Commentary: Integrating electrodermal biofeedback into pharmacologic treatment of grand mal seizures

Thirty percent of patients with epilepsy experience seizures despite optimal anticonvulsant drug treatment. Stress is frequently identified by patients with epilepsy as a precipitant of seizures (Spector et al., 2000; Ferlisi and Shorvon, 2014). Patients also often report using countermeasures to control the seizure onset. These are typically spontaneous and individualized such as increasing arousal by walking, breathing, standing, focusing attention, changing way of thinking, and more rarely inducing relaxation (Lee and No, 2005; Hether et al., 2013). In parallel, behavioral and psychological interventions, complementing conventional therapeutic methods for the management of epileptic seizures, have gained greater clinical attention over the past decade. Among these, Biofeedback (BFK) represents a noninvasive biobehavioral treatment that enables a patient to gain volitional control over a specific physiological process. BFK has already shown its value when applied to patients with epilepsy (Sterman and Friar, 1972; Rockstroh et al., 1993; Nagai et al., 2004a; Nagai, 2011; Micoulaud-Franchi et al., 2014a,b). Scrimali et al. (2015) have rightly pointed out the potential usefulness of electrodermal biofeedback in the management of refractory epilepsy. In a single case study, they report an effect of electrodermal activity (EDA) relaxation biofeedback in reducing seizures in a patient treated for 2 years. This case study supports the necessity to expand clinical armamentarium for treatment-resistant patients with few alternatives

Stimulated Raman histology: one to one comparison with standard hematoxylin and eosin staining

International audienceWe present for the first time one-to-one correspondence between standard hema-toxylin/eosin (H&E) stained tissue sections and stimulated Raman histology (SRH)-a label-free technique in which stimulated Raman scattering (SRS) and second harmonic generation (SHG) are combined to generate virtual H&E images. Experiments were performed on both human thin cryogenic slides from the gastrointestinal tract (GI) and thick freshly excised biopsies from endoscopic surgery. Results on cryogenic slides evidenced an excellent agreement between SRH and H&E images while the ones on biopsies established the relevance of SRH for rapid intraoperative histology to assist in surgical decision making

Self-control of epileptic seizures by nonpharmacological strategies

Despite the unpredictability of epileptic seizures, many patients report that they can anticipate seizure occurrence. Using certain alert symptoms (i.e., auras, prodromes, precipitant factors), patients can adopt behaviors to avoid injury during and after the seizure or may implement spontaneous cognitive and emotional strategies to try to control the seizure itself. From the patient's view point, potential means of enhancing seizure prediction and developing seizure control supports are seen as very important issues, especially when the epilepsy is drug-resistant. In this review, we first describe how some patients anticipate their seizures and whether this is effective in terms of seizure prediction. Secondly, we examine how these anticipatory elements might help patients to prevent or control their seizures and how the patient's neuropsychological profile, specifically parameters of perceived self-control (PSC) and locus of control (LOC), might impact these strategies and quality of life (QOL). Thirdly, we review the external supports that can help patients to better predict seizures. Finally, we look at nonpharmacological means of increasing perceived self-control and achieving potential reduction of seizure frequency (i.e., stress-based and arousal-based strategies). In the past few years, various approaches for detection and control of seizures have gained greater interest, but more research is needed to confirm a positive effect on seizure frequency as well as on QOL

A Comparative Analysis Shows Morphofunctional Differences between the Rat and Mouse Melanin-Concentrating Hormone Systems

Sub-populations of neurons producing melanin-concentrating hormone (MCH) are characterized by distinct projection patterns, birthdates and CART/NK3 expression in rat. Evidence for such sub-populations has not been reported in other species. However, given that genetically engineered mouse lines are now commonly used as experimental models, a better characterization of the anatomy and morphofunctionnal organization of MCH system in this species is then necessary. Combining multiple immunohistochemistry experiments with in situ hybridization, tract tracing or BrdU injections, evidence supporting the hypothesis that rat and mouse MCH systems are not identical was obtained: sub-populations of MCH neurons also exist in mouse, but their relative abundance is different. Furthermore, divergences in the distribution of MCH axons were observed, in particular in the ventromedial hypothalamus. These differences suggest that rat and mouse MCH neurons are differentially involved in anatomical networks that control feeding and the sleep/wake cycle

Symptom Network Analysis of Anxiety and Depression in Epilepsy

International audiencePurposeAnxiety symptoms and depressive symptoms are frequent in PWE and associated with poorer outcomes. Investigation of specific characteristics of anxiety and depressive symptoms in PWE is of interest.MethodsWe used psychometric analyses in symptom networks using screening tools validated in PWE: Generalized Anxiety Disorder 7 (GAD-7) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). We conducted an estimation to build the NDDIE and GAD-7 network, analyzed network inferences (especially centrality measures) and performed network robustness analyses as well as modularity-based community detection.Results145 PWE were included. The criteria with highest centrality was “Trouble relaxing” (G4) from the GAD-7, which represents a possible substantial symptom at the interface of anxiety and depressive comorbidities in epilepsy. Robustness was very moderate, despite results consistent with the literature. The two communities of nodes corresponded to criteria of the two scales.ConclusionEpilepsy is a unique model for studying psychiatric symptoms since correlation with cerebral mechanisms can be assessed. “Trouble relaxing” as a key symptom is of interest, since this relates to the “Arousal” construct of the RDoC. Limitations of this study are the number of patients, single population, limits of psychometric analysis and network analysis, and a moderate robustness. Nevertheless, arousal is linked to seizure control, and thus these observations are of relevance to future investigation of pathophysiological mechanisms of psychopathology in epilepsy

Melanin-concentrating hormone axons, but not orexin or tyrosine hydroxylase axons, innervate the claustrum in the rat: An immunohistochemical study

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What the patient's history tells us about their nonepileptic seizures

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Positron emission tomography in patients with psychogenic non-epileptic seizures

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Stress regulation in drug-resistant epilepsy

International audienceThe prevalence of psychological distress, especially depressive and anxiety disorders, is higher in epilepsy than in other chronic health conditions. These comorbid conditions contribute even more than epileptic seizures themselves to impaired quality of life in patients with epilepsy (PWE). The link between these comorbidities and epilepsy appears to have a neurobiological basis, which is at least partly mediated by stress through psychological and pathophysiological pathways. The impact of stress in PWE is also particularly important because it is the most frequently reported seizure trigger. It is therefore crucial for clinicians to take stress-related conditions and psychiatric comorbidities into account when managing PWE and to propose clinical support to enhance self-control of stress. Screening tools have been specially designed and validated in PWE for depressive disorders and anxiety disorders (e.g. NDDI-E, GAD-7). Other instruments are useful for measuring stress-related variables (e.g. SRRS, PSS, SCS, MHLCS, DSR-15, ERP-R, QOLIE-31) in order to help characterize the individual " stress profile " and thus orientate patients towards the most appropriate treatment. Management includes both pharmacological treatment and nonpharmacological methods for enhancing self-management of stress (e.g. mindfulness-based therapies, yoga, cognitive-behavioral therapies, biofeedback), which may not only protect against psychiatric comorbidities but also reduce seizure frequency