20 results on '"Britta Wandschneider"'
Search Results
2. Genetic generalized epilepsies in adults — challenging assumptions and dogmas
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Martin Holtkamp, Bernd J. Vorderwülbecke, Britta Wandschneider, and Yvonne G. Weber
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Adult ,Epilepsy ,Adolescent ,Seizure types ,business.industry ,Neuropsychology ,Electroencephalography ,Comorbidity ,Syndrome ,medicine.disease ,Juvenile Absence Epilepsy ,Cellular and Molecular Neuroscience ,Childhood absence epilepsy ,Tolerability ,Seizures ,medicine ,Etiology ,Humans ,Epilepsy, Generalized ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,business ,Clinical psychology - Abstract
Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15–20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic–clonic seizures alone. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Nevertheless, long-term follow-up studies have shown that with advancing age, many patients can discontinue their anti-seizure medication without seizure relapses. Several outcome predictors have been identified, but prognosis across the syndromes is more homogeneous than previously assumed. Overall, overlap in pathophysiology, seizure types, treatment responses and outcomes support the idea that GGEs are not separate nosological entities but represent a neurobiological continuum. In this Review, the authors consider how current understanding of four genetic generalized epilepsy syndromes that commonly occur in adults challenges traditional concepts about these conditions and suggests that they are not distinct but sit on a neurobiological continuum.
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- 2021
3. Motor hyperactivation during cognitive tasks: An endophenotype of juvenile myoclonic epilepsy
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Christian Vollmar, Sjoerd B. Vos, Meneka K. Sidhu, Alexander J. Lowe, Maria Centeno, Gavin P. Winston, John S. Duncan, Matthias J. Koepp, Britta Wandschneider, Fenglai Xiao, Pamela J. Thompson, Lili Long, Lorenzo Caciagli, and Karin Trimmel
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Adult ,Male ,cognition ,0301 basic medicine ,medicine.medical_specialty ,Elementary cognitive task ,Adolescent ,Endophenotypes ,Hyperkinesis ,Audiology ,juvenile myoclonic epilepsy ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Full Length Original Research Paper ,Motor system ,medicine ,Humans ,Prospective Studies ,medicine.diagnostic_test ,business.industry ,Myoclonic Epilepsy, Juvenile ,fMRI ,Neuropsychology ,Middle Aged ,medicine.disease ,endophenotype ,Cross-Sectional Studies ,030104 developmental biology ,medicine.anatomical_structure ,Neurology ,Endophenotype ,Full‐length Original Research ,Female ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,medicine.symptom ,Functional magnetic resonance imaging ,business ,Myoclonus ,Psychomotor Performance ,030217 neurology & neurosurgery ,motor system ,Motor cortex - Abstract
Objective: Juvenile myoclonic epilepsy (JME) is the most common genetic generalized epilepsy syndrome. Myoclonus may relate to motor system hyperexcitability and can be provoked by cognitive activities. To aid genetic mapping in complex neuropsychiatric disorders, recent research has utilized imaging intermediate phenotypes (endophenotypes). Here, we aimed to (a) characterize activation profiles of the motor system during different cognitive tasks in patients with JME and their unaffected siblings, and (b) validate those as endophenotypes of JME. / Methods: This prospective cross‐sectional investigation included 32 patients with JME, 12 unaffected siblings, and 26 controls, comparable for age, sex, handedness, language laterality, neuropsychological performance, and anxiety and depression scores. We investigated patterns of motor system activation during episodic memory encoding and verb generation functional magnetic resonance imaging (fMRI) tasks. / Results: During both tasks, patients and unaffected siblings showed increased activation of motor system areas compared to controls. Effects were more prominent during memory encoding, which entailed hand motion via joystick responses. Subgroup analyses identified stronger activation of the motor cortex in JME patients with ongoing seizures compared to seizure‐free patients. Receiver‐operating characteristic curves, based on measures of motor activation, accurately discriminated both patients with JME and their siblings from healthy controls (area under the curve: 0.75 and 0.77, for JME and a combined patient‐sibling group against controls, respectively; P < .005). / Significance: Motor system hyperactivation represents a cognitive, domain‐independent endophenotype of JME. We propose measures of motor system activation as quantitative traits for future genetic imaging studies in this syndrome.
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- 2020
4. Bildgebung beim Janz-Syndrom (juvenile myoklonische Epilepsie)
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Matthias J. Koepp, Britta Wandschneider, and Christian Vollmar
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Gynecology ,medicine.medical_specialty ,business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,Neurology (clinical) ,business - Abstract
Die Bildgebung hat in den letzten 25 Jahren wesentliche neue Hinweise zum Verstandnis der Pathophysiologie der juvenilen myoklonischen Epilepsie (JME) geliefert. In diesem Artikel werden die Kernpunkte dieser Arbeiten zusammengefasst, und ihre Bedeutung im Zusammenhang mit genetischen Veranderungen und der Hirnentwicklung bei JME wird diskutiert. Zusammenfassend liegt bei der JME eine komplexe, multifaktorielle Entwicklungsstorung vor, die zu verschiedenen strukturellen und funktionellen Veranderungen kortikaler und subkortikaler Strukturen fuhrt. Dies fuhrt letztendlich zu einer pathologisch erhohten kortikokortikalen Konnektivitat, gestorter kortikaler Inhibition und gestorter thalamokortikaler Ruckkopplung. Ein Schwerpunkt dieser Veranderungen betrifft das frontozentrale motorische System, neuere Arbeiten zeigen aber auch daruber hinaus signifikante Veranderungen in anderen Hirnregionen
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- 2020
5. 31 Disorganization of language and working memory networks in frontal versus temporal lobe epilepsy
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Lorenzo Caciagli, Casey Paquola, Xiaosong He, Christian Vollmar, Maria Centeno, Britta Wandschneider, Urs Braun, Karin Trimmel, Sjoerd B Vos, Meneka K Sidhu, Pamela J Thompson, Sallie Baxendale, Gavin P Winston, John S Duncan, Dani S Bassett, Matthias J Koepp, and Boris C Bernhardt
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Psychiatry and Mental health ,Surgery ,Neurology (clinical) - Abstract
Objectives/AimsCognitive impairment is a common comorbidity of epilepsy, and can be more burdensome than seizures themselves. Temporal and frontal lobe epilepsy (TLE, FLE) are accompanied by multi-domain cognitive impairment. While the underlying neural substrates have been extensively investigated in TLE, functional imaging studies in FLE are scarce. Here, we aimed to: (i) investigate systems-level neural processes accounting for cognitive dysfunction in FLE; (ii) directly compare FLE and TLE patients, establishing commonalities and differences; and (iii) decode the potential influence of clinical characteristics on cognitive network architecture.MethodsWe capitalized on a large, single-centre sample of 172 adult participants (56 with FLE, 64 with TLE, 52 with controls) who were investigated via: (i) an extensive neuropsychological test battery that included attention, psychomotor speed, language, working memory, executive function, and episodic memory tests; and (ii) four functional MRI tasks probing expressive language (verbal fluency, verb generation) and working memory (verbal and visuo-spatial). Patient groups were comparable in age of epilepsy onset, disease duration, and antiseizure medication load. We mapped task-related brain activation and deactivation using a novel multiscale approach, and tracked reorganization in FLE and TLE. We complemented voxel-based maps with profiling of task effects across established motifs of functional brain organization: (i) canonical resting-state functional networks, and (ii) the principal functional connectivity gradient, that encodes a continuous transition from lower-level (sensory) to higher-order (transmodal) brain areas.ResultsWe find that cognitive impairment in FLE is accompanied by broadly reduced activation across frontoparietal attentional and executive networks, and reduced default-mode network deactivation, indicating large-scale disorganization of task-related recruitment, particularly during working memory. Patterns of dysfunction in FLE and TLE are broadly similar, but some traits are syndrome-specific: impaired task-related deactivation of the default-mode network is more prominent in FLE, while impaired recruitment of posterior language areas is more marked in TLE. More severe epilepsy, as tracked by age at onset, epilepsy duration, seizure frequency, time since last seizure, and propensity for focal-to-bilateral tonic-clonic seizures, relates to more marked cognitive network disorganization both in FLE and TLE.ConclusionsOur study elucidates neural processes underlying cognitive impairment in the most common focal epilepsies, identifies frontoparietal executive alterations as a shared biological signature, irrespective of seizure focus localization, and shows that temporal lobe language alterations are TLE-specific. The highlighted systems-level behaviour may be amenable to future remediation strategies, including neurostimulation.
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- 2022
6. Disorganization of language and working memory systems in frontal versus temporal lobe epilepsy
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Lorenzo Caciagli, Casey Paquola, Xiaosong He, Christian Vollmar, Maria Centeno, Britta Wandschneider, Urs Braun, Karin Trimmel, Sjoerd B Vos, Meneka K Sidhu, Pamela J Thompson, Sallie Baxendale, Gavin P Winston, John S Duncan, Dani S Bassett, Matthias J Koepp, and Boris C Bernhardt
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Neurology (clinical) - Abstract
Cognitive impairment is a common comorbidity of epilepsy and adversely impacts people with both frontal lobe (FLE) and temporal lobe (TLE) epilepsy. While its neural substrates have been investigated extensively in TLE, functional imaging studies in FLE are scarce. In this study, we profiled the neural processes underlying cognitive impairment in FLE and directly compared FLE and TLE to establish commonalities and differences. We investigated 172 adult participants (56 with FLE, 64 with TLE and 52 controls) using neuropsychological tests and four functional MRI tasks probing expressive language (verbal fluency, verb generation) and working memory (verbal and visuo-spatial). Patient groups were comparable in disease duration and anti-seizure medication load. We devised a multiscale approach to map brain activation and deactivation during cognition and track reorganization in FLE and TLE. Voxel-based analyses were complemented with profiling of task effects across established motifs of functional brain organization: (i) canonical resting-state functional systems; and (ii) the principal functional connectivity gradient, which encodes a continuous transition of regional connectivity profiles, anchoring lower-level sensory and transmodal brain areas at the opposite ends of a spectrum. We show that cognitive impairment in FLE is associated with reduced activation across attentional and executive systems, as well as reduced deactivation of the default mode system, indicative of a large-scale disorganization of task-related recruitment. The imaging signatures of dysfunction in FLE are broadly similar to those in TLE, but some patterns are syndrome-specific: altered default-mode deactivation is more prominent in FLE, while impaired recruitment of posterior language areas during a task with semantic demands is more marked in TLE. Functional abnormalities in FLE and TLE appear overall modulated by disease load. On balance, our study elucidates neural processes underlying language and working memory impairment in FLE, identifies shared and syndrome-specific alterations in the two most common focal epilepsies and sheds light on system behaviour that may be amenable to future remediation strategies.
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- 2021
7. Cognitive Function in Genetic Generalized Epilepsies: Insights From Neuropsychology and Neuroimaging
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Corey Ratcliffe, Britta Wandschneider, Sallie Baxendale, Pamela Thompson, Matthias J. Koepp, and Lorenzo Caciagli
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cognition ,neuropsychology ,Review ,lcsh:RC346-429 ,Juvenile Absence Epilepsy ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Childhood absence epilepsy ,Medicine ,genetic generalized epilepsies ,lcsh:Neurology. Diseases of the nervous system ,030304 developmental biology ,0303 health sciences ,neuroimaging ,business.industry ,Neuropsychology ,Cognition ,medicine.disease ,endophenotype ,Frontal lobe ,Neurology ,Endophenotype ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,business ,Neuroscience ,030217 neurology & neurosurgery - Abstract
Genetic generalized epilepsies (GGE), previously called idiopathic generalized epilepsies, constitute about 20% of all epilepsies, and include childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone (CAE, JAE, JME, and GGE-GTCS, respectively). GGE are characterized by high heritability, likely underlain by polygenetic mechanisms, which may relate to atypical neurodevelopmental trajectories. Age of onset ranges from pre-school years, for CAE, to early adulthood for GGE-GTCS. Traditionally, GGE have been considered benign, a belief contrary to evidence from neuropsychology studies conducted over the last two decades. In JME, deficits in executive and social functioning are common findings and relate to impaired frontal lobe function. Studies using neuropsychological measures and cognitive imaging paradigms provide evidence for hyperconnectivity between prefrontal and motor cortices, aberrant fronto-thalamo-cortical connectivity, and reduced fronto-cortical and subcortical gray matter volumes, which are associated with altered cognitive performance. Recent research has also identified associations between abnormal hippocampal morphometry and fronto-temporal activation during episodic memory. Longitudinal studies on individuals with newly diagnosed JME have observed cortical dysmaturation, which is paralleled by delayed cognitive development compared to the patients' peers. Comorbidities and cognitive deficits observed in other GGE subtypes, such as visuo-spatial and language deficits in both CAE and JAE, have also been correlated with atypical neurodevelopment. Although it remains unclear whether cognitive impairment profiles differ amongst GGE subtypes, effects may become more pronounced with disease duration, particularly in absence epilepsies. Finally, there is substantial evidence that patients with JME and their unaffected siblings share patterns of cognitive deficits, which is indicative of an underlying genetic etiology (endophenotype), independent of seizures and anti-epileptic medication.
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- 2020
8. Effects of carbamazepine and lamotrigine on functional magnetic resonance imaging cognitive networks
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Sjoerd B. Vos, Meneka K. Sidhu, Jane L. Burdett, Dong Zhou, Fenglai Xiao, John S. Duncan, Karin Trimmel, Pamela J. Thompson, Matthias J. Koepp, Christian Vollmar, Britta Wandschneider, Gavin P. Winston, Josemir W. Sander, Lorenzo Caciagli, Andrea Hill, and Sebastien Ourselin
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0301 basic medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Working memory ,Lamotrigine ,Audiology ,medicine.disease ,03 medical and health sciences ,Fluency ,Epilepsy ,030104 developmental biology ,0302 clinical medicine ,Neurology ,medicine ,Verbal fluency test ,Neurology (clinical) ,Levetiracetam ,business ,Functional magnetic resonance imaging ,030217 neurology & neurosurgery ,Default mode network ,medicine.drug - Abstract
Objective To investigate the effects of sodium channel-blocking antiepileptic drugs (AEDs) on functional magnetic resonance imaging (fMRI) language network activations in patients with focal epilepsy. Methods In a retrospective study, we identified patients who were treated at the time of language fMRI scanning with either carbamazepine (CBZ; n = 42) or lamotrigine (LTG; n = 42), but not another sodium channel-blocking AED. We propensity-matched 42 patients taking levetiracetam (LEV) as "patient-controls" and included further 42 age- and gender-matched healthy controls. After controlling for age, age at onset of epilepsy, gender, and antiepileptic comedications, we compared verbal fluency fMRI activations between groups and out-of-scanner psychometric measures of verbal fluency. Results Patients on CBZ performed less well on a verbal fluency tests than those taking LTG or LEV. Compared to either LEV-treated patients or controls, patients taking CBZ showed decreased activations in left inferior frontal gyrus and patients on LTG showed abnormal deactivations in frontal and parietal default mode areas. All patient groups showed fewer activations in the putamen bilaterally compared to controls. In a post hoc analysis, out-of-scanner fluency scores correlated positively with left putamen activation. Significance Our study provides evidence of AED effects on the functional neuroanatomy of language, which might explain subtle language deficits in patients taking otherwise well-tolerated sodium channel-blocking agents. Patients on CBZ showed dysfunctional frontal activation and more pronounced impairment of performance than patients taking LTG, which was associated only with failure to deactivate task-negative networks. As previously shown for working memory, LEV treatment did not affect functional language networks.
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- 2018
9. Besondere bildgebende Befunde bei primär generalisierten Epilepsien
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Christian Vollmar and Britta Wandschneider
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0301 basic medicine ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,030217 neurology & neurosurgery - Abstract
Konventionelle bildgebende Verfahren sind bei Patienten mit idiopathischen generalisierten Epilepsien per definitionem unauffallig. MRT-basierte (Magnetresonanztomographie), morphometrische Verfahren konnten jedoch in Gruppenanalysen subtile strukturelle Veranderungen insbesondere im mesialen Frontallappen, supplementar motorischen Areal und Thalamus nachweisen. Erganzende funktionelle MRT- und Diffusions-Tensor-Bildgebungs(DTI)-Untersuchungen bei Patienten mit juveniler myoklonischer Epilepsie (JME) zeigen eine erhohte funktionelle und strukturelle Konnektivitat zwischen prafrontalen kognitiven und motorischen Kortexarealen, die Erklarungen fur krankheitstypische Anfallsreflexmechanismen bieten. Studien an neu diagnostizierten Patienten, longitudinale Studien sowie Untersuchungen an gesunden Geschwistern von JME-Patienten weisen darauf hin, dass diese Veranderungen am ehesten Ursache im Sinne einer genetisch determinierten Entwicklungsstorung sind und nicht eine sekundare Folge der chronischen Epilepsie.
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- 2018
10. Cerebellar, limbic, and midbrain volume alterations in sudden unexpected death in epilepsy
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John S. Duncan, Rebecca K. Harper, Beate Diehl, Luke A. Allen, Britta Wandschneider, Simona Balestrini, Catherine Scott, Jennifer A. Ogren, Rajesh Kumar, Sebsatien Ourselin, Gavin P. Winston, Ronald M. Harper, Sjoerd B. Vos, and Samden D. Lhatoo
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Cerebellum ,Limbic Lobe ,Amygdala ,Periaqueductal gray ,Article ,Midbrain ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Mesencephalon ,Internal medicine ,medicine ,Humans ,Sudden Unexpected Death in Epilepsy ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,Neurology ,Posterior cingulate ,Epilepsy syndromes ,Cardiology ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Author(s): Allen, Luke A; Vos, Sjoerd B; Kumar, Rajesh; Ogren, Jennifer A; Harper, Rebecca K; Winston, Gavin P; Balestrini, Simona; Wandschneider, Britta; Scott, Catherine A; Ourselin, Sebsatien; Duncan, John S; Lhatoo, Samden D; Harper, Ronald M; Diehl, Beate | Abstract: ObjectiveThe processes underlying sudden unexpected death in epilepsy (SUDEP) remain elusive, but centrally mediated cardiovascular or respiratory collapse is suspected. Volume changes in brain areas mediating recovery from extreme cardiorespiratory challenges may indicate failure mechanisms and allow prospective identification of SUDEP risk.MethodsWe retrospectively imaged SUDEP cases (n = 25), patients comparable for age, sex, epilepsy syndrome, localization, and disease duration who were high-risk (n = 25) or low-risk (n = 23), and age- and sex-matched healthy controls (n = 25) with identical high-resolution T1-weighted scans. Regional gray matter volume, determined by voxel-based morphometry, and segmentation-derived structure sizes were compared across groups, controlling for total intracranial volume, age, and sex.ResultsSubstantial bilateral gray matter loss appeared in SUDEP cases in the medial and lateral cerebellum. This was less prominent in high-risk subjects and absent in low-risk subjects. The periaqueductal gray, left posterior and medial thalamus, left hippocampus, and bilateral posterior cingulate also showed volume loss in SUDEP. High-risk subjects showed left thalamic volume reductions to a lesser extent. Bilateral amygdala, entorhinal, and parahippocampal volumes increased in SUDEP and high-risk patients, with the subcallosal cortex enlarged in SUDEP only. Disease duration correlated negatively with parahippocampal volume. Volumes of the bilateral anterior insula and midbrain in SUDEP cases were larger the closer to SUDEP from magnetic resonance imaging.SignificanceSUDEP victims show significant tissue loss in areas essential for cardiorespiratory recovery and enhanced volumes in areas that trigger hypotension or impede respiratory patterning. Those changes may shed light on SUDEP pathogenesis and prospectively detect patterns identifying those at risk.
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- 2018
11. Juvenile myoclonic epilepsy: A system disorder of the brain
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Matthias J. Koepp, Bettina Schmitz, Britta Wandschneider, Elza Márcia Targas Yacubian, Peter Wolf, Thomas Sander, and Giuliano Avanzini
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medicine.medical_specialty ,Mental Disorders ,Myoclonic Epilepsy, Juvenile ,Neuropsychology ,Brain ,Neuroimaging ,Voxel-based morphometry ,Grey matter ,medicine.disease ,Clinical neurophysiology ,Epilepsy ,Cognition ,medicine.anatomical_structure ,Neurology ,medicine ,Humans ,Epilepsy, Generalized ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,Generalized epilepsy ,Child ,Psychology ,Neuroscience - Abstract
Summary The prevailing understanding of generalized epilepsy is shaped by the traditional definition that “the responsible neuronal discharge takes place, if not throughout the entire grey matter, then at least in the greater part of it and simultaneously on both sides”. This view is no longer tenable since concurrent findings using multiple methods have accumulated to reveal the role of bilateral networks of distributed and selective cortical and subcortical structures in so-called generalized ictogenesis. Most of this research has been focused on juvenile myoclonic epilepsy (JME), which today is commonly considered the archetypical syndrome of the idiopathic generalized epilepsies. Based upon recent research in the fields of clinical epileptology, neuropsychology and psychiatry, clinical neurophysiology, neuroimaging and epilepsy genetics this article, for the first time, unites these new findings into a comprehensive nosological view. Genetically determined dysfunctions of important cognitive systems like visuomotor coordination and linguistic communication appear now as key mechanisms of seizure generation in JME. This review suggests a new paradigm to consider JME as a system disorder of the brain analogous to other neurological system disorders.
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- 2015
12. Levetiracetam reduces abnormal network activations in temporal lobe epilepsy
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Jason Stretton, John S. Duncan, Mark Symms, Lajos R. Kozák, Matthias J. Koepp, Meneka K. Sidhu, Maria Centeno, Pamela J. Thompson, and Britta Wandschneider
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Adult ,Male ,medicine.medical_specialty ,Levetiracetam ,Neuropsychological Tests ,Hippocampal formation ,Audiology ,behavioral disciplines and activities ,Article ,Temporal lobe ,Young Adult ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Post-hoc analysis ,Image Processing, Computer-Assisted ,medicine ,Humans ,030304 developmental biology ,0303 health sciences ,Chi-Square Distribution ,Working memory ,Brain ,Piracetam ,Cognition ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Oxygen ,Epilepsy, Temporal Lobe ,nervous system ,Anticonvulsants ,Female ,Neurology (clinical) ,Psychology ,Neuroscience ,psychological phenomena and processes ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Objective: We used functional MRI (fMRI) and a left-lateralizing verbal and a right-lateralizing visual-spatial working memory (WM) paradigm to investigate the effects of levetiracetam (LEV) on cognitive network activations in patients with drug-resistant temporal lobe epilepsy (TLE). Methods: In a retrospective study, we compared task-related fMRI activations and deactivations in 53 patients with left and 54 patients with right TLE treated with (59) or without (48) LEV. In patients on LEV, activation patterns were correlated with the daily LEV dose. Results: We isolated task- and syndrome-specific effects. Patients on LEV showed normalization of functional network deactivations in the right temporal lobe in right TLE during the right-lateralizing visual-spatial task and in the left temporal lobe in left TLE during the verbal task. In a post hoc analysis, a significant dose-dependent effect was demonstrated in right TLE during the visual-spatial WM task: the lower the LEV dose, the greater the abnormal right hippocampal activation. At a less stringent threshold (p < 0.05, uncorrected for multiple comparisons), a similar dose effect was observed in left TLE during the verbal task: both hippocampi were more abnormally activated in patients with lower doses, but more prominently on the left. Conclusions: Our findings suggest that LEV is associated with restoration of normal activation patterns. Longitudinal studies are necessary to establish whether the neural patterns translate to drug response. Classification of evidence: This study provides Class III evidence that in patients with drug-resistant TLE, levetiracetam has a dose-dependent facilitation of deactivation of mesial temporal structures.
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- 2014
13. Epilepsy in the elderly: comparing clinical characteristics with younger patients
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Frank Kerling, Britta Wandschneider, Felix Rosenow, N. Füratsch, Hermann Stefan, R. Kretz, Bettina Schmitz, C. Karakizlis, Margarete Pfäfflin, J. Geithner, Theodor W. May, Uwe Runge, and Christian Brandt
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Comorbidity ,Young Adult ,Epilepsy ,Seizures ,Surveys and Questionnaires ,Humans ,Medicine ,Prospective Studies ,Age of Onset ,Young adult ,Prospective cohort study ,Aged ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Age Factors ,General Medicine ,Middle Aged ,medicine.disease ,Neurology ,Concomitant ,Etiology ,Anticonvulsants ,Female ,Neurology (clinical) ,Age of onset ,business - Abstract
The prevalence and incidence of epilepsies in elderly is high. Due to demographic development, the portion of elderly patients with epilepsy will continue to rise over the next decades. In this study, we aimed to investigate seizure semiology, etiology, comorbidity, and therapy in elderly patients dependent on onset of epilepsy and in comparison with younger patients. In a prospective multicentre study, 202 epilepsy patients were included in a consecutive manner and subdivided into three groups (group A1: >65 years, onset of epilepsy after the age of 65 years; group A2: >65 years with early onset epilepsy, seizure onset before the age of 50 years; and group B
- Published
- 2014
14. Juvenile myoclonic epilepsy — Neuroimaging findings
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Matthias J. Koepp, Ivanka Savic, Britta Wandschneider, and Friedrich G. Woermann
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Brain Mapping ,medicine.diagnostic_test ,Myoclonic Epilepsy, Juvenile ,Brain ,Neuroimaging ,medicine.disease ,Idiopathic generalized epilepsy ,Behavioral Neuroscience ,Epilepsy ,Neurology ,Frontal lobe ,Image Processing, Computer-Assisted ,medicine ,Humans ,Myoclonic epilepsy ,Anticonvulsants ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,Generalized epilepsy ,Radionuclide Imaging ,Functional magnetic resonance imaging ,Psychology ,Neuroscience - Abstract
Juvenile myoclonic epilepsy (JME) has been classified as a syndrome of idiopathic generalized epilepsy and is characterized by specific types of seizures, showing a lack of pathology using magnetic resonance imaging (MRI) and computed tomography scanning. However, JME is associated with a particular personality profile, and behavioral and neuropsychological studies have suggested the possible involvement of frontal lobe dysfunction. The development of highly sensitive neuroimaging techniques has provided a means of elucidating the underlying mechanisms of JME. Positron emission tomography demonstrated metabolic and neurotransmitter changes in the dorsolateral prefrontal cortex reflecting the particular cognitive and behavioral profile of JME patients. (1)H-magnetic resonance spectroscopy has shown evidence of thalamic dysfunction, which appears to be progressive. Such techniques provide evidence of multi-focal disease mechanisms, suggesting that JME is a frontal lobe variant of a multi-regional, thalamocortical 'network' epilepsy, rather than a generalized epilepsy syndrome. Quantitative MRI revealed significant abnormalities of cortical gray matter in medial frontal areas close to the supplementary motor area and diffusion abnormalities with increased functional coupling between the motor and prefrontal cognitive systems. This altered structural connectivity of the supplementary motor area provides an explanatory framework for the particular imaging findings, seizure type, and seizure-provoking mechanisms in JME.
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- 2013
15. Frontal lobe function and structure in juvenile myoclonic epilepsy: A comprehensive review of neuropsychological and imaging data
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Christian Vollmar, Matthias J. Koepp, Pamela J. Thompson, and Britta Wandschneider
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Neuropsychology ,medicine.disease ,Executive functions ,Functional imaging ,Idiopathic generalized epilepsy ,Neurology ,Frontal lobe ,Epilepsy syndromes ,medicine ,Myoclonic epilepsy ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,Psychology ,Neuroscience - Abstract
Juvenile myoclonic epilepsy is the most common idiopathic epilepsy syndrome and is considered a benign seizure disorder that responds well to antiepileptic drug treatment, in particular sodium valproate. By definition, routine brain imaging shows no abnormalities, but advanced imaging studies have identified functional and structural abnormalities in the frontal cortex and thalamus. Neuropsychological studies revealed subtle cognitive deficits in patients with JME, mainly implicating the frontal lobes. These findings are in keeping with anecdotal reports of behavioral problems in JME. Cognitive dysfunction in otherwise healthy siblings of patients with JME and a high heritability support the concept of a genetically determined thalamo-frontocortical network dysfunction, accounting for the cognitive impairment and cognitively triggered "motor seizures."
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- 2012
16. Bildgebung bei idiopathisch generalisierten Epilepsien
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Friedrich G. Woermann, Britta Wandschneider, Matthias J. Koepp, and Christian Vollmar
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Pediatrics, Perinatology and Child Health ,Neurology (clinical) - Abstract
Moderne bildgebende Verfahren bieten neue Moglichkeiten, die Pathomechanismen idopathisch generalisierter Epilepsien (IGE) zu ergrunden. Dieser Beitrag fasst aktuelle Studien mit strukturellen und funktionellen MRT-, MR-Spektroskopie und PET-Untersuchungen zusammen und verdeutlicht sie exemplarisch an einigen Studien. In den meisten Studien werden strukturelle und/oder funktionelle Veranderungen des Thalamus und frontaler Kortexegionen berichtet. Zusatzlich werden syndromspezifische Unterschiede beschrieben. Die Befunde lassen eine zugrunde liegende thalamofrontokortikale Netzwerkstorung bei IGE vermuten und sprechen gegen die traditionelle syndromatische Trennung in fokale und generalisierte Epilepsien.
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- 2012
17. Prospective memory in patients with juvenile myoclonic epilepsy and their healthy siblings
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Dieter Janz, Bettina Schmitz, Ute A. Kopp, U. Stephani, Gerd Kurlemann, Matthias Kliegel, and Britta Wandschneider
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Neuropsychological Tests ,Audiology ,Idiopathic generalized epilepsy ,Executive Function ,Young Adult ,Epilepsy ,Cognition ,Memory ,Prospective memory ,medicine ,Humans ,Genetic Predisposition to Disease ,Sibling ,Psychiatry ,Siblings ,Myoclonic Epilepsy, Juvenile ,Retention, Psychology ,Electroencephalography ,medicine.disease ,Executive functions ,Case-Control Studies ,Myoclonic epilepsy ,Female ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,Psychology - Abstract
Objective: Prospective memory (PM) describes the ability to fulfill previously planned intentions and is highly dependent on executive functions. Previous studies have shown deficits in executive functions in patients with juvenile myoclonic epilepsy (JME) and in their unaffected siblings. JME has a strong genetic predisposition and it is hypothesized that cognitive deficits are also genetically determined. The present study aimed at investigating potential differences in PM between patients with JME, their siblings, and healthy controls. Methods: Nineteen patients with JME, 21 siblings, and 21 healthy controls were examined with a complex PM paradigm allowing us to evaluate the different phases of PM (i.e., intention formation, intention retention, intention initiation, intention execution). Results: Patients with JME and siblings showed specific deficits during intention formation and intention execution of PM. Patients with JME were more impaired than both siblings and healthy controls. Correlation analysis revealed an influence of planning on prospective memory abilities in patients with JME. Conclusion: The results of this study support the hypothesis of frontal dysfunctions being part of the epileptic syndrome and therefore genetically determined. As in this study patients with JME are more severely cognitively impaired than their siblings, additional influencing factors, such as side effects of anticonvulsants or cognitive effects of subclinical epileptic discharges, might contribute to patients9 performance.
- Published
- 2010
18. Fehlbildungsrisiko bei Antiepileptika
- Author
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Bettina Schmitz, V. Gaus, and Britta Wandschneider
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Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Neurology (clinical) ,Family Practice ,business - Abstract
ZusammenfassungObwohl die meisten Schwangerschaften unter Antiepileptika komplikationslos verlaufen, ist eine In-utero-Exposition mit Antikonvulsiva mit einem erhöhten Fehlbildungsrisiko assoziiert. Um eine sinnvolle Abwägung des Fehlbildungsrisikos im Vergleich zu möglichen Anfallsrezidiven bei Umstellung oder Reduktion der Antiepileptika treffen zu können, sind in den letzten Jahren mehrere prospektive Schwangerschaftsregister geschaffen worden, die eine systematische und statistisch aussagekräftige Untersuchung des Fehlbildungsrisikos erlauben. Als Risikofaktoren erhöhter Teratogenität gelten in erster Linie die Polytherapie und die Therapie mit Valproat. Dabei ist der Valproateffekt dosisabhängig. Lamotrigin und Carbamazepin scheinen zu den günstigeren Präparaten zu zählen. Bezüglich eines spezifischen Fehlbildungsprofils der neuen Antiepileptika können bei kleinen Fallzahlen keine verlässlichen Aussagen getroffen werden. Zusätzlich wurde in den letzten Jahren der Verdacht einer negativen Auswirkung auf die neurokognitive Entwicklung insbesondere bei In-utero-Exposition mit Valproat diskutiert.
- Published
- 2010
19. Epilepsy in the elderly: restrictions, fears, and quality of life
- Author
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Britta Wandschneider, Felix Rosenow, N. Füratsch, J. Geithner, Hermann Stefan, Frank Kerling, Christian Brandt, Bettina Schmitz, Margarete Pfäfflin, Uwe Runge, R. Kretz, T. W. May, and H. Karakizlis
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Cross-sectional study ,Late onset ,Comorbidity ,Epilepsy ,Quality of life ,medicine ,Humans ,Young adult ,Psychiatry ,Aged ,Aged, 80 and over ,business.industry ,General Medicine ,Fear ,Middle Aged ,medicine.disease ,humanities ,Cross-Sectional Studies ,Neurology ,Tolerability ,Quality of Life ,Anticonvulsants ,Female ,Neurology (clinical) ,Age of onset ,business - Abstract
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Objectives: Due to demographic change and high incidence of epilepsy in elderly, the number of elderly with epilepsies is increasing. However, only few studies investigated the impact of epilepsy on quality of life (QoL). We investigated how epilepsy affects different aspects of QoL dependent on the age of the patients and the age of onset of epilepsy. Materials and methods: In a multicenter, cross-sectional study, three patient groups were recruited from five centers: Group A1: 45 elderly (≥65 years.) with late onset of epilepsy (≥65 years), group A2: 51 elderly (≥65 years.) with early-onset, long-lasting epilepsy (≤50 years), group B: 41 young adults (≤50 years) with epilepsy. Statistical analysis of differences between groups was performed using generalized linear models. Results: Elderly with late-onset epilepsy (group A1) had a significantly lower seizure frequency, were treated with less anti-epileptic drugs (AEDs), and reported a better tolerability of AED treatment, but had more comorbidities compared with groups A2 and B. After adjusting for seizure frequency, tolerability of AEDs and comorbidity, young adults (group B) reported the highest overall QoL, whereas patients of group A1 and A2 did not differ significantly. Epilepsy-related fears, especially fears of stigmatization, were significantly higher in elderly with long-lasting epilepsy compared with groups A1 and B. Conclusion: Seizure-related variables, tolerability of AEDs and comorbidity have a stronger impact on QoL and on restrictions due to epilepsy than age, age at onset of epilepsy or duration of epilepsy. However, some results indicate group-specific patterns of impairment and epilepsy-related fears.
- Published
- 2014
20. Consensus on diagnosis and management of JME: From founder's observations to current trends
- Author
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Pierre Thomas, Antonio Gambardella, Sanjay M. Sisodiya, Patrick Cossette, U. Stephani, Arielle Crespel, Ronald C. Reed, Ivanka Savic Berglund, Alfonso Represa, Bobby P.C. Koeleman, Vi-Huong Nguyen-Michel, Edoardo Ferlazzo, Matthias J. Koepp, Javier Salas-Puig, Ingo Helbig, Reyna M. Durón, Betül Baykan, Anna Serafini, Judith Jerney, Iris E. Martínez-Juárez, Michelle Bureau, Martha Feucht, Friedrich Woermann, Holger Lerche, P. Gelisse, Dieter Janz, Antonio V. Delgado-Escueta, Cardan Gurses, Guido Rubboli, Carol Camfield, Pasquale Striano, Dorothée G.A. Kasteleijn-Nolst Trenité, Michael Trimble, Britta Wandschneider, Russel Buono, P. Genton, Edouard Hirsch, Charlotte Dravet, Bettina Schmitz, Marco T. Medina, Michael Koutroumanidis, Kazuhiro Yamakawa, Bruce P. Hermann, Elza Márcia Targas Yacubian, and T. Grisar
- Subjects
medicine.medical_specialty ,Consensus ,business.industry ,International Cooperation ,Myoclonic Epilepsy, Juvenile ,Myoclonic Jerk ,Disease Management ,medicine.disease ,Idiopathic generalized epilepsy ,Behavioral Neuroscience ,Epilepsy ,Sleep deprivation ,Neurology ,medicine ,Humans ,Myoclonic epilepsy ,Neurology (clinical) ,Juvenile myoclonic epilepsy ,Age of onset ,EEG with generalized epileptiform discharges ,medicine.symptom ,business ,Psychiatry - Abstract
An international workshop on juvenile myoclonic epilepsy (JME) was conducted in Avignon, France in May 2011. During that workshop, a group of 45 experts on JME, together with one of the founding fathers of the syndrome of JME ("Janz syndrome"), Prof. Dr. Dieter Janz from Berlin, reached a consensus on diagnostic criteria and management of JME. The international experts on JME proposed two sets of criteria, which will be helpful for both clinical and scientific purposes. Class I criteria encompass myoclonic jerks without loss of consciousness exclusively occurring on or after awakening and associated with typical generalized epileptiform EEG abnormalities, with an age of onset between 10 and 25. Class II criteria allow the inclusion of myoclonic jerks predominantly occurring after awakening, generalized epileptiform EEG abnormalities with or without concomitant myoclonic jerks, and a greater time window for age at onset (6-25years). For both sets of criteria, patients should have a clear history of myoclonic jerks predominantly occurring after awakening and an EEG with generalized epileptiform discharges supporting a diagnosis of idiopathic generalized epilepsy. Patients with JME require special management because their epilepsy starts in the vulnerable period of adolescence and, accordingly, they have lifestyle issues that typically increase the likelihood of seizures (sleep deprivation, exposure to stroboscopic flashes in discos, alcohol intake, etc.) with poor adherence to antiepileptic drugs (AEDs). Results of an inventory of the different clinical management strategies are given. This article is part of a supplemental special issue entitled Juvenile Myoclonic Epilepsy: What is it Really?
- Published
- 2013
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