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Tinuper P.,CNR Institute of Neurological Sciences | Tinuper P.,University of Bologna | Bisulli F.,CNR Institute of Neurological Sciences | Bisulli F.,University of Bologna | And 32 more authors.
Neurology | Year: 2016

The syndrome known as nocturnal frontal lobe epilepsy is recognized worldwide and has been studied in a wide range of clinical and scientific settings (epilepsy, sleep medicine, neurosurgery, pediatric neurology, epidemiology, genetics). Though uncommon, it is of considerable interest to practicing neurologists because of complexity in differential diagnosis from more common, benign sleep disorders such as parasomnias, or other disorders like psychogenic nonepileptic seizures.Moreover, misdiagnosis can have substantial adverse consequences on patients' lives. At present, there is no consensus definition of this disorder and disagreement persists about its core electroclinical features and the spectrum of etiologies involved. To improve the definition of the disorder and establish diagnostic criteria with levels of certainty, a consensus conference using formal recommended methodology was held in Bologna in September 2014. It was recommended that the name be changed to sleep-related hypermotor epilepsy (SHE), reflecting evidence that the attacks are associated with sleep rather than time of day, the seizures may arise from extrafrontal sites, and the motor aspects of the seizures are characteristic. The etiology may be genetic or due to structural pathology, but in most cases remains unknown. Diagnostic criteria were developed with 3 levels of certainty: witnessed (possible) SHE, video-documented (clinical) SHE, and video-EEG-documented (confirmed) SHE. Themain research gaps involve epidemiology, pathophysiology, treatment, and prognosis. © 2016 American Academy of Neurology. Source


Keller C.J.,Feinstein Institute for Medical Research | Keller C.J.,Yeshiva University | Honey C.J.,Princeton University | Honey C.J.,University of Toronto | And 7 more authors.
Philosophical Transactions of the Royal Society B: Biological Sciences | Year: 2014

The cerebral cortex forms a sheet of neurons organized into a network of interconnected modules that is highly expanded in humans and presumably enables our most refined sensory and cognitive abilities. The links of this network form a fundamental aspect of its organization, and a great deal of research is focusing on understanding how information flows within and between different regions. However, an often-overlooked element of this connectivity regards a causal, hierarchical structure of regions, whereby certain nodes of the cortical network may exert greater influence over the others. While this is difficult to ascertain non-invasively, patients undergoing invasive electrode monitoring for epilepsy provide a unique window into this aspect of cortical organization. In this review, we highlight the potential for corticocortical evoked potential (CCEP) mapping to directly measure neuronal propagation across large-scale brain networks with spatio-temporal resolution that is superior to traditional neuroimaging methods.We first introduce effective connectivity and discuss the mechanisms underlying CCEP generation. Next, we highlight how CCEP mapping has begun to provide insight into the neural basis of non-invasive imaging signals. Finally, we present a novel approach to perturbing and measuring brain network function during cognitive processing. The direct measurement of CCEPs in response to electrical stimulation represents a potentially powerful clinical and basic science tool for probing the large-scale networks of the human cerebral cortex. © 2014 The Author(s) Published by the Royal Society. All rights reserved. Source


Halasz P.,National Institute of Clinical Neuroscience
Behavioural Neurology | Year: 2015

System epilepsy is an emerging concept interpreting major nonlesional epilepsies as epileptic dysfunctions of physiological systems. I extend here the concept of reflex epilepsy to epilepsies linked to input dependent physiological systems. Experimental and clinical reseach data were collected to create a coherent explanation of underlying pathomechanism in AE and NFLE. We propose that AE should be interpreted as epilepsy linked to the corticothalamic burst-firing mode of NREM sleep, released by evoked vigilance level oscillations characterized by reactive slow wave response. In the genetic variation of NFLE the ascending cholinergic arousal system plays an essential role being in strong relationship with a gain mutation of the nicotinic acethylcholin receptors, rendering the arousal system hyperexcitable. I try to provide a more unitary interpretation for the variable seizure manifestation integrating them as different degree of pathological arosuals and alarm reactions. As a supporting hypothesis the similarity between arousal parasomnias and FNLE is shown, underpinned by overlaping pathomechanism and shared familiarity, but without epileptic features. Lastly we propose that both AE and NFLE are system epilepsies of the sleep-wake system representing epileptic disorders of the antagonistic sleep/arousal network. This interpretation may throw new light on the pathomechanism of AE and NFLE. © 2015 Péter Halász. Source


Hegyi M.,Epilepsy Center | Siegler Z.,Epilepsy Center | Fogarasi A.,Epilepsy Center | Barsi P.,Research Center | Halasz P.,National Institute of Clinical Neuroscience
Ideggyogyaszati Szemle | Year: 2016

Objectives - A retrospective study has been done at the Bethesda Children's Hospital Epilepsy Center with those patients whose EEG records fulfilled in one or more records the criteria of electrical status epilepticus in slow wave sleep (ESES) pattern, occupying at least 75% of NREM sleep with bilateral discharges, and had detailed disease history and long term follow-up data, between 2000 and 2012. Patients and methods - Thirty-three patients (mean 11.1 ±4.2 years of age) were studied by 171 sleep EEG records. Sleep was recorded after sleep deprivation or during spontaneous sleep at least for one hour length of NREM. From the 492 EEGs, 171 sleep records were performed (average five/patient). Average follow-up time was 7.5 years. Eighty-two ESES records have been analyzed in 15 non-lesional and 18 lesional (11 with dysgenetic and seven with perinatal - asphyxic or vascular origin) patients. Variability of seizure types, seizure frequency and frequency of status epilepticus was higher in the iesional group. Impairment of the cognitive functions was moderate and partial in the non-lesional, while severely damaged in the lesional group. Results - EEG records of 29 patients showed unihemispherial spike fields with a perpendicular axis (in anterior, medial and posterior variants) to the Sylvian fissure, regardless their lesional or non-lesional origin. Only three (lone non-lesional and two lesional) patients had bilateral synchronous spike-wave discharges with bilateral symmetric frontocentral spike fields. The individual discharges of the sleep EEG pattern were very similar to the awake interictal records except their extension in time and field, their increased number, amplitude, and continuity of them and furthermore in the increased trans-hemispheral propagation and their synchronity. Conclusions - Assumed circuits involved in the pathome-chanism of discharges during NREM sleep in ESES are discussed based on our findings. Source


Darnai G.,University of Pecs | Plozer E.,University of Pecs | Perlaki G.,University of Pecs | Perlaki G.,Pecs Diagnostic Center | And 14 more authors.
Neuroscience Letters | Year: 2016

Although there is evidence that the ratio of 2nd-4th digit length (2D:4D) correlates with prenatal testosterone level, psychological and health traits only two studies have assessed the relationship with brain morphological features. Here we investigated the association between the 2D:4D ratio and several brain subvolumes. Seventy-five subjects between the ages of 18 and 30 were included in the study. The length of the 2nd and 4th digits were measured with an electronic vernier caliper while MRI measurements were performed on a Siemens Magnetom Trio Tim (3. T) system. Freesurfer software suite was used for volumetric segmentation. Finger ratio significantly positively correlated with total cerebral cortex, total cerebellar white matter and total cerebellar cortex in males but not in females. Our results indicate that prenatal testosterone, as estimated by the 2D:4D ratio has an effect on adult brain morphology in males. © 2016 Elsevier Ireland Ltd. Source

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