Antagonistic activity of brain networks likely plays a fundamental role in how the brain optimizes its performance by efficient allocation of computational resources. A prominent example involves externally/internally oriented attention tasks, implicating two anticorrelated, intrinsic brain networks: the default mode network (DMN) and the dorsal attention network (DAN). To elucidate electrophysiological underpinnings and causal interplay during attention switching, we recorded intracranial EEG (iEEG) from 25 epilepsy patients with electrode contacts localized in the DMN and DAN. We show antagonistic network dynamics of activation-related changes in high-frequency (> 50 Hz) and low-frequency (< 30 Hz) power. The temporal profile of information flow between the networks estimated by functional connectivity suggests that the activated network inhibits the other one, gating its activity by increasing the amplitude of the low-frequency oscillations. Insights about inter-network communication may have profound implications for various brain disorders in which these dynamics are compromised.
- MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- elektrofyziologické jevy MeSH
- epilepsie patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mozek * fyziologie patofyziologie MeSH
- nervová síť * fyziologie MeSH
- pozornost * fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- elektroencefalografie MeSH
- lidé MeSH
- status epilepticus * diagnóza etiologie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodní články MeSH
Konvulzivní status epilepticus je tonicko-klonický záchvat trvající déle než 5 minut, nebo opakované tonicko-klonické záchvaty v tomto časovém období, mezi nimiž nedochází k návratu vědomí. Iniciálně je léčen benzodiazepiny - diazepamem i. v., midazolamem i. m. nebo podaným bukálně, nebo diazepamem podaným rektálně. V případě selhání terapie benzodiazepiny je indikováno intravenózní podání protizáchvatových léků - levetiracetamu v dávce 60 mg/kg (maximálně 4 500 mg), valproátu v dávce 40 mg/kg (maximálně 3 000 mg), nebo fenytoinu v dávce 20 mg/kg (maximálně 1 500 mg). V článku uvádíme udržovací dávky léků a věnujeme se jejich významným farmakologickým vlastnostem i možným nežádoucím účinkům. Závěrem zmiňujeme další léky potenciálně využitelné při léčbě konvulzivního status epilepticus, které jsou dostupné ve formě pro intravenózní podání - lakosamid a brivaracetam.
Convulsive status epilepticus is the form of a tonic-clonic seizure lasting longer than 5 minutes, or in the case of repeated tonic-clonic seizures within this time period. Initially is treated with benzodiazepines - diazepam i. v., midazolam i. m. or buccal, or diazepam administered rectally. If benzodiazepine therapy fails, intravenous administration of anti-seizure drugs is indicated - levetiracetam at 60 mg/kg (maximum 4500 mg), valproate at 40 mg/kg (maximum 3000 mg), or phenytoin at 20 mg/kg (maximum 1500 mg). In this article, we present maintenance doses of the drugs and discuss their important pharmacological properties and possible adverse effects. Finally, we mention other drugs potentially useful in the treatment of convulsive status epilepticus that are available in a form for intravenous administration - lacosamide and brivaracetam.
Nekonvulzivní status epilepticus (NCSE) je významnou příčinou morbidity a mortality, zvláště vzniká‐li v souvislosti s akutním mozkovým inzultem u pacientů vyžadujících neurointenzivní péči. Jedná se o heterogenní skupinu stavů a klinické projevy, nález na EEG, léčba a prognóza se velmi liší podle klinického kontextu, ve kterém NCSE vzniká - věk, přítomnost epilepsie, komorbidity, komedikace, přítomnost akutní strukturální léze mozku nebo akutní systémové poruchy. Pro diagnostiku NCSE je nezbytné EEG, ale zejména u pacientů s akutním symptomatickým NCSE existuje pestrá paleta EEG nálezů, které neumožňují s jistotou určit, zda jsou způsobeny samotnou záchvatovou aktivitou, nebo vyvolávající lézí - tzv. iktálně interiktální kontinuum. Léčba NCSE může být náročná a vyžaduje úzkou spolupráci klinika s elektroencefalografistou. Zásadní je včasné odhalení NCSE a jeho etiologie a správně vedená léčba.
Non-convulsive status epilepticus (NCSE) is an important cause of morbidity and mortality, especially in patients with acute cerebral insults and those in need of neurointensive care. NCSE is a clinically heterogeneous group of conditions and the clinical manifestations, EEG findings, treatment and prognosis vary widely according to the clinical context in which NCSE occurs (age, presence of epilepsy, comorbidities, comedication, presence of an acute structural brain lesion or acute systemic disorder). EEG is essential for the diagnosis of NCSE. However, especially in patients with acute symptomatic NCSE, a wide variety of EEG findings occur that do not allow to determine with certainty whether they are caused by the epileptic activity itself or by the causative lesion - the so-called ictal-interictal continuum. Treatment of NCSE can be challenging and requires close collaboration between clinicians and EEG-readers. Critical is the early identification of NCSE and underlying etiology and properly managed treatment.
- MeSH
- elektroencefalografie MeSH
- lidé MeSH
- prognóza MeSH
- status epilepticus * diagnóza etiologie farmakoterapie klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
BACKGROUND AND OBJECTIVES: Patients with ongoing seizures are usually not allowed to drive. The prognosis for seizure freedom is favorable in patients with autoimmune encephalitis (AIE) with antibodies against NMDA receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and the gamma-aminobutyric-acid B receptor (GABABR). We hypothesized that after a seizure-free period of 3 months, patients with AIE have a seizure recurrence risk of <20% during the subsequent 12 months. This would render them eligible for noncommercial driving according to driving regulations in several countries. METHODS: This retrospective multicenter cohort study analyzed follow-up data from patients aged 15 years or older with seizures resulting from NMDAR-, LGI1-, CASPR2-, or GABABR-AIE, who had been seizure-free for ≥3 months. We used Kaplan-Meier (KM) estimates for the seizure recurrence risk at 12 months for each antibody group and tested for the effects of potential covariates with regression models. RESULTS: We included 383 patients with NMDAR-, 440 with LGI1-, 114 with CASPR2-, and 44 with GABABR-AIE from 14 international centers. After being seizure-free for 3 months after an initial seizure period, we calculated the probability of remaining seizure-free for another 12 months (KM estimate) as 0.89 (95% confidence interval [CI] 0.85-0.92) for NMDAR, 0.84 (CI 0.80-0.88) for LGI1, 0.82 (CI 0.75-0.90) for CASPR2, and 0.76 (CI 0.62-0.93) for GABABR. DISCUSSION: Taking a <20% recurrence risk within 12 months as sufficient, patients with NMDAR-AIE and LGI1-AIE could be considered eligible for noncommercial driving after having been seizure-free for 3 months.
- MeSH
- autoprotilátky * krev MeSH
- dospělí MeSH
- encefalitida * imunologie MeSH
- Hashimotova nemoc imunologie krev MeSH
- intracelulární signální peptidy a proteiny * imunologie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- membránové proteiny * imunologie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- následné studie MeSH
- proteiny nervové tkáně * imunologie MeSH
- proteiny imunologie MeSH
- receptory GABA-B * imunologie MeSH
- receptory N-methyl-D-aspartátu imunologie MeSH
- recidiva * MeSH
- retrospektivní studie MeSH
- senioři MeSH
- záchvaty etiologie imunologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Social cognition is a set of mental skills necessary to create satisfactory interpersonal relationships and feel a sense of belonging to a social group. Its deficits significantly reduce the quality of life in people with epilepsy. Studies on social cognition and its impairments focus predominantly on people with focal epilepsies. Idiopathic generalised epilepsies are a group of diseases that share similar clinical, prognostic and electrographic characteristics. Despite their typically normal intelligence, people with Idiopathic generalised epilepsies can suffer from learning disabilities and executive dysfunctions. Current studies also suggest social cognition impairments, but their results are inconsistent. This review offers the latest knowledge of social cognition in adults with Idiopathic generalised epilepsies. In addition, we provide an overview of the most frequently used assessment methods. We explain possible reasons for different outcomes and discuss future research perspectives.
- MeSH
- epilepsie generalizovaná * psychologie patofyziologie MeSH
- exekutivní funkce fyziologie MeSH
- lidé MeSH
- sociální kognice * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- kongresy jako téma MeSH
- neurologie * MeSH
- Publikační typ
- zprávy MeSH
BACKGROUND AND OBJECTIVE: Patients with presumed nonlesional focal epilepsy-based on either MRI or histopathologic findings-have a lower success rate of epilepsy surgery compared with lesional patients. In this study, we aimed to characterize a large group of patients with focal epilepsy who underwent epilepsy surgery despite a normal MRI and had no lesion on histopathology. Determinants of their postoperative seizure outcomes were further studied. METHODS: We designed an observational multicenter cohort study of MRI-negative and histopathology-negative patients who were derived from the European Epilepsy Brain Bank and underwent epilepsy surgery between 2000 and 2012 in 34 epilepsy surgery centers within Europe. We collected data on clinical characteristics, presurgical assessment, including genetic testing, surgery characteristics, postoperative outcome, and treatment regimen. RESULTS: Of the 217 included patients, 40% were seizure-free (Engel I) 2 years after surgery and one-third of patients remained seizure-free after 5 years. Temporal lobe surgery (adjusted odds ratio [AOR]: 2.62; 95% CI 1.19-5.76), shorter epilepsy duration (AOR for duration: 0.94; 95% CI 0.89-0.99), and completely normal histopathologic findings-versus nonspecific reactive gliosis-(AOR: 4.69; 95% CI 1.79-11.27) were significantly associated with favorable seizure outcome at 2 years after surgery. Of patients who underwent invasive monitoring, only 35% reached seizure freedom at 2 years. Patients with parietal lobe resections had lowest seizure freedom rates (12.5%). Among temporal lobe surgery patients, there was a trend toward favorable outcome if hippocampectomy was part of the resection strategy (OR: 2.94; 95% CI 0.98-8.80). Genetic testing was only sporadically performed. DISCUSSION: This study shows that seizure freedom can be reached in 40% of nonlesional patients with both normal MRI and histopathology findings. In particular, nonlesional temporal lobe epilepsy should be regarded as a relatively favorable group, with almost half of patients achieving seizure freedom at 2 years after surgery-even more if the hippocampus is resected-compared with only 1 in 5 nonlesional patients who underwent extratemporal surgery. Patients with an electroclinically identified focus, who are nonlesional, will be a promising group for advanced molecular-genetic analysis of brain tissue specimens to identify new brain somatic epilepsy genes or epilepsy-associated molecular pathways.
- MeSH
- elektroencefalografie MeSH
- epilepsie parciální * diagnostické zobrazování chirurgie MeSH
- epilepsie temporálního laloku * chirurgie MeSH
- epilepsie * diagnostické zobrazování chirurgie MeSH
- kohortové studie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- záchvaty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
OBJECTIVE: Refractory epilepsy may have an underlying autoimmune etiology. Our aim was to assess the prevalence of neural autoantibodies in a multicenter national prospective cohort of patients with drug-resistant epilepsy undergoing epilepsy surgery utilizing comprehensive clinical, serologic, and histopathological analyses. METHODS: We prospectively recruited patients undergoing epilepsy surgery for refractory focal epilepsy not caused by a brain tumor from epilepsy surgery centers in the Czech Republic. Perioperatively, we collected cerebrospinal fluid (CSF) and/or serum samples and performed comprehensive commercial and in-house assays for neural autoantibodies. Clinical data were obtained from the patients' medical records, and histopathological analysis of resected brain tissue was performed. RESULTS: Seventy-six patients were included, mostly magnetic resonance imaging (MRI)-lesional cases (74%). Mean time from diagnosis to surgery was 21 ± 13 years. Only one patient (1.3%) had antibodies in the CSF and serum (antibodies against glutamic acid decarboxylase 65) in relevant titers; histology revealed focal cortical dysplasia (FCD) III (FCD associated with hippocampal sclerosis [HS]). Five patients' samples displayed CSF-restricted oligoclonal bands (OCBs; 6.6%): three cases with FCD (one with FCD II and two with FCD I), one with HS, and one with negative histology. Importantly, eight patients (one of them with CSF-restricted OCBs) had findings on antibody testing in individual serum and/or CSF tests that could not be confirmed by complementary tests and were thus classified as nonspecific, yet could have been considered specific without confirmatory testing. Of these, two had FCD, two gliosis, and four HS. No inflammatory changes or lymphocyte cuffing was observed histopathologically in any of the 76 patients. SIGNIFICANCE: Neural autoantibodies are a rare finding in perioperatively collected serum and CSF of our cohort of mostly MRI-lesional epilepsy surgery patients. Confirmatory testing is essential to avoid overinterpretation of autoantibody-positive findings.
- MeSH
- autoprotilátky MeSH
- epilepsie * epidemiologie chirurgie komplikace MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- malformace mozkové kůry * komplikace MeSH
- prevalence MeSH
- prospektivní studie MeSH
- refrakterní epilepsie * diagnostické zobrazování chirurgie komplikace MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Visuospatial perspective-taking (VPT) is the ability to imagine a scene from a position different from the one used in self-perspective judgments (SPJ). We typically use VPT to understand how others see the environment. VPT requires overcoming the self-perspective, and impairments in this process are implicated in various brain disorders, such as schizophrenia and autism. However, the underlying brain areas of VPT are not well distinguished from SPJ-related ones and from domain-general responses to both perspectives. In addition, hierarchical processing theory suggests that domain-specific processes emerge over time from domain-general ones. It mainly focuses on the sensory system, but outside of it, support for this hypothesis is lacking. Therefore, we aimed to spatiotemporally distinguish brain responses domain-specific to VPT from the specific ones to self-perspective, and domain-general responses to both perspectives. In particular, we intended to test whether VPT- and SPJ specific responses begin later than the general ones. We recorded intracranial EEG data from 30 patients with epilepsy who performed a task requiring laterality judgments during VPT and SPJ, and analyzed the spatiotemporal features of responses in the broad gamma band (50-150 Hz). We found VPT-specific processing in a more extensive brain network than SPJ-specific processing. Their dynamics were similar, but both differed from the general responses, which began earlier and lasted longer. Our results anatomically distinguish VPT-specific from SPJ-specific processing. Furthermore, we temporally differentiate between domain-specific and domain-general processes both inside and outside the sensory system, which serves as a novel example of hierarchical processing.
- MeSH
- elektrokortikografie * MeSH
- lidé MeSH
- mínění fyziologie MeSH
- mozek fyziologie MeSH
- schizofrenie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
