) are limited. Material and methods: Six patients (4 females and 2 males) were studied in the first months of life in order to make a diagnosis of congenital cytomegalovirus, and identify the cortical and subcortical lesions using the necessary MRI sequences. Results: The six patients showed malformations of cortical development (MDC) (schizencephaly, polymicrogyria or lissencephaly-pachygyria) from the neonatal period, and diffuse changes of the white matter, which remained with few changes during the first two years. They then began reducing in size in the form of high signal areas in T2, restricted to certain areas, and were evident for a few years more with little change. Conclusion: Intrauterine infection due to cytomegalovirus causes changes in the cortical grey matter, which consists of MDC, and in the subcortical white matter. The latter show a changing aspect as they appear as diffuse and wide areas of high signal intensity, which is usually due to delay in myelinisation, but could also be caused directly by the cytomegalovirus. These changes in the white matter are subjected to morphological changes throughout the first years of life, leading to brain atrophy. The neurological sequelae of these lesions left by these alterations are severe and chronic (AU)

Three-dimensional regulation of radial glial functions by Lis1-Nde1 and dystrophin glycoprotein complexes.

Radial glial cells (RGCs) are distinctive neural stem cells with an extraordinary slender bipolar morphology and dual functions as precursors and migration scaffolds for cortical neurons. Here we show a novel mechanism by which the Lis1-Nde1 complex maintains RGC functions through stabilizing the dystrophin/dystroglycan glycoprotein complex (DGC). A direct interaction between Nde1 and utrophin/dystrophin allows for the assembly of a multi-protein complex that links the cytoskeleton to the extracellular matrix of RGCs to stabilize their lateral membrane, cell-cell adhesion, and radial morphology. Lis1-Nde1 mutations destabilized the DGC and resulted in deformed, disjointed RGCs and disrupted basal lamina. Besides impaired RGC self-renewal and neuronal migration arrests, Lis1-Nde1 deficiencies also led to neuronal over-migration. Additional to phenotypic resemblances of Lis1-Nde1 with DGC, strong synergistic interactions were found between Nde1 and dystroglycan in RGCs. As functional insufficiencies of LIS1, NDE1, and dystroglycan all cause lissencephaly syndromes, our data demonstrated that a three-dimensional regulation of RGC's cytoarchitecture by the Lis1-Nde1-DGC complex determines the number and spatial organization of cortical neurons as well as the size and shape of the cerebral cortex.