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1.
Annu Rev Biomed Eng ; 26(1): 273-306, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38959389

RESUMO

Nanomaterials are becoming important tools for vaccine development owing to their tunable and adaptable nature. Unique properties of nanomaterials afford opportunities to modulate trafficking through various tissues, complement or augment adjuvant activities, and specify antigen valency and display. This versatility has enabled recent work designing nanomaterial vaccines for a broad range of diseases, including cancer, inflammatory diseases, and various infectious diseases. Recent successes of nanoparticle vaccines during the coronavirus disease 2019 (COVID-19) pandemic have fueled enthusiasm further. In this review, the most recent developments in nanovaccines for infectious disease, cancer, inflammatory diseases, allergic diseases, and nanoadjuvants are summarized. Additionally, challenges and opportunities for clinical translation of this unique class of materials are discussed.


Assuntos
COVID-19 , Nanoestruturas , SARS-CoV-2 , Desenvolvimento de Vacinas , Humanos , Nanoestruturas/química , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Vacinas contra COVID-19/química , Animais , Adjuvantes Imunológicos/química , Neoplasias/imunologia , Neoplasias/prevenção & controle , Nanopartículas/química , Vacinas , Pandemias/prevenção & controle
2.
Sensors (Basel) ; 22(5)2022 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-35270994

RESUMO

In this paper, we addressed the problem of dataset scarcity for the task of network intrusion detection. Our main contribution was to develop a framework that provides a complete process for generating network traffic datasets based on the aggregation of real network traces. In addition, we proposed a set of tools for attribute extraction and labeling of traffic sessions. A new dataset with botnet network traffic was generated by the framework to assess our proposed method with machine learning algorithms suitable for unbalanced data. The performance of the classifiers was evaluated in terms of macro-averages of F1-score (0.97) and the Matthews Correlation Coefficient (0.94), showing a good overall performance average.


Assuntos
Algoritmos , Aprendizado de Máquina , Projetos de Pesquisa
3.
Entropy (Basel) ; 24(7)2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35885165

RESUMO

Most of the methods for real-time semantic segmentation do not take into account temporal information when working with video sequences. This is counter-intuitive in real-world scenarios where the main application of such methods is, precisely, being able to process frame sequences as quickly and accurately as possible. In this paper, we address this problem by exploiting the temporal information provided by previous frames of the video stream. Our method leverages a previous input frame as well as the previous output of the network to enhance the prediction accuracy of the current input frame. We develop a module that obtains feature maps rich in change information. Additionally, we incorporate the previous output of the network into all the decoder stages as a way of increasing the attention given to relevant features. Finally, to properly train and evaluate our methods, we introduce CityscapesVid, a dataset specifically designed to benchmark semantic video segmentation networks. Our proposed network, entitled FASSVid improves the mIoU accuracy performance over a standard non-sequential baseline model. Moreover, FASSVid obtains state-of-the-art inference speed and competitive mIoU results compared to other state-of-the-art lightweight networks, with significantly lower number of computations. Specifically, we obtain 71% of mIoU in our CityscapesVid dataset, running at 114.9 FPS on a single NVIDIA GTX 1080Ti and 31 FPS on the NVIDIA Jetson Nano embedded board with images of size 1024×2048 and 512×1024, respectively.

4.
Epilepsy Behav ; 114(Pt A): 107560, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33243680

RESUMO

OBJECTIVE: To determine the usefulness and efficacy of radiofrequency ablations (RFA) of the Centromedian thalamic nucleus (CMN) to control primarily generalized or multifocal seizures in refractory epilepsy. METHODS: Six patients with clinical diagnosis of multifocal or primarily generalized drug-resistant epilepsy were included. Bilateral RFA of the CMN was performed through a monopolar 1.8 mm. tip electrode with a temperature of 80 °C during 90 seconds. Patients were followed in every 3 months visit for 20 to 36 months and kept a monthly seizure count calendar. We also compared maximal paroxysmal electroencephalogram (EEG) activity and neuropsychological evaluation pre and 6 months postoperatively. RESULTS: A significant reduction in the number of generalized seizures was observed in all subjects in the range of 79-98%, starting the first post-operative month. Although focal aware seizures remained unchanged throughout follow-up, there was an important reduction on paroxysmal activity between the pre and postoperative EEG. No major changes on cognitive status were detected. There was post-operative dysphagia and odynophagia lasting one week and there was no mortality in this group of patients. CONCLUSION: Preliminary results of CMN RFA suggest safety and a trend toward reduction of some seizure types, it may reduce the seizure frequency like other palliative procedures since the first post-operative month, but a larger, controlled study would be needed to establish the value of this therapy.


Assuntos
Epilepsia Resistente a Medicamentos , Núcleos Intralaminares do Tálamo , Preparações Farmacêuticas , Ablação por Radiofrequência , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia , Humanos
5.
Stereotact Funct Neurosurg ; 97(4): 232-240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31722358

RESUMO

BACKGROUND: Positron emission tomography (PET) imaging in epilepsy is an in vivo technique that allows the localization of a possible seizure onset zone (SOZ) during the interictal period. Stereo-electro-encephalography (SEEG) is the gold standard to define the SOZ. The objective of this research was to evaluate the accuracy of PET imaging in localizing the site of SOZ compared with SEEG. METHODS: Seven patients with refractory temporal lobe epilepsy (Ep) and 2 healthy controls (HC) underwent 2 PET scans, one with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) and another with 2'-[18F]fluoroflumazenil (FFMZ), acquired 1 day apart. FDG was acquired for 10 min (static scan) 1 h after administration. An FFMZ scan was acquired for 60 min from radiopharmaceutical administration in a dynamic mode. Each brain PET image was segmented using a standard template implemented in PMOD 3.8. The pons was used as the reference region for modeling of the nondisplaceable binding potential (BPND)for FFMZ, and to obtain uptake ratios for FDG. SEEG studies of patients were performed as a part of their surgical evaluation to define the SOZ. RESULTS: Well-defined differences between HC and Ep were found with both radiopharmaceuticals, showing the utility to identify abnormal brain regions using quantitative PET imaging. Lateralization of the SOZ findings by PET (lower uptake/binding in a specific brain hemisphere) matched in 86% for FFMZ and 71% for FDG with SEEG data. CONCLUSION: Quantitative PET imaging is an excellent complementary tool that matches reasonably well with SEEG to define SOZ in presurgical evaluation.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia do Lobo Temporal/diagnóstico por imagem , Flumazenil/análogos & derivados , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons/métodos , Adolescente , Adulto , Mapeamento Encefálico/métodos , Epilepsia Resistente a Medicamentos/metabolismo , Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia do Lobo Temporal/metabolismo , Epilepsia do Lobo Temporal/cirurgia , Feminino , Flumazenil/metabolismo , Radioisótopos de Flúor/metabolismo , Fluordesoxiglucose F18/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/diagnóstico por imagem , Convulsões/metabolismo , Convulsões/cirurgia
6.
Mycologia ; 108(1): 123-34, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26553779

RESUMO

Species in the Inocybe praetervisa group are characterized by producing nodulose to angular basidiospores and a bulbous, marginate, white stipe devoid of any pinkish to reddish tinge. Species delimitation problems and common misinterpretations in the I. praetervisa group have not yet been resolved through type studies and analysis of molecular data. This study seeks to clarify the taxonomy and nomenclature of species around I. praetervisa. Analyses of the nuc rDNA internal transcribed regions (ITS) recovered two major groups within the I. praetervisa group that can be separated on the basis of cystidial morphology. The study of three authentic and topotypic specimens in the Bresadola herbarium revealed that the name I. praetervisa has been misapplied often. The ITS region of one of the specimens was obtained, and this specimen is designated as epitype in support of a lectotype. Inocybe rivularis is demonstrated to be a later synonym of I. praetervisa, while Inocybe phaeocystidiosa is the correct name for the species most often misdetermined as I. praetervisa. Inocybe salicis-herbaceae and I. praetervisa var. flavofulvida are shown to be synonyms of I. phaeocystidiosa based on ITS sequence data from type collections. A new species sister to I. phaeocystidiosa with a Mediterranean distribution is described as I. praetervisoides. Cystidial morphology, distribution of caulocystidia, basidiospore morphology and ecology are shown to be the main diagnostic characters for separating the species. Inocybe praetervisa and I. phaeocystidiosa have a transoceanic distribution in Europe and North America, whereas I. praetervisoides so far is known only from the Mediterranean region.


Assuntos
Agaricales/classificação , Agaricales/citologia , Agaricales/genética , Sequência de Bases , Código de Barras de DNA Taxonômico , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Região do Mediterrâneo , Dados de Sequência Molecular , Filogenia , Análise de Sequência de DNA , Esporos Fúngicos
7.
Mycologia ; 108(2): 441-56, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26740538

RESUMO

We constructed a comprehensive phylogeny of the genus Genea, with new molecular data from samples collected in several countries in temperate and Mediterranean Europe, as well as North America. Type specimens and authentic material of most species were examined to support identifications. The molecular identity of the most common species in Genea was compared with nuc rDNA internal transcribed spacer (ITS), D1-D2 domains of 28S nuc rDNA (28S rDNA) and translation elongation factor 1-α ene (TEF1) profiles of 10 recently proposed taxa, G. brunneocarpa, G. compressa, G. dentata, G. fageticola, G. lobulata, G. oxygala, G. pinicola, G. pseudobalsleyi, G. pseudoverrucosa and G. tuberculata, supporting their status as distinct species. Genea mexicana and G. thaxteri on the one hand and G. sphaerica and G. lespiaultii on the other are closely related. Multiple lineages were recorded for G. verrucosa and G. fragrans, but we found no morphological traits to discriminate among them, so we tentatively interpreted them as cryptic species. A key to species of the genus Genea is provided to facilitate identification. We provide macroscopic images of fresh specimens and of representative spores of most species. Finally, we conducted a molecular analysis of the divergence time for Genea and discuss the implications of our results.


Assuntos
Ascomicetos/classificação , Ascomicetos/genética , Filogenia , Ascomicetos/fisiologia , Demografia , Europa (Continente) , Especificidade da Espécie , Esporos Fúngicos/classificação , Esporos Fúngicos/ultraestrutura
8.
Mycologia ; 107(1): 123-36, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25344261

RESUMO

A molecular multigene analysis (ITS, 18S and 28S nrLSU ribosomal DNA, tef1, rpb2) was used to support the proposition of three new genera of clitocyboid fungi. Leucocybe is proposed to accommodate the clade formed by Clitocybe connata and C. candicans. Clitocybe inornata is invested as type species of Atractosporocybe, while the new genus, Rhizocybe, is proposed for the former species of section Vernae of Clitocybe, C. vermicularis, C. pruinosa and C. rhizoides. The three lineages are related to the families Lyophyllaceae and Entolomataceae and independent from the Clitocybeae clade. Morphologically Rhizocybe is characterized by the presence of conspicuous rhizomorphs, while Atractosporocybe presents long fusiform spores. Leucocybe includes two whitish species in the former section Candicantes of Clitocybe, but no relevant shared characteristic feature was detected. Other whitish clitocyboid species, such as C. phyllophila (= C. cerussata), C. dealbata, C. rivulosa, and Singerocybe hydrogramma, are shown to be genetically related to the core lineage of the Clitocybeae.


Assuntos
Agaricales/classificação , Agaricales/isolamento & purificação , Agaricales/genética , DNA Fúngico/genética , Proteínas Fúngicas/genética , Dados de Sequência Molecular , Filogenia , RNA Ribossômico 28S/genética , Microbiologia do Solo
9.
Front Robot AI ; 11: 1356692, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38863780

RESUMO

Soft grippers are garnering increasing attention for their adeptness in conforming to diverse objects, particularly delicate items, without warranting precise force control. This attribute proves especially beneficial in unstructured environments and dynamic tasks such as food handling. Human hands, owing to their elevated dexterity and precise motor control, exhibit the ability to delicately manipulate complex food items, such as small or fragile objects, by dynamically adjusting their grasping configurations. Furthermore, with their rich sensory receptors and hand-eye coordination that provide valuable information involving the texture and form factor, real-time adjustments to avoid damage or spill during food handling appear seamless. Despite numerous endeavors to replicate these capabilities through robotic solutions involving soft grippers, matching human performance remains a formidable engineering challenge. Robotic competitions serve as an invaluable platform for pushing the boundaries of manipulation capabilities, simultaneously offering insights into the adoption of these solutions across diverse domains, including food handling. Serving as a proxy for the future transition of robotic solutions from the laboratory to the market, these competitions simulate real-world challenges. Since 2021, our research group has actively participated in RoboSoft competitions, securing victories in the Manipulation track in 2022 and 2023. Our success was propelled by the utilization of a modified iteration of our Retractable Nails Soft Gripper (RNSG), tailored to meet the specific requirements of each task. The integration of sensors and collaborative manipulators further enhanced the gripper's performance, facilitating the seamless execution of complex grasping tasks associated with food handling. This article encapsulates the experiential insights gained during the application of our highly versatile soft gripper in these competition environments.

10.
ACS Biomater Sci Eng ; 10(5): 3041-3056, 2024 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-38623037

RESUMO

Oral immunization is a promising strategy for preventing and treating gastrointestinal (GI) infections and diseases, as it allows for direct access to the disease site. To elicit immune responses within the GI tract, however, there are many obstacles that oral vaccines must surmount, including proteolytic degradation and thick mucus barriers. Here, we employed a modular self-assembling peptide nanofiber platform to facilitate oral immunization against both peptide and small molecule epitopes. Synthesizing nanofibers with d-amino acids rendered them resistant to proteases in vitro, whereas l-amino acid nanofibers were rapidly degraded. Additionally, the inclusion of peptide sequences rich in proline, alanine, and serine (PAS), increased nanofiber muco-penetration, and accelerated nanofiber transport through the GI tract. Oral immunization with PASylated nanofibers and mucosal adjuvant generated local and systemic immune responses to a peptide epitope but only for l-amino acid nanofibers. Further, we were able to apply this design to also enable oral immunization against a small molecule epitope and illustrated the therapeutic and prophylactic effectiveness of these immunizations in mouse models of colitis. These findings demonstrate that supramolecular peptide self-assemblies have promise as oral vaccines and immunotherapies.


Assuntos
Imunização , Nanofibras , Peptídeos , Animais , Administração Oral , Nanofibras/química , Peptídeos/imunologia , Peptídeos/química , Peptídeos/administração & dosagem , Camundongos , Imunização/métodos , Epitopos/imunologia , Feminino , Camundongos Endogâmicos C57BL , Colite/imunologia , Colite/prevenção & controle , Colite/induzido quimicamente
11.
Soft Robot ; 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38813671

RESUMO

Robotics is entering our daily lives. The discipline is increasingly crucial in fields such as agriculture, medicine, and rescue operations, impacting our food, health, and planet. At the same time, it is becoming evident that robotic research must embrace and reflect the diversity of human society to address these broad challenges effectively. In recent years, gender inclusivity has received increasing attention, but it still remains a distant goal. In addition, awareness is rising around other dimensions of diversity, including nationality, religion, and politics. Unfortunately, despite the efforts, empirical evidence shows that the field has still a long way to go before achieving a sufficient level of equality, diversity, and inclusion across these spectra. This study focuses on the soft robotics community-a growing and relatively recent subfield-and it outlines the present state of equality and diversity panorama in this discipline. The article argues that its high interdisciplinary and accessibility make it a particularly welcoming branch of robotics. We discuss the elements that make this subdiscipline an example for the broader robotic field. At the same time, we recognize that the field should still improve in several ways and become more inclusive and diverse. We propose concrete actions that we believe will contribute to achieving this goal, and provide metrics to monitor its evolution.

12.
Soft Robot ; 10(3): 527-544, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36346280

RESUMO

A new generation of soft functional materials and actuator designs has ushered the development of highly advanced soft grippers as adaptive alternatives to traditional rigid end-effectors for grasping and manipulation applications. While being advantageous over their rigid counterparts, soft gripper capabilities such as contact effort are mostly a consequence of the gripper workspace, which in turn is largely constrained by the gripper design. Moreover, soft grippers designed for highly specific grasping tasks such as scooping grains or wide payloads are usually limited in grasping other payload types or in their manipulation versatility. This article describes a reconfigurable workspace soft (RWS) gripper that exploits compliant structures and pneumatic actuators to reconfigure its workspace to suit a wide range of grasping tasks. To achieve desired kinematics, finite element analysis (FEA) studies are conducted to dictate actuator design and materials used. Various grasping modes and their reconfiguration of the gripper workspace are presented and characterized, including the gripper's capability to reliably scoop granular items with radii as small as 1.5 mm, precisely pick items as thin as 300 µm from flat surfaces, as well as grasp large convex, nonconvex, and deformable items as heavy as 1.4 kg. The RWS gripper can modify and increase its grasping workspace volume by 397%, enabling the widest range of grasping capabilities to date achieved by a single soft gripper.


Assuntos
Extremidade Superior , Análise de Elementos Finitos
13.
Mycologia ; 104(4): 894-910, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22314593

RESUMO

New collections of T. gennadii, T. oligospermum and T. asa (Tuberaceae, Pezizales) from the Mediterranean basin were compared on the basis of morphology and DNA sequences. Phylogenetic inference based on the internal transcribed spacer region (ITS) and the 28S nuclear large ribosomal subunit (nrLSU) indicates that T. gennadii includes at least two lineages with characteristic morphological traits. T. gennadii s. str. has small subglobose ascomata with conspicuous glebal locules that form a continuous labyrinth when mature and has a prosenchymatic peridium. T. lacunosum has medium to large, deeply lobed ascomata with small to very small isolated locules when mature and has a pseudoparenchymatic peridium. Two major clades were identified within the T. oligospermum group. On the basis of morphological, ecological and biogeographical data, these are identified with the taxa T. oligospermum (= T. asa) and T. sphaerospermum. Tuber oligospermum forms small to medium globose or subglobose, whitish ascomata, with globose to broadly ellipsoidal ascospores and is found in alkaline, sandy soils. Tuber sphaerospermum forms medium to large, irregularly globose or deeply lobed, yellowish ascomata, with regularly globose ascospores and is found in acidic soils. Finally, a new truffle species with a prosenchymatic peridium and globose to ellipsoid reticulate spores, collected in acidic argillaceous soils of Spain under Cistus ladanifer is proposed here as the new species T. cistophilum.


Assuntos
Ascomicetos/classificação , DNA Fúngico , Microbiologia do Solo , Ácidos , Ascomicetos/citologia , Ascomicetos/genética , Sequência de Bases , Teorema de Bayes , DNA Espaçador Ribossômico/genética , Ecossistema , Carpóforos/citologia , Hifas/citologia , Técnicas de Tipagem Micológica , Filogenia , Filogeografia , RNA Ribossômico 28S/genética , Subunidades Ribossômicas Maiores de Eucariotos/genética , Estações do Ano , Alinhamento de Sequência , Análise de Sequência de DNA , Especificidade da Espécie
14.
MycoKeys ; 92: 63-78, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36761314

RESUMO

In the present work, an epitype for Sphaeriaapiospora, the basionym of the type species of the genus Apiospora, Apiosporamontagnei, is selected among collections growing in the host plant species reported in the original protologue, Arundomicrantha. Most samples obtained from localities near that of the lectotype (Perpignan, France) belong to the same species, which is not significantly different from the clade previously named Ap.phragmitis, suggesting that this name is a later synonym of Ap.montagnei. In addition, the name Ap.marianiae is here proposed to accommodate a newly discovered species found in the Balearic Islands (Spain), and the asexual state of Ap.sichuanensis is described for the first time from samples growing in the same islands.

16.
Mycoscience ; 63(6): 274-283, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-37089519

RESUMO

A previously unknown morel species apparently endemic to Japan is here described. Morchella nipponensis is proposed for this species. This new taxon displays archaic features recalling section Rufobrunnea (pileus lanceolate, few primary alveoli), and a yellow pileus similar to subsection Sceptriformis of section Morchella. The phylogenetic analysis of ITS rDNA, as well as RPB1, RPB2 and TEF1 genes from up to four collections suggests that this morel species represents a basal branch of section Morchella (yellow morels), for which the new subsection Japonicae is proposed.

17.
ACS Appl Mater Interfaces ; 14(1): 2301-2315, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-34962370

RESUMO

Freeform liquid three-dimensional printing (FL-3DP) is a promising new additive manufacturing process that uses a yield stress gel as a temporary support, enabling the processing of a broader class of inks into complex geometries, including those with low viscosities or long solidification kinetics that were previously not processable. However, the full exploitation of these advantages for the fabrication of complex multilateral structures has been hindered by difficulties in controlling the interfaces between inks and supports. In this work, an in-depth study of the rheological properties and interfacial stabilities between a nanoclay-modified support and silicone-based inks enabled a better understanding of the impact printing parameters have on the extruded filament morphology, and thus on printing resolutions. With these improvements, the fabrication of functional multimaterial pneumatic components applied to soft robotics could be demonstrated, exhibiting superior capabilities compared to casting or traditional extrusion-based additive manufacturing in terms of geometric freedom (overhanging and multimaterial structures), tunability of the component's functionality, and robustness between different phases. Overall, the full exploitation of FL-3DP advantages enables a broader design space for features and functionalities in soft robotic components that require complex and robust combinations of materials.

18.
Front Neurol ; 13: 796846, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35280275

RESUMO

A comparative analysis of the targets for deep brain stimulation (DBS) to treat refractory temporal lobe epilepsy and the rationale for its use is presented, with an emphasis on the latency to obtain the significant antiepileptic effect and the long-term seizure control. The analysis includes consideration of surgical techniques currently used to optimize antiseizure effects and decrease surgical risks. Seizure control is similar for programed DBS and DBS responsive to abnormal cortical or subcortical electroencephalogram (EEG) activity. There is no difference in the long-term seizure control between programmed and responsive and intermittent or continuous DBS. However, intermittent programed DBS may have a significant antiseizure effect starting in the first month when applied to a non-sclerotic tissue such as the parahippocampal cortex. DBS induces no neuropsychological deterioration.

19.
Biology (Basel) ; 11(5)2022 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-35625498

RESUMO

In Europe, amatoxin-containing mushrooms are responsible for most of the deadly poisonings caused by macrofungi. The present work presents a multidisciplinary revision of the European species of Amanita sect. Phalloideae based on morphology, phylogeny, epidemiology, and biochemistry of amatoxins and phallotoxins. Five distinct species of this section have been identified in Europe to date: A. phalloides, A. virosa, A. verna, the recently introduced North American species A. amerivirosa, and A. vidua sp. nov., which is a new name proposed for the KOH-negative Mediterranean species previously described as A. verna or A. decipiens by various authors. Epitypes or neotypes are selected for species lacking suitable reference collections, namely A. verna and A. virosa. Three additional taxa, Amanita decipiens, A. porrinensis, and A. virosa var. levipes are here considered later heterotypic synonyms of A. verna, A. phalloides, and A. amerivirosa, respectively.

20.
J Neurosurg ; : 1-8, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35171814

RESUMO

OBJECTIVE: The authors sought to determine the antiseizure effects of deep brain stimulation (DBS) of the parahippocampal cortex (PHC) for treatment of drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS: After a 3-month baseline period, 6 adult patients with drug-resistant MTLE and hippocampal sclerosis (HS) had stereoelectroencephalography (SEEG)-DBS electrodes implanted at the PHC for identification of the seizure onset zone (SOZ). Patients entered an 8-month, randomized, double-blind protocol for DBS, followed by a 12-month open-phase study. Monthly reports of seizure frequency were collected, with separate counting of focal seizures with or without awareness impairment (focal impaired awareness seizures [FIAS] or focal aware seizures [FAS], respectively) and focal evolving to bilateral generalized tonic clonic seizures (GTCS). Stimulation parameters were 130 Hz, 450 µsec, 2.5-3 V, and cyclic stimulation 1 minute on/4 minutes off. RESULTS: The total seizure rate decrement during follow-up was 41% (CI 25%-56%), with better seizure control for GTCS (IQR 19%-20%) and FIAS (IQR 0%-16%), with FAS being less responsive (IQR 67%-236%). No neuropsychological deterioration was observed. CONCLUSIONS: PHC DBS induced important antiseizure effects in patients with incapacitating FIAS and GTCS, most likely through blocking the propagation of hippocampal-onset seizures. The PHC target can be easily and safely approached due to positioning away from vascular structures, and there was no evidence of DBS-induced cognitive deterioration.

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