Gender, Psychiatric and Cognitive Status Related to Experiential Auras in Patients with Temporal Lobe Epilepsy

Objective: To determine whether the experiential auras in patients with temporal lobe epilepsy (TLE) are related to gender, psychiatric comorbidity, material-specific memory impairment, lateralization by video-EEG and structural neuroimaging abnormalities.Material and methods: Retrospective review (1998-2015) of clinical charts and video-EEG of patients with TLE and experiential auras followed at the JM Ramos Mejía and El Cruce Hospitals Results: We included 35 patients, 51.4% were male, mean age 35 years, mean epilepsy duration 20.3 years. Laterality of the epileptogenic zone was right (57.1%) and left (37.1%) temporal. An epileptogenic lesion was detected in most of cases and hippocampal sclerosis was the most common finding. Seventy-four percent of patients underwent epilepsy surgery (Engel I-II: 65.4%). The most frequent neuropsychological finding was visual memory deficit, and most patients had executive dysfunction. Almost half patients had a psychiatric comorbidity. Déjà vu was the most frequent experiential aura (60%), followed by jamais vu (20%), strangeness (20%), depersonalization (14.3%), dreaminess (11.4%), autobiographical memory recall (8.6%) and time perception alteration (5.7%). Most patients (62.9%) had a single experiential aura (déjà vu 54.5%, jamais vu 18.2%, strangeness 13.6%, depersonalization 9.1%, prescience 4.5%) associated with non-experiential auras in the majority of cases (81%).Conclusion: Most of patients presented a single experiential aura, most frequently déjà vu, associated with non-experiential auras, mainly fear. A right temporal lobe seizure focus was the most frequent, including for patients with déjà vu. In relation to gender, déjà vu was more common in male patients. A high prevalence of psychiatric comorbidity was observed and despite of the reduced number of cases, the 3 patients with psychosis presented déjà vu. Most of patients presented visual memory deficit associated with executive dysfunction.Fil: Vanessa Benjumea-Cuartas. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Brenda Giagante. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Kochen, Sara Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentin

Disease mongering in neurological disorders

“Diseases mongering”, than a simple definition would be enforced "to promote or sell disease". The main and common characteristhics of all these "diseases" is that they are amenable to treatment with drugs. So, the pharmaceutical industry redefining the concept of disease, the normal and pathological. In Neurology exploits the deepest atavistic fears of suffering and death. We select some diseases, the choise was based on lack or weak evidence in definition of disease; or cost benefit of treatment; or the new clasiffication that assign criteria of severity of one disease. In everything this situation implied use of expensive treatments. The entities included, Attention deficit hyperactivity disorder, in adults, Multiple Sclerosis, Mild Cognitive Impairment, Drug Resistant Epilepsy, Amyotrophic lateral sclerosis, Excessive daytime sleepiness/ Chronic Fatigue. In developing countries the impact of this situation is even worse for the scarce resources and inequitable health condition. Health professionals become aware of this situation.Fil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Córdoba, Marta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentin

Clinical features of a series of non-surgical patients with focal cortical dysplasia and epilepsy

Most published series of patients with focal cortical dysplasia and epilepsy are surgical or pathological series of pediatric cases. Patients have a high frequency of seizure. The description of clinical features and the frequency patterns of non-surgical adult patients are less describe. We retrospectively reviewed the clinical records of adult patients (>18 years of age) that visited the Epilepsy Centre of the Ramos Mejía Hospital in the city of Buenos Aires between 2010 and 2012. We included all cases with confirmed diagnosis of epilepsy and MRI diagnosis of focal cortical dysplasia by standardized 1.5 T MRI. We analyzed the following variables: sex, age at seizure onset, seizure types, seizure frequency, presence of abnormal neurological exam, family history of epilepsy, existence of perinatal insults and electroencephalography or video-EEG with at least one ictal recording. We included 20 patients since 2010–2012. Mean age of our population was 25.9 years (9–46 years), 7 females, 13 males, they all had a negative family history of epilepsy, and only two patients had pathological neurological exam, both with mild contralateral paresis. Mean seizure onset age was 5.71 years (2 months–17 years) and the average frequency was 5.1 seizures per month (0–15). Two patients became seizure-free after adjusting antiepileptic drugs. Focal seizures were presented in the 100% of our population. The low frequency of seizure emphasizes the heterogeneity of these patients and the importance of the correct use of antiepileptic drugs schemes, as well as it can be dynamic over time. A proportion of medically resistant patients with cortical dysplasia are poor surgical candidates because the lesion cannot be completely identify or removed if it involves eloquent areas of the cortex. With the development of new drugs and the correct choice of treatment schedules is expected that more patients with focal cortical dysplasia would be treated successfully.Fil: Seifer, Gustavo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Princich, Juan Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentin

Assessing effective connectivity in epileptogenic networks: a model-based simulation approach

Different connectivity configurations were simulated using epileptogenic and non epileptogenic neuronal populations. Connectivity between them was measured using Partial Directed Coherence and Directed Transfer Function. The results were satisfactory and in some cases of clinical utility. The methodology that was used is discussed in comparison with previous works.Fil: Jacobacci, Florencia. Universidad Favaloro. Facultad de Ingeniería y Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Sapir, Martín. Universidad Favaloro. Facultad de Ingeniería y Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Collavini, Santiago. Universidad Favaloro. Facultad de Ingeniería y Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Blenkmann, Alejandro Omar. Universidad Favaloro. Facultad de Ingeniería y Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; Argentin

Episodic and semantic autobiographical memory in temporal lobe epilepsy

Autobiographical memory (AM) is understood as the retrieval of personal experiences that occurred in specific time and space. To date, there is no consensus on the role of medial temporal lobe structures in AM. Therefore, we investigated AM in medial temporal lobe epilepsy (TLE) patients. Twenty TLE patients candidates for surgical treatment, 10 right (RTLE) and 10 left (LTLE), and 20 healthy controls were examined with a version of the Autobiographical Interview adapted to Spanish language. Episodic and semantic AM were analyzed during five life periods through two conditions: recall and specific probe. AM scores were compared with clinical and cognitive data. TLE patients showed lower performance in episodic AM than healthy controls, being significantly worst in RTLE group and after specific probe. In relation to semantic AM, LTLE retrieved higher amount of total semantic details compared to controls during recall, but not after specific probe. No significant differences were found between RTLE and LTLE, but a trend towards poorer performance in RTLE group was found. TLE patients obtained lower scores for adolescence period memories after specific probe. Our findings support the idea that the right hippocampus would play a more important role in episodic retrieval than the left, regardless of a temporal gradient.Fil: Múnera Martínez, Claudia Patricia. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Lomlomdjian, Ana Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Gori, María Belén. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Terpiluk, Veronica. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Medel, Nancy Ruth. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Solis, Patricia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Kochen, Sara Silvia. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentin

Rapid and efficient localization of depth electrodes and cortical labeling using free and open source medical software in epilepsy surgery candidates

Depth intracranial electrodes (IEs) placement is one of the most used procedures to identify the epileptogenic zone (EZ) in surgical treatment of drug resistant epilepsy patients, about 20?30% of this population. IEs localization is therefore a critical issue defining the EZ and its relation with eloquent functional areas. That information is then used to target the resective surgery and has great potential to affect outcome. We designed a methodological procedure intended to avoid the need for highly specialized medical resources and reduce time to identify the anatomical location of IEs, during the first instances of intracranial EEG recordings. This workflow is based on established open source software; 3D Slicer and Freesurfer that uses MRI and Post-implant CT fusion for the localization of IEs and its relation with automatic labeled surrounding cortex. To test this hypothesis we assessed the time elapsed between the surgical implantation process and the final anatomical localization of IEs by means of our proposed method compared against traditional visual analysis of raw post-implant imaging in two groups of patients. All IEs were identified in the first 24 H (6?24 H) of implantation using our method in 4 patients of the first group. For the control group; all IEs were identified by experts with an overall time range of 36 h to 3 days using traditional visual analysis. It included (7 patients), 3 patients implanted with IEs and the same 4 patients from the first group. Time to localization was restrained in this group by the specialized personnel and the image quality available. To validate our method; we trained two inexperienced operators to assess the position of IEs contacts on four patients (5 IEs) using the proposed method. We quantified the discrepancies between operators and we also assessed the efficiency of our method to define the EZ comparing the findings against the results of traditional analysis.Fil: Princich, Juan Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos; ArgentinaFil: Wassermann, Demian. Harvard Medical School; Estados Unidos de América;Fil: Latini, Facundo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos; ArgentinaFil: Oddo, Silvia Andrea. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos; ArgentinaFil: Blenkmann, Alejandro Omar. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurcs. ; ArgentinaFil: Seifer, Gustavo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos; ArgentinaFil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurcs. ; Argentin

Language and communication abilities in temporal lobe epilepsy patients: right vs. left hemisphere's processing

Purpose : Most of previous studies in temporal lobe epilepsy have focused on production and comprehension of single word and sentence level analysis, centered in the left hemisphere. Although communication abilities, in which right hemisphere ' s processing is required, have remained unexplored in this population. The purpose of this study was to investigate interictal communication abilities in patients with right lateralized medial temporal lobe epilepsy (RTLE) comparing it with that of patients with left TLE (LTLE) to determine potential impairments and it lateralizing value. Methods : 120 pharmacoresistant TLE patients were evaluated: 55 with RTLE and 65 with LTLE. Subjects underwent a battery of language tests that measure: naming, verbal fluency, verbal inhibition, logic- temporal sequencing, conversational discourse, prosody, comprehension, narrative discourse, indirect speech acts and idiom expressions. Results were compared to those of normal population and deficit was established when performance was below the Z - 1.5 or percentile 5. Statistical significant value was considered at p < 0.001. Results : RTLE compared to LTLE patients, showed significant poorer performance in conversational and narrative discourse, idiom expressions’ and indirect speech ' s comprehension and emotional prosody. RTLE group had a tendency to tangential and disintegrated speech, lack of hierarchical and categorized codification and a significant deficit in social meaning inference. Otherwise, LTLE group showed lower performance in logical temporal sequencing No statistical differences were found in single word level tests analysis. Conclusion : RTLE patients showed communication deficits which are similar to been described in right hemisphere damaged patients due to other etiologies. These communication deficits demonstrated to have a lateraling value and could guide cognitive stimulation programs. Right anterior and mesial temporal structures would have a direct role in prosody processing, and an important role in discourse and pragmatic processing as a link between semantic, language and social processing to build a coherent meaning according to the context.Fil: Lomlomdjian, A. C.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Gobierno de la Provincia de Buenos Aires. Hospital El Cruce Doctor Nestor Carlos Kirchner. Centro de Medicina Traslacional.; ArgentinaFil: Terpiluk, V.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Prestupa, Romina Vanesa. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Oddo, Silvia Andrea. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Gobierno de la Provincia de Buenos Aires. Hospital El Cruce Doctor Nestor Carlos Kirchner. Centro de Medicina Traslacional.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Giagante, B.. Gobierno de la Provincia de Buenos Aires. Hospital El Cruce Doctor Nestor Carlos Kirchner. Centro de Medicina Traslacional.; ArgentinaFil: Princich, Juan Pablo. Gobierno de la Provincia de Buenos Aires. Hospital El Cruce Doctor Nestor Carlos Kirchner. Centro de Medicina Traslacional.; ArgentinaFil: Solis, P.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Gobierno de la Provincia de Buenos Aires. Hospital El Cruce Doctor Nestor Carlos Kirchner. Centro de Medicina Traslacional.; ArgentinaFil: Kochen, Sara Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Gobierno de la Provincia de Buenos Aires. Hospital El Cruce Doctor Nestor Carlos Kirchner. Centro de Medicina Traslacional.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina33° Congreso Internacional de EpilepsiaBangkokTailandiaInternational League Against Epileps

Characterization of cross frequency couplings produced by harmonic and non-harmonic frequency bands during seizure activity from intracerebral recordings in patients candidate to epilepsy surgery

Cross frequency coupling (CFC) phenomenon has been proposed to be functionally involved in neuronal communication, memory formation and learning. Besides, experimental findings have shown that phase-amplitude (PAC) and phase-phase (PPC) couplings are important variants of CFC linked to physiological and pathological brain states. In particular, PAC and PPC have been observed in local field potentials (LFP) recorded during epileptic seizures. PPC represents the phase coherence across frequency bands and/or recording sites, which in general increases between nearby areas of the neural tissue recruited to the ictal event. In PAC, the amplitude of a high frequency band is modulated by the phase of another band with a lower frequency content. Recent works have shown that nested oscillations, associated to the scale free neural activity, and sharp waveforms both produce PAC, however, they reflect two distinct neural mechanisms that are anatomically segregated in the human brain.In this work, we study the CFC dynamics during the seizure activity in patients with focal epilepsy who were candidates for surgery treatment. The analysis was performed on LFP obtained from 5 patients undergoing intracerebral electroencephalography (stereo EEG) and 2 patients undergoing subdural electrocorticography (ECoG). To quantify the CFC dynamics during the seizure activity we use non-parametric methods: the Phase Locking Value (PLV) and the Modulation Index based on the Kullback-Leibler distance (KLMI). In addition, we have developed specialized tools to characterize the nature of the observed CFC patterns. Specifically, the Time Locked Index (TLI) and Harmonic Index (HI) were implemented to quantify the presence of harmonics associated to the emergence of CFC. Moreover, the correlation of LFP and CFC for a given recording site across seizures was evaluated in order to quantify the seizure stereotypy.We have found that the ictal activity gives rise to different types of CFC, which were highly stereotyped during the seizure dynamics. Importantly, two essentially different PAC patterns produced by non-sinusoidal waveforms were identified. In the first one, the PAC was elicited by highly cyclostationary (pseudo-periodic) LFP signals, which were characterized by well-defined harmonic spectral components present in their Fourier spectrum. In the second one, the PAC was produced by sharp waveforms constituted by non-harmonic high frequency components. The proposed tools allowed us to better characterize the CFC patterns emerging during the seizure dynamics, which could pave the way to unveil the underlying neural mechanisms that initiate and propagate the ictal activity.Fil: Dellavale Clara, Hector Damian. Comisión Nacional de Energía Atómica. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología. - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y Nanotecnología; ArgentinaFil: Urdapilleta, Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica. Gerencia de Área de Investigaciones y Aplicaciones No Nucleares. Gerencia de Física (CAB); ArgentinaFil: Cámpora, Nuria Elide. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Velarde, Osvaldo Matias. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica. Gerencia de Área de Investigaciones y Aplicaciones No Nucleares. Gerencia de Física (CAB); ArgentinaFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Mato, German. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica. Gerencia de Área de Investigaciones y Aplicaciones No Nucleares. Gerencia de Física (CAB); ArgentinaNeuroscience 2018San DiegoEstados UnidosSociety for Neuroscienc

ApoE ε4 might modify the silent interval of mesial temporal lobe epilepsy with hippocampal sclerosis

El gen de la apolipoproteína E (ApoE) presenta polimorfismos en su secuencia odificante que modulan distintos mecanismos de regeneración neuronal. La epilepsia mesial temporal con esclerosis del hipocampo (EMT-EH) frecuentemente se desarrolla años después de una injuria cerebral, habiéndose sucedido fenómenos plásticos neuro-regenerativos potencialmente epileptogénicos durante este intervalo denominado «período silente». Estudios previos han sido controversiales en cuanto al rol de esta variante genética en la EMT-EH. En particular, podría modificar la edad de comienzo de la patología. Objetivos: Nuestro objetivo fue explorar en mayor profundidad el rol de la variación genética de ApoE en el intervalo silente de la epileptogenesis de la EMT-EH. Pacientes y Métodos: Se realizó un estudio de epidemiología molecular que incluyó 78 pacientes con EMT-EH, investigando el efecto del polimorfismo sobre la edad de comienzo de la patología. La genotipificación fue hecho mediante PCR-RFLP. Se realizó un análisis limitado a nuestra población y un meta-análisis de la evidencia acumulada incluyendo nuestros datos (574 pacientes en total). Resultados: En nuestra población, los sujetos portadores de la variante ApoE E4 evidenciaron una tendencia a comenzar sus crisis a más temprana edad. En el meta-análisis se confirmó esta tendencia, aquellos sujetos portadores de la variante ApoE ε4 comienzan sus crisis casi 4 años antes que los sujetos portadores de las isoformas 2 y 3 de ApoE (p=0,005). Conclusión: ApoE ε4 es un factor genético que modifica la edad de comienzo de la EMT-EH, pudiendo estar implicado en los procesos epileptogénicos que se suceden en el período silente del desarrollo de la Epilepsia Mesial Temporal con Esclerosis del Hipocampo.Background: ApoE has a role in the maintenance and repair of neurons, but its three isoforms have different efficiency for these tasks. MTE-HS typically begins many years after an early cerebral insult. During this so called “silent interval” different epileptogenic proccesses occur that might involve the damage and repairing of neurons. Previous studies have evaluated the role of ApoE variants as modifiers of the clinical features of MTE-HS, but the results obtained have been controversial so far. Specifically, ApoE ε4 isoform might modulate the epileptic syndrome age of onset, suggesting a shorter “silent interval”. Aims: Our aim was to explore the role of Apolipoprotein E (ApoE) ε4 isoform as a modifier of the “silent interval” of Mesial temporal lobe epilepsy with hippocampal sclerosis (MTE-HS) development. Patients and Methods: We included a population of 78 MTE-HS patients in a molecular epidemiology study that investigated the effect of ApoE ε4 in the syndrome age of onset. Genotyping was done by a PCR-RFLP assay. In order to better estimate the role of this variant as a modifier of this clinical feature, we performed a systematic review of the literature, incorporating into a meta-analysis our results along data available (6 studies; 574 patients) in published studies that have investigated the role of ApoE ε4 in Temporal lobe epilepsy (TLE). Results: In our population, ApoE ε4 carriers showed a trend to begin their epilepsy at a shorter age than non-carriers. The meta-analysis confirmed this trend, where ApoE ε4 carriers had an onset of habitual seizures almost 4 years earlier than non-carriers (mean difference 3.7 years; CI 95% 1.66-5.74; p=0.0001). Conclusions: ApoE ε4 is a genetic modifier of the age of onset of MTE-HS syndrome, that might have a role in the epileptogenic processes that occur during the «silent interval» of this pathology development.Fil: Kauffman, Marcelo Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Consalvo, Damian. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: González Morón, Dolores. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; ArgentinaFil: Pujol, Virginia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Solis, Patricia Cristina Lourdes. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Oddo, Silvia Andrea. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lomlomdjian, Carolina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Kochen, Sara Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Biología Celular y Neurociencia "Prof. Eduardo de Robertis". Universidad de Buenos Aires. Facultad de Medicina. Instituto de Biología Celular y Neurociencia; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; Argentin

Global survey of guidelines for the management of epilepsy in pregnancy: A report from the international league against epilepsy task force on women and pregnancy

The ILAE Task Force on Women and Pregnancy conducted a survey among ILAE Chapters of their use of guidelines or recommendations for the management of women with epilepsy during pregnancy. A web-based questionnaire including 10 questions was sent to the 118 ILAE Chapters in December 2017 with repeated reminders until the end of February 2018. In total, 77 chapters (65%) responded, although not to all questions. Out of those responding, 68% reported having guidelines or recommendations, 34% of which were from 2014 or earlier. At least 20% of the guidelines did not include information on possible risk to cognitive development, information regarding specific risks with specific antiepileptic drugs, nor recommendations regarding selection of antiepileptic drugs. Among those responding to the question, 91% reported that recommendations were made regarding folate supplementation, but the recommended dose ranged from 0.4 mg/d to 4 mg/d or more; 34% did not include recommendations regarding drug level monitoring during pregnancy, and 19% did not include guidelines on breastfeeding. Our survey demonstrates that there is a need for the development of up-to-date, globally applicable recommendations for the management of epilepsy during pregnancy.Fil: Tomson, Torbjörn. Karolinska Huddinge Hospital. Karolinska Institutet; Suecia. Karolinska University Hospital. Department of Neurology; SueciaFil: Battino, Dina. Fondazione IRCCS Istituto Neurologico Carlo Besta. Department of Neurophysiology and Experimental Epileptology. Epilepsy Center; ItaliaFil: Bromley, Rebecca. Central Manchester University Hospitals NHS Foundation Trust; Reino Unido. University of Manchester; Reino UnidoFil: Kochen, Sara Silvia. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; ArgentinaFil: Meador, Kimford J.. University of Stanford; Estados UnidosFil: Pennell, Page B.. Brigham and Women's Hospital. Harvard Medical School. Department of Neurology. Divisions of Epilepsy and Women's Health; Estados UnidosFil: Thomas, Sanjeev V.. Sree Chitra Tirunal Institute of Medical Sciences and Technology. Department of Neurology; Indi