Presently,we develop a simplified corticothalamic(SCT)model and propose a single-pulse alternately resetting stimulation(SARS)with sequentially applying anodic(A,“+”)or cathodic(C,“−”)phase pulses to the thalamic ...Presently,we develop a simplified corticothalamic(SCT)model and propose a single-pulse alternately resetting stimulation(SARS)with sequentially applying anodic(A,“+”)or cathodic(C,“−”)phase pulses to the thalamic reticular(RE)nuclei,thalamus-cortex(TC)relay nuclei,and cortical excitatory(EX)neurons,respectively.Abatement effects of ACC-SARS of RE,TC,and EX for the 2 Hz-4 Hz spike and wave discharges(SWD)of absence seizures are then concerned.The m∶n on-off ACC-SARS protocol is shown to effectively reduce the SWD with the least current consumption.In particular,when its frequency is out of the 2 Hz-4 Hz SWD dominant rhythm,the desired seizure abatements can be obtained,which can be further improved by our proposed directional steering(DS)stimulation.The dynamical explanations for the SARS induced seizure abatements are lastly given by calculating the averaged mean firing rate(AMFR)of neurons and triggering averaged mean firing rates(TAMFRs)of 2 Hz-4 Hz SWD.展开更多
In this paper,a reduced globus pallidus internal(GPI)-corticothalamic(GCT)model is developed,and a tri-phase delay stimulation(TPDS)with sequentially applying three pulses on the GPI representing the inputs from the s...In this paper,a reduced globus pallidus internal(GPI)-corticothalamic(GCT)model is developed,and a tri-phase delay stimulation(TPDS)with sequentially applying three pulses on the GPI representing the inputs from the striatal D_(1)neurons,subthalamic nucleus(STN),and globus pallidus external(GPE),respectively,is proposed.The GPI is evidenced to control absence seizures characterized by 2 Hz–4 Hz spike and wave discharge(SWD).Hence,based on the basal ganglia-thalamocortical(BGCT)model,we firstly explore the triple effects of D_(1)-GPI,GPE-GPI,and STN-GPI pathways on seizure patterns.Then,using the GCT model,we apply the TPDS on the GPI to potentially investigate the alternative and improved approach if these pathways to the GPI are blocked.The results show that the striatum D_(1),GPE,and STN can indeed jointly and significantly affect seizure patterns.In particular,the TPDS can effectively reproduce the seizure pattern if the D_(1)-GPI,GPE-GPI,and STN-GPI pathways are cut off.In addition,the seizure abatement can be obtained by well tuning the TPDS stimulation parameters.This implies that the TPDS can play the surrogate role similar to the modulation of basal ganglia,which hopefully can be helpful for the development of the brain-computer interface in the clinical application of epilepsy.展开更多
Background In the new International League Against Epilepsy(ILAE)classification of seizure types,generalized seizures such as absence seizures(ASs)may originate from a focal point and rapidly spread to the bilaterally...Background In the new International League Against Epilepsy(ILAE)classification of seizure types,generalized seizures such as absence seizures(ASs)may originate from a focal point and rapidly spread to the bilaterally distributed brain network.Increasing evidence from animal and clinical studies has indicated that focal changes may occur prior to ASs;however,the relationship of ASs with epileptogenic lesions remains unclear.Methods We retrospectively collected and analyzed the clinical,imaging,and electrophysiological data of 16 patients who had ASs and structural lesions with seizure-free outcomes after lesion resection.Results In semiology analysis,nine patients displayed focal onset;only two patients showed simple ASs,and seizure types other than ASs were observed in the remaining patients.On ictal electroencephalography(EEG),four patients showed bilateral synchronous symmetric 3 Hz generalized spike-wave discharges(GSWDs),and the remaining patients showed bilateral 1.5–2.5 Hz GSWDs.Moreover,most patients(13/16,81.3%)exhibited focal features in addition to ASs,while interictal EEG was the same in 12 patients.Furthermore,on stereoelectroencephalogram(SEEG),2/5 patients showed focal discharges before bilateral burst GSWDs.Additionally,all patients had structural lesions on imaging.In four typical AS patients,the lesions were located in deep brain regions.Notably,in 9 patients(9/16,56%),the lesions were located in the posterior cortex.All patients underwent lesion resection and had seizure-free outcomes during follow-up,and intelligence quotient(IQ)also improved by 10.71±3.90 one year after surgery.Conclusions Patients with lesion-related epilepsy may present with ASs that have a focal onset and are associated with good surgical outcomes.展开更多
Background Recent studies suggest potential roles of immune response in the pathophysiology of epilepsy.Anti-seizure medications(ASMs)are known to have side effects of drug eruption caused by immune responses.A few re...Background Recent studies suggest potential roles of immune response in the pathophysiology of epilepsy.Anti-seizure medications(ASMs)are known to have side effects of drug eruption caused by immune responses.A few reports in adults have demonstrated disappearance of seizures after an ASM drug eruption episode.In this paper,we described 2 cases of childhood absence epilepsy(CAE)who showed seizure disappearance after ethosuximide(ESM)drug eruption,suggesting the possibility that the epilepsy disappears due to immune responses to ASM.Case presentation Case 1 was an 8-year-old girl diagnosed with CAE.She was treated with valproate acid(VPA)initially,and then ESM was administered as an additional treatment.Her epileptic seizure disappeared 4 days after initiation of ESM.However,drug eruption appeared 1 week after the administration of ESM.Even after discontinuation of ESM administration,she maintains no seizure after the drug eruption.Case 2 was a 5-year-old boy diagnosed as CAE.He was treated with VPA initially,and ESM was administered additionally.Drug eruption appeared 1 month after the administration of ESM.Even after ESM was terminated,he maintained seizure freedom after the appearance of eruption.Conclusions Epileptic seizures may have been suppressed due to the immune responses caused by ASM eruption.Further studies are needed to elucidate the pathophysiologic effects of drug eruption on epilepsy through immune responses.展开更多
目的总结肌阵挛失神癫痫(epilepsy with myoclonic absence,EMA)患儿电临床特征,并分析与预后的关系。方法回顾性分析2012年1月至2022年12月在北京大学人民医院和北京大学第一医院儿科脑电监测中心监测的25例EMA患儿的临床资料,根据起...目的总结肌阵挛失神癫痫(epilepsy with myoclonic absence,EMA)患儿电临床特征,并分析与预后的关系。方法回顾性分析2012年1月至2022年12月在北京大学人民医院和北京大学第一医院儿科脑电监测中心监测的25例EMA患儿的临床资料,根据起病前后发育情况分为三组,分析电临床特征及与预后的关系。结果25例中,男14例、女11例,癫痫起病中位年龄48(26,74)月龄。A组16例(起病前后发育均正常组)、B组5例(起病前发育正常但起病后发育落后组)、C组4例(起病前后发育均落后组)。三组起病中位年龄分别为62(36,82)月龄、34(21,66)月龄、26(20,32)月龄,早发性起病各组分别3例、3例、4例。脑电图背景活动慢化10例,三组分别为6例、1例、3例。发作间期脑电图除1例正常外,24例均有广泛性放电,其中11例共存局灶性放电,三组中均有病例分布且区域涉及前后头部、颞区及Rolandic区。15例过度换气诱发肌阵挛失神(myoclonic absence,MA)发作,A组10例、B组4例、C组1例。最常见的伴随发作类型为肌阵挛发作(myoclonic seizure,MS),A组9例、B组3例、C组2例。三组间早发性EMA和药物难治性EMA比率差异均有统计学意义(均P<0.05)。进一步两两比较,C组患儿早发性EMA和药物难治性EMA比率均大于A组,差异均有统计学意义(均P<0.017)。三组间伴随MS比率差异无统计学意义(P>0.05)。结论EMA患儿的MA发作对过度换气敏感,常合并MS。部分患儿呈现起病年龄早和药物难治性的特点,具有发育性癫痫性脑病倾向。展开更多
基金Project supported by the National Natural Science Foundation of China(Nos.11702018,11932003,and 11672074)。
文摘Presently,we develop a simplified corticothalamic(SCT)model and propose a single-pulse alternately resetting stimulation(SARS)with sequentially applying anodic(A,“+”)or cathodic(C,“−”)phase pulses to the thalamic reticular(RE)nuclei,thalamus-cortex(TC)relay nuclei,and cortical excitatory(EX)neurons,respectively.Abatement effects of ACC-SARS of RE,TC,and EX for the 2 Hz-4 Hz spike and wave discharges(SWD)of absence seizures are then concerned.The m∶n on-off ACC-SARS protocol is shown to effectively reduce the SWD with the least current consumption.In particular,when its frequency is out of the 2 Hz-4 Hz SWD dominant rhythm,the desired seizure abatements can be obtained,which can be further improved by our proposed directional steering(DS)stimulation.The dynamical explanations for the SARS induced seizure abatements are lastly given by calculating the averaged mean firing rate(AMFR)of neurons and triggering averaged mean firing rates(TAMFRs)of 2 Hz-4 Hz SWD.
基金supported by the National Natural Science Foundation of China(Nos.11932003,12072021,and 11672074)。
文摘In this paper,a reduced globus pallidus internal(GPI)-corticothalamic(GCT)model is developed,and a tri-phase delay stimulation(TPDS)with sequentially applying three pulses on the GPI representing the inputs from the striatal D_(1)neurons,subthalamic nucleus(STN),and globus pallidus external(GPE),respectively,is proposed.The GPI is evidenced to control absence seizures characterized by 2 Hz–4 Hz spike and wave discharge(SWD).Hence,based on the basal ganglia-thalamocortical(BGCT)model,we firstly explore the triple effects of D_(1)-GPI,GPE-GPI,and STN-GPI pathways on seizure patterns.Then,using the GCT model,we apply the TPDS on the GPI to potentially investigate the alternative and improved approach if these pathways to the GPI are blocked.The results show that the striatum D_(1),GPE,and STN can indeed jointly and significantly affect seizure patterns.In particular,the TPDS can effectively reproduce the seizure pattern if the D_(1)-GPI,GPE-GPI,and STN-GPI pathways are cut off.In addition,the seizure abatement can be obtained by well tuning the TPDS stimulation parameters.This implies that the TPDS can play the surrogate role similar to the modulation of basal ganglia,which hopefully can be helpful for the development of the brain-computer interface in the clinical application of epilepsy.
基金The National Natural Science Foundation of China supported this work(82171448,82201613).
文摘Background In the new International League Against Epilepsy(ILAE)classification of seizure types,generalized seizures such as absence seizures(ASs)may originate from a focal point and rapidly spread to the bilaterally distributed brain network.Increasing evidence from animal and clinical studies has indicated that focal changes may occur prior to ASs;however,the relationship of ASs with epileptogenic lesions remains unclear.Methods We retrospectively collected and analyzed the clinical,imaging,and electrophysiological data of 16 patients who had ASs and structural lesions with seizure-free outcomes after lesion resection.Results In semiology analysis,nine patients displayed focal onset;only two patients showed simple ASs,and seizure types other than ASs were observed in the remaining patients.On ictal electroencephalography(EEG),four patients showed bilateral synchronous symmetric 3 Hz generalized spike-wave discharges(GSWDs),and the remaining patients showed bilateral 1.5–2.5 Hz GSWDs.Moreover,most patients(13/16,81.3%)exhibited focal features in addition to ASs,while interictal EEG was the same in 12 patients.Furthermore,on stereoelectroencephalogram(SEEG),2/5 patients showed focal discharges before bilateral burst GSWDs.Additionally,all patients had structural lesions on imaging.In four typical AS patients,the lesions were located in deep brain regions.Notably,in 9 patients(9/16,56%),the lesions were located in the posterior cortex.All patients underwent lesion resection and had seizure-free outcomes during follow-up,and intelligence quotient(IQ)also improved by 10.71±3.90 one year after surgery.Conclusions Patients with lesion-related epilepsy may present with ASs that have a focal onset and are associated with good surgical outcomes.
文摘Background Recent studies suggest potential roles of immune response in the pathophysiology of epilepsy.Anti-seizure medications(ASMs)are known to have side effects of drug eruption caused by immune responses.A few reports in adults have demonstrated disappearance of seizures after an ASM drug eruption episode.In this paper,we described 2 cases of childhood absence epilepsy(CAE)who showed seizure disappearance after ethosuximide(ESM)drug eruption,suggesting the possibility that the epilepsy disappears due to immune responses to ASM.Case presentation Case 1 was an 8-year-old girl diagnosed with CAE.She was treated with valproate acid(VPA)initially,and then ESM was administered as an additional treatment.Her epileptic seizure disappeared 4 days after initiation of ESM.However,drug eruption appeared 1 week after the administration of ESM.Even after discontinuation of ESM administration,she maintains no seizure after the drug eruption.Case 2 was a 5-year-old boy diagnosed as CAE.He was treated with VPA initially,and ESM was administered additionally.Drug eruption appeared 1 month after the administration of ESM.Even after ESM was terminated,he maintained seizure freedom after the appearance of eruption.Conclusions Epileptic seizures may have been suppressed due to the immune responses caused by ASM eruption.Further studies are needed to elucidate the pathophysiologic effects of drug eruption on epilepsy through immune responses.
