Vagal Nerve Stimulation in Epilepsy : Experiences of Participants with Cognitive Deficits

Introduction: The purpose of this study was to examine patients experiences of vagal nerve stimulation (VNS) with a special interest in patients with cognitive deficit (CD). Materials and Methods: An open, retrospective study was conducted on 82 patients with pharmacoresistant epilepsy, who were treated with VNS for at least 10 months. Based on the inability to live independently, they were divided into two groups: patients with cognitive deficit (CD group) and patients without cognitive deficit (non-CD group). A specially designed questionnaire was used for semi-structured interviews about patients experiences of VNS treatment. Results: Approximately one-third described a continuous reduction of seizure frequency of 50% or more and were regarded as responders. Fewer subjects in the CD group were responders than in the non-CD group. Approximately one-third of all subjects had no positive effect of VNS treatment. More CD patients described additional improvements and the most common were milder seizures and improved alertness. The most commonly reported adverse effect was hoarseness. Discussion: VNS treatment in patients without CD had better effect on seizure frequency reduction than in patients with CD, but many patients with CD reported other benefits from the treatment

Similar Profile and Magnitude of Cognitive Impairments in Focal and Generalized Epilepsy : A Pilot Study

Introduction: Cognitive impairments in epilepsy are not well-understood. In addition, long-term emotional, interpersonal, and social consequences of the underlying disturbances are important to evaluate.Purpose: To compare cognitive function including language in young adults with focal or generalized epilepsy. In addition, quality of life and self-esteem were investigated.Patients and Methods: Young adults with no primary intellectual disability, 17 with focal epilepsy and 11 with generalized epilepsy participated and were compared to 28 healthy controls. Groups were matched on age (mean = 26 years), sex, and education. Participants were administered a battery of neuropsychological tasks and carried out self-ratings of quality of life, self-esteem, and psychological problems.Results: Similar impairments regarding cognitive function were noted in focal and generalized epilepsy. The cognitive domains tested were episodic long-term memory, executive functions, attention, working memory, visuospatial functions, and language. Both epilepsy groups had lower results compared to controls (effect sizes 0.24-1.07). The total number of convulsive seizures was predictive of episodic long-term memory function. Participants with focal epilepsy reported lower quality of life than participants with generalized epilepsy. Lowered self-esteem values were seen in both epilepsy groups and particularly in those with focal epilepsy. Along with measures of cognitive speed and depression, the total number of seizures explained more than 50% of variation in quality of life.Conclusion: Interestingly, similarities rather than differences characterized the widespread cognitive deficits that were seen in focal and generalized epilepsy, ranging from mild to moderate. These similarities were modified by quality of life and self-esteem. This study confirms the notion that epilepsy is a network disorder

Low Thalamic NAA-Concentration Corresponds to Strong Neural Activation in Working Memory in Kleine-Levin Syndrome

Background Kleine Levin Syndrome (KLS) is a rare disorder of periodic hypersomnia and behavioural disturbances in young individuals. It has previously been shown to be associated with disturbances of working memory (WM), which, in turn, was associated with higher activation of the thalamus with increasing WM load, demonstrated with functional magnetic resonance imaging (fMRI). In this study we aimed to further elucidate how these findings are related to the metabolism of the thalamus. Methods fMRI and magnetic resonance spectroscopy were applied while performing a WM task. Standard metabolites were examined: n-acetylaspartate (NAA), myo-inositol, choline, creatine and glutamate-glutamine. Fourteen KLS-patients and 15 healthy controls participated in the study. The patients with active disease were examined in asymptomatic periods. Results There was a statistically significant negative correlation between thalamic fMRI-activation and thalamic NAA, i.e., high fMRI-activation corresponded to low NAA-levels. This correlation was not seen in healthy controls. Thalamic levels of NAA in patients and controls showed no significant differences between the groups. None of the other metabolites showed any co-variation with fMRI-activiation. Conclusion This study shows negative correlation between NAA-levels and fMRI-activity in the left thalamus of KLS-patients while performing a WM task. This correlation could not be found in healthy control subjects, primarily interpreted as an effect of increased effort in the patient group upon performing the task. It might indicate a disturbance in the neuronal networks responsible for WM in KLS patients, resulting in higher effort at lower WM load, compared with healthy subjects. The general relationship between NAA and BOLD-signal is also discussed in the article

Experiences of awake surgery in non-tumoural epilepsy in eloquent localizations

International audienceBackground: Whilst modern awake intraoperative mapping has been widely accepted and implemented in the last decades in neuro-oncology, sparse reports have been published on the safety and efficiency of this approach in epilepsy surgery.Method: This article reports four cases with different locations of epileptogenic zones as examples of possible safe and efficient resections.Result: The results of the resections on seizure control were Engel 1 (no disabling seizures) in all cases and no patient experienced significant neurological deficits.Discussion: The discussion focuses on aspects of the future of epilepsy surgery in a hodotopical paradigm

Differences in fMRI-activation of the left thalamus at the most difficult level (Level 4) of the WM task in KLS-patients and healthy control subjects.

<p>p = 0.04 (t-test).</p

Differences in group mean metabolite concentrations on MRS.

<p>Differences in group mean metabolite concentrations as determined by magnetic resonance spectroscopy (MRS). SE = standard error. tCr = total creatine, NAA = n-acetylaspartate, tNA = NAA+ n-acetylaspartateglutamate, mIns = myo-inositol, tCho = total choline, tGlx = glutamate+glutamine. TH-L = left thalamus. TH-R = right thalamus.</p

Region of interest analysis in the left thalamus showing significant difference in KLS compared to control subjects.

<p>Region of interest analysis in the left thalamus showing significant difference in KLS compared to control subjects.</p

Clinical characteristics of the included patients.

<p>YoB = year of birth, Ann. Freq = patient appreciated annual frequency of episodes, Duration = duration of episodes, Hs = hypersomnia, Hph = hyperphagia, Ha = hallucinations, Dp = depersonalisation and/or derealisation (as not clearly separated by some patients), Hx = hypersexuality, Ps = psychiatric symptoms, A = alcohol intake, I = infection, Me = Mental exhaustion, sWmi = subjective working memory impairment (asymptomatic periods), R = right.</p