Background Psychiatric comorbidities are common in patients with epilepsy.Reasons for the co-occurrence of psychiatric conditions and epilepsy remain poorly understood.Aim We aimed to triangulate the relationship betw...Background Psychiatric comorbidities are common in patients with epilepsy.Reasons for the co-occurrence of psychiatric conditions and epilepsy remain poorly understood.Aim We aimed to triangulate the relationship between epilepsy and psychiatric conditions to determine the extent and possible origins of these conditions.Methods Using nationwide Swedish health registries,we quantified the lifetime prevalence of psychiatric disorders in patients with epilepsy.We then used summarydata from genome-wide association studies to investigate whether the identified observational associations could be attributed to a shared underlying genetic aetiology using cross-trait linkage disequilibrium score regression.Finally,we assessed the potential bidirectional relationships using two-sample Mendelian randomisation.Results In a cohort of 7628495 individuals,we found that almost half of the 94435 individuals diagnosed with epilepsy were also diagnosed with a psychiatric condition in their lifetime(adjusted lifetime prevalence,44.09%;95%confidence interval(Cl)43.78%to 44.39%).We found evidence for a genetic correlation between epilepsy and some neurodevelopmental and psychiatric conditions.For example,we observed a genetic correlation between epilepsy and attention-deficit/hyperactivity disorder(r,=0.18,95%Cl 0.09 to 0.27,p<0.001)—a correlation that was more pronounced in focal epilepsy(r=0.23,95%CI 0.09 to 0.36,p<0.001).Findings from Mendelian randomisation using common genetic variants did not support bidirectional effects between epilepsy and neurodevelopmental or psychiatric conditions.Conclusions Psychiatric comorbidities are common in patients with epilepsy.Genetic correlations may partially explain some comorbidities;however,there is little evidence of a bidirectional relationship between the genetic liability of epilepsy and psychiatric conditions.These findings highlight the need to understand the role of environmental factors or rare genetic variations in the origins of psychiatric comorbidities in epilepsy.展开更多
Objective To explore the ability of interictal diffusion-weighted imaging(DWI)to localize the temporal lobe of seizure origin and to predict postoperative seizure control in patients with temporal lobe epilepsy(TLE).M...Objective To explore the ability of interictal diffusion-weighted imaging(DWI)to localize the temporal lobe of seizure origin and to predict postoperative seizure control in patients with temporal lobe epilepsy(TLE).Methods Twenty-seven patients with intractable TLE considered for surgery and 19 healthy volunteers were studied with conventional magnetic resonance imaging(MRI)and DWI.Apparent diffusion coefficients(ADCs)of bilateral hippocampi in both TLE patients and control subjects were obtained.Lateralization to either temporal lobe with hippocampal ADC was based on the threshold values derived from ±1SD of right/left ratios in normal subjects.And the postoperative pathology was reviewed.Results Hippocampal ADCs were higher on the side of surgery compared with those on the contralateral side as well as the ipsilateral side in control subjects [resected side(109.8±7.3)×10-5 cm2/s,contralateral side(91.7±4.7)×10-5 cm2/s,control subjects(81.6±5.2)×10-5 cm2/s,all P<0.01].Right/left hippocampal ADC ratio and conventional MRI lateralized to the operated temporal lobe in 21 of 27(77.8%)and in 18 of 27(66.7%)patients.Lateralization to the surgical side was not associated with postoperative seizure control with right/left hippocampal ADC ratio(P>0.05).Conclusions Conventional MRI is a sensitive method to detect hippocampal sclerosis.Accuracy of the right/left hippocampal ADC ratio for lateralizing to the side of surgery is very high,but it isn't a better predictor of surgical outcome.展开更多
Objective To evaluate metabolic abnormalities in patients with mesial temporal lobe epilepsy （MTLE） with proton magnetic resonance spectroscopy （MRS） using a 3.0T MR scanner. Methods Sixty-three patients （32 wom...Objective To evaluate metabolic abnormalities in patients with mesial temporal lobe epilepsy （MTLE） with proton magnetic resonance spectroscopy （MRS） using a 3.0T MR scanner. Methods Sixty-three patients （32 women and 31 men） with diagnosed MTLE underwent diagnostic MR imaging （MRI） and proton MRS using a 3.0T MR scanner. The clinical history and interictal epileptiform discharges （IEDs） were recorded. Sixteen healthy volunteers served as control. The results of proton MRS were compared with the findings of electroencephalogram and structural MRI findings. Results Twenty-seven of the 63 patients with MTLE showed unilateral hippocampal sclerosis, and 9 showed bilateral hippocampal sclerosis. The concentration ratio of N-acytelaspartate （NAA） / [ creatine （ Cr ） ＋ choline （Cho） ] in the hippocampal region of MTLE patients （0. 64±0. 07） was significantly lower than control （0. 80±0. 05, P = 0.023）. In the patients with unilateral hippocampal sclerosis, NAA/（Cr ＋ Cho） in the hippocampal region ipsilateral to the sclerotic hippocampus （0.56±0.06） was significantly lower than the ratio in the contralateral hippocampal region （0.69±0.07, P 〈 0. 001 ）. There was significant difference in hippocampal NAA/（ Cr ＋ Cho） between the refractory patients and the non-refractory patients （0. 64±0. 05 vs.0.71±0. 07, P =0. 04）. Forty-five patients were lateralized by IEDs, while 49 patients were lateralized by metabolite ratio. And lateralization determined by proton MRS and IEDs was concordant in 33 patients. Conclusions MRS as a noninvasive tool adds helpful metabolite information to routine MRI in evaluation of MTLE. The method is well established and should be a routine clinical application in the investigation of epilepsy.展开更多
Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secon...Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy. Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years(mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated. Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I(75.00%), 5 were class II(13.89%), 2 were class III(5.56%), and 2 were class IV(5.56%), thus the total effective rate(class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes(P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes(P=0.041). Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.展开更多
INTRODUCTION.Depression,a common mental disorder,is a leading cause of disability worldwide,with a global prevalence ranging from 20% to 25% in women and 7% to 12% in men,and it has exhibited an increasing trend in re...INTRODUCTION.Depression,a common mental disorder,is a leading cause of disability worldwide,with a global prevalence ranging from 20% to 25% in women and 7% to 12% in men,and it has exhibited an increasing trend in recent decades.Despite being known for decades,a consensus on the definition and diagnosis of treatment-resistant depression(TRD)is still lacking.展开更多
In this study, we investigate the cross-frequency coupling and functional brain networks in the subjects with temporal lobe epilepsy(TLE) using interictal EEG signals. The phase to phase synchronization within and acr...In this study, we investigate the cross-frequency coupling and functional brain networks in the subjects with temporal lobe epilepsy(TLE) using interictal EEG signals. The phase to phase synchronization within and across frequency bands is calculated and a significant difference between the epilepsy and control groups is observed. Compared with the controls,the epilepsy patients exhibit a stronger within-frequency coupling(WFC) within theta and beta bands, and shows a stronger cross-frequency coupling(CFC) in the delta–alpha and theta–alpha band pairs, but a weakened CFC in alpha–beta band pairs. The weakened coupling between alpha and high frequency band reflects a suppression of phase modulation between the brain regions related to epilepsy. Moreover, WFC and CFC are positively correlated, which is higher in the patients relative to controls. We further reconstruct functional brain connectivity and find that both WFC and CFC networks show small-world properties. For the epilepsy, the small-world efficiency is enhanced in the CFC networks in delta–alpha and theta–alpha band pairs, whereas weakened between alpha and beta bands, which suggests a shift away from the optimal operating point in the epileptic brain with a new balance between WFC and CFC. Our results may help us to understand the important role of information communication across different frequency bands and shed new light on the study of pathology of epilepsy.展开更多
Experimental records in the cerebral cortex indicate that ammonia injection can lead to seizures. Considering that astrocytes play a vital role in mediating the uptake and absorption of ammonium ions in the extracellu...Experimental records in the cerebral cortex indicate that ammonia injection can lead to seizures. Considering that astrocytes play a vital role in mediating the uptake and absorption of ammonium ions in the extracellular space of the cortical circuit, we constructed a new astrocyte neuron coupling model, which is composed of a neuron and its astrocytes connected through the extracellular space, taking into account of the influence of extracellular ammonium ions. The numerical results verified the previous experimental observation that obtained epileptic firing modes of neurons and postsynaptic GABA reversal potential depolarization triggered by ammonia injection. In addition, we also determined the concentration–response relationship between the ammonium ion concentration and the time of entering epilepsy and predicted the threshold of the ammonium ion concentration for the onset of epilepsy.展开更多
The basal ganglia have been implicated in a modulation role in idiopathic generalized epilepsy （IGE） by an invasive electrophysioigic means. This paper investigates the basal ganglia functional connectivity by using...The basal ganglia have been implicated in a modulation role in idiopathic generalized epilepsy （IGE） by an invasive electrophysioigic means. This paper investigates the basal ganglia functional connectivity by using the region-wise functional connection analysis in resting-state functional magnetic resonance imaging （fMRI） in IGE. The increased functional connectivity within basal ganglia, and between the basal ganglia and the thalamus, and decreased functional connectivity between basal ganglia and motor cortex are found in IGE compared with the controls. These findings not only implicate dysfunctional integration in the motor loop in IGE and the enhanced interaction in the modulated loop, but also suggest that the basal ganglia modulate the generalized epileptic discharges with the influence over thalamus in the corticothalamus network.展开更多
The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analys...The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analysis.rsfMRI is performed in 46 adult patients with FLE and 46 age matched healthy controls(HCs).A functional network is built from these subjects,and the topological properties of such network are analyzed quantitatively using graph theoretical methods.According to the results,both FLE patients and HCs exhibit prominent small world features.Compared with HCs,FLE shows a decrease in local efficiency(Eloc),clustering coefficient,nodal efficiency as well as nodal degree.Furthermore,FLE(seven)has fewer hubs than HCs(ten).The functional abnormalities in the network organization suggest functional disturbances in patients with FLE.This study helps to gain new insights into the functional disorder in patients with FLE.The networks built here can also be a set of potential biomarkers for the diagnosis,monitoring and the treatment of FLE.展开更多
Objective To determine the spatio-temporal expression of p70S6k activation in hippocampus in mesial temporal lobe epilepsy. Methods Temporal lobe epilepsy model was established by stereotaxically unilateral and intrah...Objective To determine the spatio-temporal expression of p70S6k activation in hippocampus in mesial temporal lobe epilepsy. Methods Temporal lobe epilepsy model was established by stereotaxically unilateral and intrahip-pocampal injection of kainite acid (KA) in adult male C57BL/6 mice. Latent and chronic epileptogenesis were represented by mice 5 days after KA injection (n=5) and mice 5 weeks after KA injection (n=8), respectively. Control mice (n=5) were injected with saline. Immunohistochemical assays were performed on brain sections of the mice. Results Hippocampus both ipsilateral and contralateral to the KA injection displayed significantly up-regulated pS6 immunoreactivity in dispersed granule cells in 5-day and 5-week model mice. Conclusion The activation of p70S6k is mainly located in the dentate gyrus in KA-induced mouse model of temporal lobe epilepsy, indicating that the activation may be related with the disperse degree and hypertrophy of granule cells.展开更多
ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in ep...ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in epilepsy surgery to delineate margins of epileptogenic zones, guide resection,展开更多
Objective: To investigate the knowledge level related to compliance in patients with epilepsy. Methods: Eighty-seven patients with epilepsy were tested in the city of Xi’an with a knowledge questionnaire containing 2...Objective: To investigate the knowledge level related to compliance in patients with epilepsy. Methods: Eighty-seven patients with epilepsy were tested in the city of Xi’an with a knowledge questionnaire containing 21 questions related to compliance. Results: Over 39.5% of patients did not know that epilepsy is the result of abnormal firing of neurons, while 29.9% were uncertain or did not realize that epilepsy attacks can bring up accidents such as traffic accidents, drowning and trauma. A total of 36.6% of responders thought that the best therapy for epilepsy could be found in Traditional Chinese Medicine. As many as 36.8% of tested patients were uncertain or did not know that frequent epilepsy attacks can affect their intelligence. Up to 36% were unaware of the possible consequence of sudden withdrawal of anti-epileptic drugs (AED). Among responders, 39.1% did not know the right treatment method of epilepsy. That AED can control seizure attacks were doubted in 57.5% of epileptic patients. Furthermore, 32.2% did not know whether the disease could be cured. Conclusion: In this group of epileptic patients, generally they do not have enough indispensable knowledge to cope with epilepsy. They urgently need for proper health education besides effective AED to control seizure attacks and improve their quality of life.展开更多
Zolpidem is a short-acting non-benzodiazepine hypnotic agent,commonly recommended for short-term treatment of insomnia.Zolpidem has less dependence potential than benzodiazepines.Patients with mental illnesses often h...Zolpidem is a short-acting non-benzodiazepine hypnotic agent,commonly recommended for short-term treatment of insomnia.Zolpidem has less dependence potential than benzodiazepines.Patients with mental illnesses often have disturbed sleep,for which zolpidem is often prescribed.Long-term use and self-medication(in more than recommended doses)are more likely to cause dependence.We report here a case of bipolar affective disorder with epilepsy,who developed dependence to zolpidem and had severe withdrawal symptoms.The management issues are also discussed with review of the literature.展开更多
Traumatic brain injury(TBI) is a significant globa public health challenge, with an estimated mortality rate of 13 per 100,000 people in China. Bedsides the immediate neurological consequences,^([1]) TBI is associated...Traumatic brain injury(TBI) is a significant globa public health challenge, with an estimated mortality rate of 13 per 100,000 people in China. Bedsides the immediate neurological consequences,^([1]) TBI is associated with longterm sequelae and an elevated risk of neurodegenerative conditions such as dementia, Parkinson's disease, and epilepsy. Moreover, TBI can induce systemic effects including acute gastrointestinal injury(AGI), contributing to poor patient outcomes.展开更多
Network approaches have been widely accepted to guide surgical strategy and predict outcome for epilepsy treatment.This study starts with a single oscillator to explore brain activity,using a phenomenological model ca...Network approaches have been widely accepted to guide surgical strategy and predict outcome for epilepsy treatment.This study starts with a single oscillator to explore brain activity,using a phenomenological model capable of describing healthy and epileptic states.The ictal number of seizures decreases or remains unchanged with increasing the speed of oscillator excitability and in each seizure,there is an increasing tendency for ictal duration with respect to the speed.The underlying reason is that the strong excitability speed is conducive to reduce transition behaviors between two attractor basins.Moreover,the selection of the optimal removal node is estimated by an indicator proposed in this study.Results show that when the indicator is less than the threshold,removing the driving node is more possible to reduce seizures significantly,while the indicator exceeds the threshold,the epileptic node could be the removal one.Furthermore,the driving node is such a potential target that stimulating it is obviously effective in suppressing seizure-like activity compared to other nodes,and the propensity of seizures can be reduced 60%with the increased stimulus strength.Our results could provide new therapeutic ideas for epilepsy surgery and neuromodulation.展开更多
Kainate receptors,a subclass of ionotropic glutamate receptors,are tetrameric ligand-gated ion channels that mediate excitatory neurotransmission1-4.Kainate receptors modulate neuronal circuits and synaptic plasticity...Kainate receptors,a subclass of ionotropic glutamate receptors,are tetrameric ligand-gated ion channels that mediate excitatory neurotransmission1-4.Kainate receptors modulate neuronal circuits and synaptic plasticity during the development and function of the central nervous system and are implicated in various neurological and psychiatric diseases,including epilepsy,depression,schizophrenia,anxiety and autism5-11.Although structures of kainate receptor domains and subunit assemblies are available12-18,the mechanism of kainate receptor gating remains poorly understood.Here we present cryo-electron microscopy structures of the kainate receptor GluK2 in the presence of the agonist glutamate and the positive allosteric modulators lectin concanavalin A and BPAM344.展开更多
基金the National Institutes of Health(1R01NS107607-01A1)Erik and Edith Fernstrom Foundation for Medical Research(2020-00321)+5 种基金Karolinska Institutet(2020-00160,2020-01172)the Swedish Society for Medical Research(RM21-0005)This study was also supported by the NIHR Biomedical Research Centre at the University of Bristol and University Hospitals Bristol and the Weston NHS Foundation TrustThe Medical Research Council(MRC)and the University of Bristol supported the MRC Integrative Epidemiology Unit(MC_UU_00011/1)NMD was supported by the Norwegian Research Council(grant number 295989)The Swedish Research Council(523-2010-1052)supports the(Psychiatry Sweden)register linkage.
文摘Background Psychiatric comorbidities are common in patients with epilepsy.Reasons for the co-occurrence of psychiatric conditions and epilepsy remain poorly understood.Aim We aimed to triangulate the relationship between epilepsy and psychiatric conditions to determine the extent and possible origins of these conditions.Methods Using nationwide Swedish health registries,we quantified the lifetime prevalence of psychiatric disorders in patients with epilepsy.We then used summarydata from genome-wide association studies to investigate whether the identified observational associations could be attributed to a shared underlying genetic aetiology using cross-trait linkage disequilibrium score regression.Finally,we assessed the potential bidirectional relationships using two-sample Mendelian randomisation.Results In a cohort of 7628495 individuals,we found that almost half of the 94435 individuals diagnosed with epilepsy were also diagnosed with a psychiatric condition in their lifetime(adjusted lifetime prevalence,44.09%;95%confidence interval(Cl)43.78%to 44.39%).We found evidence for a genetic correlation between epilepsy and some neurodevelopmental and psychiatric conditions.For example,we observed a genetic correlation between epilepsy and attention-deficit/hyperactivity disorder(r,=0.18,95%Cl 0.09 to 0.27,p<0.001)—a correlation that was more pronounced in focal epilepsy(r=0.23,95%CI 0.09 to 0.36,p<0.001).Findings from Mendelian randomisation using common genetic variants did not support bidirectional effects between epilepsy and neurodevelopmental or psychiatric conditions.Conclusions Psychiatric comorbidities are common in patients with epilepsy.Genetic correlations may partially explain some comorbidities;however,there is little evidence of a bidirectional relationship between the genetic liability of epilepsy and psychiatric conditions.These findings highlight the need to understand the role of environmental factors or rare genetic variations in the origins of psychiatric comorbidities in epilepsy.
文摘Objective To explore the ability of interictal diffusion-weighted imaging(DWI)to localize the temporal lobe of seizure origin and to predict postoperative seizure control in patients with temporal lobe epilepsy(TLE).Methods Twenty-seven patients with intractable TLE considered for surgery and 19 healthy volunteers were studied with conventional magnetic resonance imaging(MRI)and DWI.Apparent diffusion coefficients(ADCs)of bilateral hippocampi in both TLE patients and control subjects were obtained.Lateralization to either temporal lobe with hippocampal ADC was based on the threshold values derived from ±1SD of right/left ratios in normal subjects.And the postoperative pathology was reviewed.Results Hippocampal ADCs were higher on the side of surgery compared with those on the contralateral side as well as the ipsilateral side in control subjects [resected side(109.8±7.3)×10-5 cm2/s,contralateral side(91.7±4.7)×10-5 cm2/s,control subjects(81.6±5.2)×10-5 cm2/s,all P<0.01].Right/left hippocampal ADC ratio and conventional MRI lateralized to the operated temporal lobe in 21 of 27(77.8%)and in 18 of 27(66.7%)patients.Lateralization to the surgical side was not associated with postoperative seizure control with right/left hippocampal ADC ratio(P>0.05).Conclusions Conventional MRI is a sensitive method to detect hippocampal sclerosis.Accuracy of the right/left hippocampal ADC ratio for lateralizing to the side of surgery is very high,but it isn't a better predictor of surgical outcome.
文摘Objective To evaluate metabolic abnormalities in patients with mesial temporal lobe epilepsy （MTLE） with proton magnetic resonance spectroscopy （MRS） using a 3.0T MR scanner. Methods Sixty-three patients （32 women and 31 men） with diagnosed MTLE underwent diagnostic MR imaging （MRI） and proton MRS using a 3.0T MR scanner. The clinical history and interictal epileptiform discharges （IEDs） were recorded. Sixteen healthy volunteers served as control. The results of proton MRS were compared with the findings of electroencephalogram and structural MRI findings. Results Twenty-seven of the 63 patients with MTLE showed unilateral hippocampal sclerosis, and 9 showed bilateral hippocampal sclerosis. The concentration ratio of N-acytelaspartate （NAA） / [ creatine （ Cr ） ＋ choline （Cho） ] in the hippocampal region of MTLE patients （0. 64±0. 07） was significantly lower than control （0. 80±0. 05, P = 0.023）. In the patients with unilateral hippocampal sclerosis, NAA/（Cr ＋ Cho） in the hippocampal region ipsilateral to the sclerotic hippocampus （0.56±0.06） was significantly lower than the ratio in the contralateral hippocampal region （0.69±0.07, P 〈 0. 001 ）. There was significant difference in hippocampal NAA/（ Cr ＋ Cho） between the refractory patients and the non-refractory patients （0. 64±0. 05 vs.0.71±0. 07, P =0. 04）. Forty-five patients were lateralized by IEDs, while 49 patients were lateralized by metabolite ratio. And lateralization determined by proton MRS and IEDs was concordant in 33 patients. Conclusions MRS as a noninvasive tool adds helpful metabolite information to routine MRI in evaluation of MTLE. The method is well established and should be a routine clinical application in the investigation of epilepsy.
文摘Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy. Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years(mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated. Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I(75.00%), 5 were class II(13.89%), 2 were class III(5.56%), and 2 were class IV(5.56%), thus the total effective rate(class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes(P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes(P=0.041). Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.
文摘INTRODUCTION.Depression,a common mental disorder,is a leading cause of disability worldwide,with a global prevalence ranging from 20% to 25% in women and 7% to 12% in men,and it has exhibited an increasing trend in recent decades.Despite being known for decades,a consensus on the definition and diagnosis of treatment-resistant depression(TRD)is still lacking.
基金Project supported by the National Natural Science Foundation of China(Grant No.61302002)
文摘In this study, we investigate the cross-frequency coupling and functional brain networks in the subjects with temporal lobe epilepsy(TLE) using interictal EEG signals. The phase to phase synchronization within and across frequency bands is calculated and a significant difference between the epilepsy and control groups is observed. Compared with the controls,the epilepsy patients exhibit a stronger within-frequency coupling(WFC) within theta and beta bands, and shows a stronger cross-frequency coupling(CFC) in the delta–alpha and theta–alpha band pairs, but a weakened CFC in alpha–beta band pairs. The weakened coupling between alpha and high frequency band reflects a suppression of phase modulation between the brain regions related to epilepsy. Moreover, WFC and CFC are positively correlated, which is higher in the patients relative to controls. We further reconstruct functional brain connectivity and find that both WFC and CFC networks show small-world properties. For the epilepsy, the small-world efficiency is enhanced in the CFC networks in delta–alpha and theta–alpha band pairs, whereas weakened between alpha and beta bands, which suggests a shift away from the optimal operating point in the epileptic brain with a new balance between WFC and CFC. Our results may help us to understand the important role of information communication across different frequency bands and shed new light on the study of pathology of epilepsy.
基金supported by the National Natural Science Foundation of China (Grant Nos. 12132012 and 11972275)the National Science Foundation for Young Scientists of China (Grant No. 12102240)。
文摘Experimental records in the cerebral cortex indicate that ammonia injection can lead to seizures. Considering that astrocytes play a vital role in mediating the uptake and absorption of ammonium ions in the extracellular space of the cortical circuit, we constructed a new astrocyte neuron coupling model, which is composed of a neuron and its astrocytes connected through the extracellular space, taking into account of the influence of extracellular ammonium ions. The numerical results verified the previous experimental observation that obtained epileptic firing modes of neurons and postsynaptic GABA reversal potential depolarization triggered by ammonia injection. In addition, we also determined the concentration–response relationship between the ammonium ion concentration and the time of entering epilepsy and predicted the threshold of the ammonium ion concentration for the onset of epilepsy.
基金supported by the National Natural Science Foundation of China under Grant No. 81071222
文摘The basal ganglia have been implicated in a modulation role in idiopathic generalized epilepsy （IGE） by an invasive electrophysioigic means. This paper investigates the basal ganglia functional connectivity by using the region-wise functional connection analysis in resting-state functional magnetic resonance imaging （fMRI） in IGE. The increased functional connectivity within basal ganglia, and between the basal ganglia and the thalamus, and decreased functional connectivity between basal ganglia and motor cortex are found in IGE compared with the controls. These findings not only implicate dysfunctional integration in the motor loop in IGE and the enhanced interaction in the modulated loop, but also suggest that the basal ganglia modulate the generalized epileptic discharges with the influence over thalamus in the corticothalamus network.
基金supported by the Natural Science Foundation of China (Nos. 81422022, 81271553, 81201155, 81171328, 61131003, 81401402, and 81201161)the Grant for a Young Scholar of Jinling Hospital (No. 2015055)12.5 Key Grants (Nos. BWS11J063 and 10z026)
文摘The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analysis.rsfMRI is performed in 46 adult patients with FLE and 46 age matched healthy controls(HCs).A functional network is built from these subjects,and the topological properties of such network are analyzed quantitatively using graph theoretical methods.According to the results,both FLE patients and HCs exhibit prominent small world features.Compared with HCs,FLE shows a decrease in local efficiency(Eloc),clustering coefficient,nodal efficiency as well as nodal degree.Furthermore,FLE(seven)has fewer hubs than HCs(ten).The functional abnormalities in the network organization suggest functional disturbances in patients with FLE.This study helps to gain new insights into the functional disorder in patients with FLE.The networks built here can also be a set of potential biomarkers for the diagnosis,monitoring and the treatment of FLE.
基金Supported by National Natural Science Foundation of China (31021091, 30971001)Beijing Natural Science Foundation (7102109)Fok Ying Tong Education Foundation (121024)
文摘Objective To determine the spatio-temporal expression of p70S6k activation in hippocampus in mesial temporal lobe epilepsy. Methods Temporal lobe epilepsy model was established by stereotaxically unilateral and intrahip-pocampal injection of kainite acid (KA) in adult male C57BL/6 mice. Latent and chronic epileptogenesis were represented by mice 5 days after KA injection (n=5) and mice 5 weeks after KA injection (n=8), respectively. Control mice (n=5) were injected with saline. Immunohistochemical assays were performed on brain sections of the mice. Results Hippocampus both ipsilateral and contralateral to the KA injection displayed significantly up-regulated pS6 immunoreactivity in dispersed granule cells in 5-day and 5-week model mice. Conclusion The activation of p70S6k is mainly located in the dentate gyrus in KA-induced mouse model of temporal lobe epilepsy, indicating that the activation may be related with the disperse degree and hypertrophy of granule cells.
文摘ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in epilepsy surgery to delineate margins of epileptogenic zones, guide resection,
文摘Objective: To investigate the knowledge level related to compliance in patients with epilepsy. Methods: Eighty-seven patients with epilepsy were tested in the city of Xi’an with a knowledge questionnaire containing 21 questions related to compliance. Results: Over 39.5% of patients did not know that epilepsy is the result of abnormal firing of neurons, while 29.9% were uncertain or did not realize that epilepsy attacks can bring up accidents such as traffic accidents, drowning and trauma. A total of 36.6% of responders thought that the best therapy for epilepsy could be found in Traditional Chinese Medicine. As many as 36.8% of tested patients were uncertain or did not know that frequent epilepsy attacks can affect their intelligence. Up to 36% were unaware of the possible consequence of sudden withdrawal of anti-epileptic drugs (AED). Among responders, 39.1% did not know the right treatment method of epilepsy. That AED can control seizure attacks were doubted in 57.5% of epileptic patients. Furthermore, 32.2% did not know whether the disease could be cured. Conclusion: In this group of epileptic patients, generally they do not have enough indispensable knowledge to cope with epilepsy. They urgently need for proper health education besides effective AED to control seizure attacks and improve their quality of life.
文摘Zolpidem is a short-acting non-benzodiazepine hypnotic agent,commonly recommended for short-term treatment of insomnia.Zolpidem has less dependence potential than benzodiazepines.Patients with mental illnesses often have disturbed sleep,for which zolpidem is often prescribed.Long-term use and self-medication(in more than recommended doses)are more likely to cause dependence.We report here a case of bipolar affective disorder with epilepsy,who developed dependence to zolpidem and had severe withdrawal symptoms.The management issues are also discussed with review of the literature.
文摘Traumatic brain injury(TBI) is a significant globa public health challenge, with an estimated mortality rate of 13 per 100,000 people in China. Bedsides the immediate neurological consequences,^([1]) TBI is associated with longterm sequelae and an elevated risk of neurodegenerative conditions such as dementia, Parkinson's disease, and epilepsy. Moreover, TBI can induce systemic effects including acute gastrointestinal injury(AGI), contributing to poor patient outcomes.
基金Project supported by the National Natural Science Foundation of China(Grant Nos.12072265,12272295,and 11972288)。
文摘Network approaches have been widely accepted to guide surgical strategy and predict outcome for epilepsy treatment.This study starts with a single oscillator to explore brain activity,using a phenomenological model capable of describing healthy and epileptic states.The ictal number of seizures decreases or remains unchanged with increasing the speed of oscillator excitability and in each seizure,there is an increasing tendency for ictal duration with respect to the speed.The underlying reason is that the strong excitability speed is conducive to reduce transition behaviors between two attractor basins.Moreover,the selection of the optimal removal node is estimated by an indicator proposed in this study.Results show that when the indicator is less than the threshold,removing the driving node is more possible to reduce seizures significantly,while the indicator exceeds the threshold,the epileptic node could be the removal one.Furthermore,the driving node is such a potential target that stimulating it is obviously effective in suppressing seizure-like activity compared to other nodes,and the propensity of seizures can be reduced 60%with the increased stimulus strength.Our results could provide new therapeutic ideas for epilepsy surgery and neuromodulation.
文摘Kainate receptors,a subclass of ionotropic glutamate receptors,are tetrameric ligand-gated ion channels that mediate excitatory neurotransmission1-4.Kainate receptors modulate neuronal circuits and synaptic plasticity during the development and function of the central nervous system and are implicated in various neurological and psychiatric diseases,including epilepsy,depression,schizophrenia,anxiety and autism5-11.Although structures of kainate receptor domains and subunit assemblies are available12-18,the mechanism of kainate receptor gating remains poorly understood.Here we present cryo-electron microscopy structures of the kainate receptor GluK2 in the presence of the agonist glutamate and the positive allosteric modulators lectin concanavalin A and BPAM344.
