Arnaud Biraben

Semiologic and electrophysiologic correlations in temporal lobe seizure subtypes

Summary:  Purpose: The International League Against Epilepsy (ILAE) classification distinguishes medial and neocortical temporal lobe epilepsies. Among other criteria, this classification relies on the identification of two different electroclinical patterns, those of medial (limbic) and lateral (neocortical) temporal lobe seizures, depending on the structure initially involved in the seizure activity. Recent electrophysiologic studies have now identified seizures in which medial and neocortical structures are both involved at seizure onset. The purpose of the study was therefore to study the correlations of ictal semiology with the spatiotemporal pattern of discharge in temporal lobe seizures.

Exacerbation of juvenile myoclonic epilepsy with lamotrigine

The efficacy and safety of lamotrigine (LTG) (Lamictal; Glaxo-Wellcome Laboratories, Research Triangle Park, NC) are documented in different types of epileptic seizures and syndromes, notably in idiopathic generalized epilepsies. In the case of childhood and juvenile absence epilepsies, this drug is effective when given in cotherapy with valproic acid (resistant forms) or as substitution therapy when valproic acid is poorly tolerated.1-3⇓⇓ The same therapeutic strategy could be proposed, …

From Intracerebral EEG Signals to Brain Connectivity: Identification of Epileptogenic Networks in Partial Epilepsy

Epilepsy is a complex neurological disorder characterized by recurring seizures. In 30% of patients, seizures are insufficiently reduced by anti-epileptic drugs. In the case where seizures originate from a relatively circumscribed region of the brain, epilepsy is said to be partial and surgery can be indicated. The success of epilepsy surgery depends on the accurate localization and delineation of the epileptogenic zone (which often involves several structures), responsible for seizures. It requires a comprehensive pre-surgical evaluation of patients that includes not only imaging data but also long-term monitoring of electrophysiological signals (scalp and intracerebral EEG). During the past decades, considerable effort has been devoted to the development of signal analysis techniques aimed at characterizing the functional connectivity among spatially distributed regions over interictal (outside seizures) or ictal (during seizures) periods from EEG data. Most of these methods rely on the measurement of statistical couplings among signals recorded from distinct brain sites. However, methods differ with respect to underlying theoretical principles (mostly coming from the field of statistics or the field of non-linear physics). The objectives of this paper are: (i) to provide an brief overview of methods aimed at characterizing functional brain connectivity from electrophysiological data, (ii) to provide concrete application examples in the context of drug-refractory partial epilepsies, and iii) to highlight some key points emerging from results obtained both on real intracerebral EEG signals and on signals simulated from physiologically plausible models in which the underlying connectivity patterns are known a priori (ground truth).

Removal of muscle artifact from EEG data: comparison between stochastic (ICA and CCA) and deterministic (EMD and wavelet-based) approaches

Electroencephalographic (EEG) recordings are often contaminated with muscle artifacts. This disturbing myogenic activity not only strongly affects the visual analysis of EEG, but also most surely impairs the results of EEG signal processing tools such as source localization. This article focuses on the particular context of the contamination epileptic signals (interictal spikes) by muscle artifact, as EEG is a key diagnosis tool for this pathology. In this context, our aim was to compare the ability of two stochastic approaches of blind source separation, namely independent component analysis (ICA) and canonical correlation analysis (CCA), and of two deterministic approaches namely empirical mode decomposition (EMD) and wavelet transform (WT) to remove muscle artifacts from EEG signals. To quantitatively compare the performance of these four algorithms, epileptic spike-like EEG signals were simulated from two different source configurations and artificially contaminated with different levels of real EEG-recorded myogenic activity. The efficiency of CCA, ICA, EMD, and WT to correct the muscular artifact was evaluated both by calculating the normalized mean-squared error between denoised and original signals and by comparing the results of source localization obtained from artifact-free as well as noisy signals, before and after artifact correction. Tests on real data recorded in an epileptic patient are also presented. The results obtained in the context of simulations and real data show that EMD outperformed the three other algorithms for the denoising of data highly contaminated by muscular activity. For less noisy data, and when spikes arose from a single cortical source, the myogenic artifact was best corrected with CCA and ICA. Otherwise when spikes originated from two distinct sources, either EMD or ICA offered the most reliable denoising result for highly noisy data, while WT offered the better denoising result for less noisy data. These results suggest that the performance of muscle artifact correction methods strongly depend on the level of data contamination, and of the source configuration underlying EEG signals. Eventually, some insights into the numerical complexity of these four algorithms are given.

Abnormal functional lateralization and activity of language brain areas in typical specific language impairment (developmental dysphasia)

Atypical functional lateralization and specialization for language have been proposed to account for developmental language disorders, yet results from functional neuroimaging studies are sparse and inconsistent. This functional magnetic resonance imaging study compared children with a specific subtype of specific language impairment affecting structural language (n = 21), to a matched group of typically developing children using a panel of four language tasks neither requiring reading nor metalinguistic skills, including two auditory lexico-semantic tasks (category fluency and responsive naming) and two visual phonological tasks based on picture naming. Data processing involved normalizing the data with respect to a matched pairs paediatric template, groups and between-groups analysis, and laterality indices assessment within regions of interest using single and combined task analysis. Children with specific language impairment exhibited a significant lack of left lateralization in all core language regions (inferior frontal gyrus-opercularis, inferior frontal gyrus-triangularis, supramarginal gyrus and superior temporal gyrus), across single or combined task analysis, but no difference of lateralization for the rest of the brain. Between-group comparisons revealed a left hypoactivation of Wernickes area at the posterior superior temporal/supramarginal junction during the responsive naming task, and a right hyperactivation encompassing the anterior insula with adjacent inferior frontal gyrus and the head of the caudate nucleus during the first phonological task. This study thus provides evidence that this subtype of specific language impairment is associated with atypical lateralization and functioning of core language areas.

Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial‐onset seizures: Results of a phase III, double‐blind, randomized, placebo‐controlled trial

To evaluate the efficacy and safety of adjunctive eslicarbazepine acetate (ESL) in patients with refractory partial‐onset seizures.

Distinct hyperexcitability mechanisms underlie fast ripples and epileptic spikes

In partial epilepsies, interictal epileptic spikes (IESs) and fast ripples (FRs) represent clinically relevant biomarkers characteristic of epileptogenic networks. However, their specific significance and the pathophysiological changes leading to either FRs or IESs remain elusive. The objective of this study was to analyze the conditions in which hyperexcitable networks can generate either IESs or FRs and to reveal shared or distinct mechanisms that underlie both types of events.

Correlation Between Interictal Regional Cerebral Blood Flow and Depth-Recorded Interictal Spiking in Temporal Lobe Epilepsy

Summary: Purpose: Single photon emission computed tomography (SPECT) is used as an adjunctive method in preoperative localization of epileptic foci. In temporal lobe epilepsy (TLE), interictal hypoperfusion is observed in 60–70% of cases. Correlation with ictal EEG changes is observed in ∼50–60% of cases. Relationships with interictal EEG have been studied less. We compared interictal SPECT data obtained in 20 patients with their interictal intracerebral electrical activity recorded by depth electrodes to evaluate a potential relationship.

Dysfunction of GABAA receptor glycolysis-dependent modulation in human partial epilepsy

A reduction in GABAergic neurotransmission has been put forward as a pathophysiological mechanism for human epilepsy. However, in slices of human epileptogenic neocortex, GABAergic inhibition can be clearly demonstrated. In this article we present data showing an increase in the functional lability of GABAergic inhibition in epileptogenic tissue compared with nonepileptogenic human tissue. We have previously shown that the glycolytic enzyme GAPDH is the kinase involved in the glycolysis-dependent endogenous phosphorylation of the α1-subunit of GABAA receptor, a mechanism necessary for maintaining GABAA function. In human epileptogenic cortex obtained during curative surgery of patients with partial seizures, we demonstrate an intrinsic deficiency of GABAA receptor endogenous phosphorylation resulting in an increased lability of GABAergic currents in neurons isolated from this tissue when compared with neurons from nonepileptogenic human tissue. This feature was not related to a reduction in the number of GABAA receptor α1-subunits in the epileptogenic tissue as measured by [3H]flunitrazepam photoaffinity labeling. Maintaining the receptor in a phosphorylated state either by favoring the endogenous phosphorylation or by inhibiting a membrane-associated phosphatase is needed to sustain GABAA receptor responses in epileptogenic cortex. The increased functional lability induced by the deficiency in phosphorylation can account for transient GABAergic disinhibition favoring seizure initiation and propagation. These findings imply new therapeutic approaches and suggest a functional link to the regional cerebral glucose hypometabolism observed in patients with partial epilepsy, because the dysfunctional GABAergic mechanism depends on the locally produced glycolytic ATP.

Early pattern of epilepsy in the ring chromosome 20 syndrome.

Summary:  Purpose: The characteristics of epilepsy in ring chromosome 20 have been reported in adolescents and adults. The mode of onset most often remains imprecise. To clarify this onset period, we studied the early‐onset features in our personal series and in the reported pediatric cases.