On the Threshold of Scientific Medicine: Gerard van Swieten and His Perception of the Pathophysiology in Traumatic Brain Injury

Gerard van Swieten (1700-1772), famous pupil of Professor Herman Boerhaave (1668-1738) of Leiden University and personal physician of Austrian Habsburg Empress Maria Theresa (1717-1780). Herman Boerhaave was a renowned Dutch physician inside and outside Europe in the 18th century. He was not only appointed professor in medicine, chemistry, and botany but also a chancellor of the Leiden University in 1714 and published his well-known Aphorismi de cognoscendis et curandis morbis in 1709. Gerard van Swieten commented upon Boerhaave's aphorisms and demonstrated actual knowledge, less well-known among the medical community, about the pathophysiology of traumatic brain injury which half a century later (19th century) became known as the Monro-Kellie doctrine. Using the original commentaries upon Boerhaave's aphorisms by van Swieten himself, we explored his way of formulating the pathophysiological concept of traumatic brain injury, which still is valid today

Long-term behavioral outcome after early-life hyperthermia-induced seizures

Febrile seizures (FS) are among the most common types of seizures in the developing brain. It has been suggested that FS cause cognitive deficits that proceed into adulthood, but the information is conflicting. The aim of the present study was to determine whether experimental FS have long-term cognitive or behavioral deficits. FS were induced by hyperthermia (30 minutes, approximately 41 degrees C) in 10-day-old rat pups, and behavioral testing was performed. Hippocampus-dependent water maze learning, locomotor activity, and choice reaction time parameters (e.g., reaction time) were generally not affected by FS. However, more detailed analysis revealed that reaction times on the right side were slower than those on the left in controls, whereas this was not observed after FS. Early-life experimental FS did not cause overt cognitive and behavioral deficits, which is in line with previous work, but eliminated the lateralization effect in reaction time known to occur in normal controls, an effect that may be due to the combination of FS and kainic acid or to FS alone

Stability metrics for optic radiation tractography : towards damage prediction after resective surgery

An accurate delineation of the optic radiation (OR) is useful in reducing the risk of a visual field deficit after temporal lobe resective surgery. However, tractography, especially of the probabilistic kind, is prone to generate spurious (false-positive) streamlines that are poorly aligned with the surrounding bundle. Fiber-to-bundle coherence measures are applied to identify and remove spurious fibers, which together with test-retest parameter estimation can provide a reconstruction of the OR that is robust to the stochastic realization of probabilistic tractography. Pre- and post-operative comparison of the OR is performed for epilepsy patients to quantify the accuracy of damage prediction.<br/

Automated identification of intracranial depth electrodes in computed tomography data

Intracranial depth electrodes are commonly used to identify the regions of the brain that are responsible for epileptic seizures. Knowledge of the exact location of the electrodes is important as to properly interpret the EEG in relation to the anatomy. In order to provide fast and accurate identification of these electrodes, a procedure has been developed for automatic detection and localization in computed tomography data. Results indicate that in the vast majority of cases the depth electrodes can be automatically found. The localization of the electrodes versus the anatomy showed an acceptably small error when compared to manual positioning. Furthermore, interactive visualization software is developed to show the detected electrodes together with pre-operative MRI images, which enables the physician to confirm that the electrode is placed at the expected anatomical location

Microvascular changes associated with epilepsy: A narrative review

The blood-brain barrier (BBB) is dysfunctional in temporal lobe epilepsy (TLE). In this regard, microvascular changes are likely present. The aim of this review is to provide an overview of the current knowledge on microvascular changes in epilepsy, and includes clinical and preclinical evidence of seizure induced angiogenesis, barriergenesis and microcirculatory alterations. Anatomical studies show increased microvascular density in the hippocampus, amygdala, and neocortex accompanied by BBB leakage in various rodent epilepsy models. In human TLE, a decrease in afferent vessels, morphologically abnormal vessels, and an increase in endothelial basement membranes have been observed. Both clinical and experimental evidence suggests that basement membrane changes, such as string vessels and protrusions, indicate and visualize a misbalance between endothelial cell proliferation and barriergenesis. Vascular endothelial growth factor (VEGF) appears to play a crucial role. Following an altered vascular anatomy, its physiological functioning is affected as expressed by neurovascular decoupling that subsequently leads to hypoperfusion, disrupted parenchymal homeostasis and potentially to seizures". Thus, epilepsy might be a condition characterized by disturbed cerebral microvasculature in which VEGF plays a pivotal role. Additional physiological data from patients is however required to validate findings from models and histological studies on patient biopsies

Deterioration of dyslexia after non-dominant temporal lobectomy for drug-resistant epilepsy

Item does not contain fulltextWe present a patient with drug-resistant right-sided temporal lobe epilepsy, caused by a ganglioglioma of the parahippocampal gyrus. Preoperatively, the patient was also known to have dyslexia. A right-sided anterior temporal lobectomy, including complete lesionectomy, was performed. Several months after the otherwise uncomplicated procedure, the patient complained about visual memory disturbances, accompanied by increased reading and spelling problems. Postoperative neuropsychological examination revealed deterioration of the visual memory functions, compared to the preoperative assessment, and consequently provided a possible explanation for worsening of the pre-existing dyslexia. In this case report, we hypothesize on the cause of this unusual deterioration and present recommendations to be included in the preoperative epilepsy surgery evaluation for patients with verbal or reading disorders such as dyslexia.6 p

Wakkere hersenchirurgie voor epilepsie: Preventie van taalstoornissen?

Tijdens een wakkere hersenoperatie worden hersengebieden in kaart gebracht die betrokken zijn bij taalfuncties. In een onderzoek waarvan hier verslag wordt gedaan, werden van patiënten die in aanmerking kwamen voor epilepsiechirurgie de expressieve en receptieve taalfunctie en de aanvalsfrequentie pre- en postoperatief onderzocht. De resultaten tonen dat deze operatietechniek leidt tot een hoge kans op complete aanvalsvrijheid zonder verslechtering van taalfunctie

Spontaneous Epileptic Recordings from hiPSC-Derived Cortical Neurons Cultured with a Human Epileptic Brain Biopsy on a Multi Electrode Array

A growing societal awareness is calling upon scientists to reconsider the use of animals in research, which stimulates the development of translational in vitro models. The physiological and architectural interactions between different cell types within an organ present a challenge to these models, particularly for a complex organ such as the brain. Thus far, in vitro brain models mostly consist of a single cell type and demonstrate little predictive value. Here, we present a co-culture of an epileptic human neocortical biopsy on a layer of human induced pluripotent stem cell (hiPSC)-derived cortical neurons. The activity of the cortical neurons was recorded by a 120-electrode multi-electrode array. Recordings were obtained at 0, 3, and 6 days after assembly and compared to those obtained from cortical neurons without a biopsy. On all three recording days, the hybrid model displayed a firing rate, burst behavior, number of isolated spikes, inter-spike interval, and network bursting pattern that aligns with the characteristics of an epileptic network as reported by others. Thus, this novel model may be a non-animal, translational alternative for testing new therapies up to six days after resection