Treatment Of Temporal Lobe Epilepsy Research Articles

Neuromodulatory Focused Ultrasound for Epilepsy: Are Animal Models Useful?

Ultrasound neuromodulation is a potential alternative therapy for suppressing epileptic discharges. Recently, several human clinical trials have reported promising results from repeated focused ultrasound (FUS) treatments for temporal lobe epilepsy. In this Viewpoint, we highlight the valuable guidance of preclinical validation methods for choosing the optimal FUS parameters, thus ensuring consistency with the outcomes of clinical trials and leading human trials to the safest and most effective approaches.

Surgical treatment may improve depressive and hysterical traits in temporal lobe epilepsy with hippocampal sclerosis: Study using the Minnesota Multiphasic Personality Inventory

AbstractAimThe influence of surgeries on psychiatric symptoms and personality traits is not well known in patients with intractable temporal lobe epilepsy (TLE). We investigated changes in personality traits with respect to postoperative seizure outcomes, etiology, side of surgery, and sex differences.MethodsClinical information was retrospectively collected for 44 patients whose Minnesota Multiphasic Personality Inventory (MMPI) was examined before and 1 year after surgical treatment for drug‐resistant TLE. Postoperative changes in MMPI T‐scores were analyzed using a paired t‐test. Participants were divided into two groups based on postoperative seizure outcome, the presence or absence of hippocampal sclerosis (HS) as the etiology, side of surgery, and sex differences. The effect of these clinical factors on postoperative changes in MMPI T‐scores was evaluated using analysis of covariance (P‐values < 0.05).ResultsThe hypochondria (Hs) scale decreased significantly in all patients (p = 0.022). The postoperative seizure‐free group had a significant decrease in the depression (D) scale (p = 0.037). The HS group had significant decreases in the D scale and the hysteria (Hy) scale (p = 0.016 and 0.004, respectively), and a significant increase in the masculinity‐femininity (Mf) scale (p = 0.009). No significant differences existed between the sides of surgery or sex.ConclusionDepressive traits were improved in patients with postoperative seizure freedom. Depressive and hysterical traits were improved in patients with HS, which may be attributed to a reduction in anxiety and fear associated with aura. Most personality traits are not significantly changed or exacerbated by surgical treatment of TLE.

1130 Anatomical Features Predicting Outcome From Stereotactic Laser Amygdalohippocampotomy

INTRODUCTION: Stereotactic laser amygdalohippocampotomy (SLAH) is a novel procedure which is effective and safe for the treatment of temporal lobe epilepsy. Optimal operative ablation location and extent, however, is uncertain, as are the neuroanatomical features guiding successful ablations. METHODS: Patients treated with SLAH for MTS at Emory University between 2011 and 2019 (n = 65) were considered in this retrospective study. Post-procedure T1 MRI scans of patients were used to create manual segmentations of the ablation region of each patient. Ablations were assessed in relation to 1) whether they crossed the coronal plane of the lateral mesencephalic sulcus (LMS), 2) the extent to which the ablation extended posterior to the LMS, and 3) extent of ablation of the uncus. Wilcoxon ranked-sign test was performed for each variable between groups of patients with Engel score 1 versus Engel score 2-4. RESULTS: Distance of ablation past the LMS was not different between Engel class 1 (mean 6.32 ± 4.16 mm), and Engel class 2-4 (7.93 ± 3.75 mm) (p = 0.099). Ratio of ablations extending posterior to the LMS was 0.82 (SD = 0.39) in Engel 1, and 0.90 (SD = 0.30) in Engel 2-4 (p = 0.370). Volume of ablation showed little correlation with outcome, with average ablation of Engel 1 = 6064 ± 2128 mm3, Engel 2-4 = 5828 ± 3031 mm3, and no significant difference with Wilcoxon ranked-sign test (p = 0.239). Ablation of the uncus showed a strong association with better surgical outcome, with ratio of uncus ablation for Engel 1 at 0.71(SD = 0.31), and Engel 2-4 at 0.37 (SD = 0.36); p < 0.001). CONCLUSIONS: Larger ablation alone was not associated with better surgical outcomes. Ablation of the uncus was shown to result in better outcomes. Contrary to current practice, extension of SLAH ablation posterior to the lateral mesencephalic sulcus did not demonstrate improved post-operative outcomes.

Functional outcomes in MRI-guided laser interstitial therapy for temporal lobe epilepsy: a systematic review and meta-analysis.

The use of MRI-guided laser interstitial thermal therapy (MRgLITT) has emerged as a promising treatment option for patients with drug-resistant temporal lobe epilepsy (TLE). Although the minimally invasive approach holds promise as an effective treatment for achieving seizure freedom, a comprehensive review of its impact on functional outcomes is still warranted. To address this need, this review aims to summarize data pertaining to the functional and neurocognitive outcomes following MRgLITT for TLE. Four primary electronic databases were screened following PRISMA guidelines by two independent reviewers. All functional data related to cognitive, behavioral, and emotional outcomes were gathered and analyzed as well as the neuropsychological tests issued to assess pre- and postoperative outcomes. The functional outcomes assessed were grouped into the 5 most common categories: verbal cognition, visual cognition, cognitive emotion, visual deficits, and other higher-order cognitive functioning. A total of 4184 studies were screened and ultimately 408 patients from 14 studies were included for analysis. Changes in functional areas were assessed by comparing pre- and postoperative scores across a comprehensive set of 31 different functional and cognitive assessments, and were tabulated as the percentage of patients whose status improved, declined, or was maintained, where possible. In verbal (n = 112) and visual (n = 42) cognition, the rates of patients experiencing a decline were 20.4% and 13.5%, respectively, and the rates of improvement were 24.9% and 16.7%, respectively. Other functional outcomes assessed, including cognitive emotion (n = 150), visual deficits (n = 325), and higher-order cognitive processes like attention/processing (n = 19), motor cognition (n = 18), and general executive function (n = 4), exhibited varying rates of decline, ranging from 10.5% to 25%. MRgLITT is an effective and minimally invasive surgical alternative treatment for TLE, but there is an observable impact on patient functioning and cognitive status. This review demonstrates the need for standardized methods that can accurately capture and quantify the associated risk of MRgLITT to optimize its effect on patient quality of life moving forward.

Anti-seizure effects of JNJ-54175446 in the intra-amygdala kainic acid model of drug-resistant temporal lobe epilepsy in mice.

There remains a need for new drug targets for treatment-resistant temporal lobe epilepsy. The ATP-gated P2X7 receptor coordinates neuroinflammatory responses to tissue injury. Previous studies in mice reported that the P2X7 receptor antagonist JNJ-47965567 suppressed spontaneous seizures in the intraamygdala kainic acid model of epilepsy and reduced attendant gliosis in the hippocampus. The drug-resistance profile of this model is not fully characterised, however, and newer P2X7 receptor antagonists with superior pharmacokinetic profiles have recently entered clinical trials. Using telemetry-based continuous EEG recordings in mice, we demonstrate that spontaneous recurrent seizures in the intraamygdala kainic acid model are refractory to the common anti-seizure medicine levetiracetam. In contrast, once-daily dosing of JNJ-54175446 (30mg/kg, intraperitoneal) resulted in a significant reduction in spontaneous recurrent seizures which lasted several days after the end of drug administration. Using a combination of immunohistochemistry and ex vivo radiotracer assay, we find that JNJ-54175446-treated mice at the end of recordings display a reduction in astrogliosis and altered microglia process morphology within the ipsilateral CA3 subfield of the hippocampus, but no difference in P2X7 receptor surface expression. The present study extends the characterisation of the drug-resistance profile of the intraamygdala kainic acid model in mice and provides further evidence that targeting the P2X7 receptor may have therapeutic applications in the treatment of temporal lobe epilepsy.

Quantitative analysis of the optogenetic excitability of CA1 neurons.

Optogenetics has emerged as a promising technique for modulating neuronal activity and holds potential for the treatment of neurological disorders such as temporal lobe epilepsy (TLE). However, clinical translation still faces many challenges. This in-silico study aims to enhance the understanding of optogenetic excitability in CA1 cells and to identify strategies for improving stimulation protocols. Employing state-of-the-art computational models coupled with Monte Carlo simulated light propagation, the optogenetic excitability of four CA1 cells, two pyramidal and two interneurons, expressing ChR2(H134R) is investigated. The results demonstrate that confining the opsin to specific neuronal membrane compartments significantly improves excitability. An improvement is also achieved by focusing the light beam on the most excitable cell region. Moreover, the perpendicular orientation of the optical fiber relative to the somato-dendritic axis yields superior results. Inter-cell variability is observed, highlighting the importance of considering neuron degeneracy when designing optogenetic tools. Opsin confinement to the basal dendrites of the pyramidal cells renders the neuron the most excitable. A global sensitivity analysis identified opsin location and expression level as having the greatest impact on simulation outcomes. The error reduction of simulation outcome due to coupling of neuron modeling with light propagation is shown. The results promote spatial confinement and increased opsin expression levels as important improvement strategies. On the other hand, uncertainties in these parameters limit precise determination of the irradiance thresholds. This study provides valuable insights on optogenetic excitability of CA1 cells useful for the development of improved optogenetic stimulation protocols for, for instance, TLE treatment.

Surgical treatment of temporal lobe epilepsy: comparative results of selective amygdalohippocampectomy versus anterior temporal lobectomy from a referral center in Brazil.

Temporal lobe epilepsy (TLE) is a high prevalence neurological disorder. Surgery has emerged as a promising treatment. The objective of this work is to compare the surgical results of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) in a cohort of 132 patients. We performed a retrospective study of 146 patients operated for TLE from 2008 to 2019. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, SAH was performed and in right temporal lobe epilepsy, ATL was the approach of choice. The mean follow-up time after surgery was 57.2 months (12-137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% versus 31%) and a higher rate of satisfactory seizure control (88.6% versus 69.3%) p = 0,006, when compared with patients undergoing SAH. The literature is still controversial about seizure control concerning the technique used due to the lack of a robust methodology. Our data analysis identified the superiority of ATL over SAH in seizure outcomes. ATL may be the best option for adequately controlling seizures with minimal additional morbidity in countries with a cost limitation for extended propaedeutics.

Adult-born neurons in critical period maintain hippocampal seizures via local aberrant excitatory circuits

Temporal lobe epilepsy (TLE), one common type of medically refractory epilepsy, is accompanied with altered adult-born dentate granule cells (abDGCs). However, the causal role of abDGCs in recurrent seizures of TLE is not fully understood. Here, taking advantage of optogenetic and chemogenetic tools to selectively manipulate abDGCs in a reversible manner, combined with Ca2+ fiber photometry, trans-synaptic viral tracing, in vivo/vitro electrophysiology approaches, we aimed to test the role of abDGCs born at different period of epileptogenic insult in later recurrent seizures in mouse TLE models. We found that abDGCs were functionally inhibited during recurrent seizures. Optogenetic activation of abDGCs significantly extended, while inhibition curtailed, the seizure duration. This seizure-modulating effect was attributed to specific abDGCs born at a critical early phase after kindled status, which experienced specific type of circuit re-organization. Further, abDGCs extended seizure duration via local excitatory circuit with early-born granule cells (ebDGCs). Repeated modulation of “abDGC-ebDGC” circuit may easily induce a change of synaptic plasticity, and achieve long-term anti-seizure effects in both kindling and kainic acid-induced TLE models. Together, we demonstrate that abDGCs born at a critical period of epileptogenic insult maintain seizure duration via local aberrant excitatory circuits, and inactivation of these aberrant circuits can long-termly alleviate severity of seizures. This provides a deeper and more comprehensive understanding of the potential pathological changes of abDGCs circuit and may be helpful for the precise treatment in TLE.

Conduction treatment of temporal lobe epilepsy in rats: the dose-effect relationship between current resistance and therapeutic effect.

To investigate the effect of current resistance on therapeutic outcomes, and the mechanism of current conduction treatment in a rat model of temporal lobe epilepsy (TLE). Rats were randomly divided into four groups: normal control, epileptic group, low-resistance conduction (LRC) and high-resistance conduction (HRC) group. The content of glutamate (Glu) and gamma-amino butyric acid (GABA) in the hippocampus was determined using a neurotransmitter analyzer. mRNA and protein expression of interleukin 1β (IL-1β) /IL-1 receptor 1(IL-1R1) and high mobility group protein B1 (HMGB-1)/toll-like receptor-4 (TLR-4) in hippocampal neurons were tested. Video electroencephalogram monitoring was used to record seizures and EEG discharges. Cognitive function in the rats was tested using the Morris water maze. Glu/GABA ratio in the epileptic control and HRC groups was significant differences from LRC group. The levels of HMGB1/TLR4 and IL-1β/IL-1R1 in the LRC group and normal control group were significantly lower than those in epileptic control group (p < 0.01) and the HRC group. The mRNA levels of HMGB1/TLR4 and IL-1β/IL-1R1 in the LRC group and normal control group were significantly lower than those in epileptic control group. The frequency of total and propagated seizures was lower in the LRC group than in the epileptic control and HRC groups (p < 0.01). The numbers of platform crossings in the LRC group and normal control group were significantly higher than those in the epileptic control and HRC groups in the space exploration experiment. Current resistance affected seizure control and cognitive protection in rats with TLE treated by current conduction. The lower current resistance, the better seizure control and cognitive protection in rats with TLE treated by current conduction. Glu/GABA, IL-1β/IL-1R1, and HMGB1/TLR-4 may participate in the anti-seizure mechanism of current conduction treatment.

Preclinical Proof-of-concept of a Novel AAV9-microRNA based Targeting of GRIK2 for the Treatment of Temporal Lobe Epilepsy (S44.001)

<h3>Objective:</h3> The objective of this study was to determine if lowering the expression of the Glutamate Ionotropic Receptor Kainate Type Subunit 2 (GRIK2) using RNA interference can be a therapeutic strategy for temporal lobe epilepsy (TLE). <h3>Background:</h3> TLE is the most common form of focal epilepsy characterized by recurrent seizures generated in the hippocampus. Patients with TLE are often resistant to anti-seizure medications. Recurrent mossy fiber sprouting from dentate granule cells (DGCs) is a consistent anatomical hallmark of TLE leading to synaptic reorganization in an aberrant excitatory network. In TLE the DGCs operate via ectopic expression of GluK2/GluK5 receptors. GluK2/GluK5 plays a central role in the generation of seizure activity. <h3>Design/Methods:</h3> We created an AAV9-vector carrying two miRNAs under the control of a neuron-specific promotor targeting GRIK2 (AMT-260). The vector has been tested in a pilocarpine mouse model for TLE and assessed for safety in non-human primates (NHP). Additionally, hippocampal organotypic slices from TLE patients were treated with AMT-260. The efficacy of AMT-260 was measured in the mouse model using electroencephalogram (EEG) and behavior as readouts, and in hippocampal organotypic slices using electrophysiological recordings. The safety and biodistribution of AMT-260 was assessed in NHP after 1 month of treatment. <h3>Results:</h3> AMT-260 showed a dose-dependent decrease in electrical seizures and hyperlocomotion and improved health. A full biological effect was observed at 5.0E+09 vg per hippocampus. Organotypic slices from patients with TLE treated with AMT-260 showed a decrease in the number of electrical seizures. Convection enhanced, MRI guided intrahippocampal delivery in NHP resulted in local high copies of vector and miRNA expression with substantial knockdown of GRIK2, but with no adverse findings and limited peripheral exposure to the vector. <h3>Conclusions:</h3> AMT-260 shows an excellent preclinical and safety profile and will proceed into clinical testing to treat patients with refractory mesial temporal lobe epilepsy. <b>Disclosure:</b> Nick Pearson has nothing to disclose. Dr. Baudouin has received personal compensation for serving as an employee of Uniqure. Dr. Baudouin has stock in Uniqure. Dr. Wartel has received personal compensation for serving as an employee of uniQure biopharma B.V.. Dr. Wartel has stock in uniQure biopharma B.V.. Mr. Keskin has received personal compensation for serving as an employee of uniQure. Mr. Keskin has stock in uniQure. Mr. Keskin has a non-compensated relationship as a Technician with uniQure that is relevant to AAN interests or activities. Dr. Danos has received personal compensation for serving as an employee of REGENXBIO. Dr. Danos has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vor Bio. Dr. Danos has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Coave Therapeutics. Dr. Danos has stock in REGENXBIO. Dr. Danos has stock in Coave Therapeutics. Dr. Danos has stock in Rocket Therapeutics. Dr. Mulle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Corlieve Therapeutics. Dr. Mulle has stock in Corlieve Therapeutics. Mr. Partouche has nothing to disclose. Dr. CREPEL has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Corlieve Therapeutics. Dr. CREPEL has stock in Corlieve Therapeutics. The institution of Dr. CREPEL has received research support from Corlieve Therapeutics. Dr. CREPEL has received intellectual property interests from a discovery or technology relating to health care. Dr. Borta has received personal compensation for serving as an employee of uniQure. Dr. Borta has stock in uniQure. Dr. Porter has received personal compensation for serving as an employee of Uniqure. Dr. Porter has stock in uniqure. Dr. Porter has stock in roche.

Montelukast activates BK channels associated with the β4 accessory subunit and emerges as a pharmacological tool to reduce hippocampal excitability.

Different β accessory subunits are associated with the large conductance voltage- and Ca2+- dependent K+ channel (BK) in a tissue-specific manner. In particular, BK channel/β4 subunits complexes (α/β4) control neuronal excitability in granule cells of the hippocampal dentate gyrus (GCDG) and, β4 deficient mice display a temporal lobe epilepsy (TLE). Thus, compounds that increase α/β4 activity are of interest for improving epilepsy treatment. Then, based on the β-dependent activating effect of leukotrienes on BK channel, we explore the effect of Montelukast (MTK) on this channel heterologously expressed in HEK cells with or without its β accessory subunits (β1, β2, and β4). MTK is a CysLT1 receptor antagonist used as an anti-asthmatic drug that could share the affinity properties with the leukotrienes. Using the patch-clamp technique we found that MTK shifts the activation curves of α/β1 and α/β4 to more hyperpolarized voltages in a concentration-dependent manner (300 nM MTK: ΔV1/2 (α/β1)= −54.4 ± 8.4 mV; n=6; p<0.05 and ΔV1/2 (α/β4)= −36 ± 13.5 mV; n=5; p<0.05) without affecting α/β2 channel and, only at concentrations greater than 1 µM, slightly shifts the homomeric BK channel curve (ΔV1/2= −10.8 ± 3.7 mV; n=3; p<0.05). MTK delays α/β4 deactivation, suggesting an open channel stabilization (1 µM MTK (−60 mV): τMTK= 27.6 ± 3.7 ms vs. τcontrol= 2.0 ± 0.3 ms n= 5, p<0.05). Finally, as a promising result, we observed that 1 µM MTK decreases the number of action potential spikes induced by 140 pA injection in GCDG from mouse brain slices (58 ± 8%, n=3, p<0.05). Our results indicate that MTK directly activates the α/β4 channel and suggest that it could reduce GCDG excitability and may be a putative new treatment for TLE.

Transplantation of neurogenic-fusionogenic embryonic stem cells modified to overexpress GABA into a model of temporal lobe epilepsy: Promises and potential pitfalls.

Cell-based therapy is likely to become a clinically useful tool to treat severe neurological disease. Disease states such as intractable temporal lobe epilepsy will be candidates for this type of therapeutic approach. Embryonic stem cells are pluripotent, and are considered a viable source for cell replacement strategies. Embryonic stem cells can be genetically manipulated to express reporter molecules, and they can be forced into neural differentiation by controlling the expression of key transcription factors. One strategy for the treatment of temporal lobe epilepsy is to transplant enriched populations of transplantable GABAergic neurons into the damaged, epileptogenic, hippocampus. The goal would be to suppress seizures, and to replace and repair damaged circuits. We genetically engineered an embryonic stem cell -derived neurogenic, fusionogenic cell line with GAD65 and transplanted them into an animal model of temporal lobe epilepsy. We found some evidence of seizure suppression, and also evidence of widespread dispersion from the transplantation site. The pattern of staining of embryonic stem cell reporter molecule that was detected, suggested a pathotropism, and selective involvement of reportedly fusionogenic cell populations within the host. We feel that the evidence suggests that embryonic stem cell-derived neural cells might have a significant capacity to fuse with host neurons, which can cloud the interpretation of cellular replacement and circuit repair. This study, and other investigations that have reported stem cell fusion events in the transplanted host, reveal embryonic stem cell capacities that may not be fully appreciated. More research is needed to fully reveal the potential of cellular therapies using stem cells.

Identification of key potassium channel genes of temporal lobe epilepsy by bioinformatics analyses and experimental verification.

One of the most prevalent types of epilepsy is temporal lobe epilepsy (TLE), which has unknown etiological factors and drug resistance. The detailed mechanisms underlying potassium channels in human TLE have not yet been elucidated. Hence, this study aimed to mine potassium channel genes linked to TLE using a bioinformatic approach. The results found that Four key TLE-related potassium channel genes (TERKPCGs) were identified: potassium voltage-gated channel subfamily E member (KCNA) 1, KCNA2, potassium inwardly rectifying channel, subfamily J, member 11 (KCNJ11), and KCNS1. A protein-protein interaction (PPI) network was constructed to analyze the relationship between TERKPCGs and other key module genes. The results of gene set enrichment analysis (GSEA) for a single gene indicated that the four TERKPCGs were highly linked to the cation channel, potassium channel, respiratory chain, and oxidative phosphorylation. The mRNA-TF network was established using four mRNAs and 113 predicted transcription factors. A ceRNA network containing seven miRNAs, two mRNAs, and 244 lncRNAs was constructed based on the TERKPCGs. Three common small-molecule drugs (enflurane, promethazine, and miconazole) target KCNA1, KCNA2, and KCNS1. Ten small-molecule drugs (glimepiride, diazoxide, levosimendan, and thiamylal et al.) were retrieved for KCNJ11. Compared to normal mice, the expression of KCNA1, KCNA2, KCNJ11, and KCNS1 was downregulated in the brain tissue of the epilepsy mouse model at both the transcriptional and translational levels, which was consistent with the trend of human data from the public database. The results indicated that key potassium channel genes linked to TLE were identified based on bioinformatics analysis to investigate the potential significance of potassium channel genes in the development and treatment of TLE.

Hierarchical particle optimization for cortical shape correspondence in temporal lobe resection

BackgroundAnterior temporal lobe resection is an effective treatment for temporal lobe epilepsy. The post-surgical structural changes could influence the follow-up treatment. Capturing post-surgical changes necessitates a well-established cortical shape correspondence between pre- and post-surgical surfaces. Yet, most cortical surface registration methods are designed for normal neuroanatomy. Surgical changes can introduce wide ranging artifacts in correspondence, for which conventional surface registration methods may not work as intended. MethodsIn this paper, we propose a novel particle method for one-to-one dense shape correspondence between pre- and post-surgical surfaces with temporal lobe resection. The proposed method can handle partial structural abnormality involving non-rigid changes. Unlike existing particle methods using implicit particle adjacency, we consider explicit particle adjacency to establish a smooth correspondence. Moreover, we propose hierarchical optimization of particles rather than full optimization of all particles at once to avoid trappings of locally optimal particle update. ResultsWe evaluate the proposed method on 25 pairs of T1-MRI with pre- and post-simulated resection on the anterior temporal lobe and 25 pairs of patients with actual resection. We show improved accuracy over several cortical regions in terms of ROI boundary Hausdorff distance with 4.29 mm and Dice similarity coefficients with average value 0.841, compared to existing surface registration methods on simulated data. In 25 patients with actual resection of the anterior temporal lobe, our method shows an improved shape correspondence in qualitative and quantitative evaluation on parcellation-off ratio with average value 0.061 and cortical thickness changes. We also show better smoothness of the correspondence without self-intersection, compared with point-wise matching methods which show various degrees of self-intersection. ConclusionThe proposed method establishes a promising one-to-one dense shape correspondence for temporal lobe resection. The resulting correspondence is smooth without self-intersection. The proposed hierarchical optimization strategy could accelerate optimization and improve the optimization accuracy. According to the results on the paired surfaces with temporal lobe resection, the proposed method outperforms the compared methods and is more reliable to capture cortical thickness changes.

Exoscope improves visualization and extent of hippocampal resection in temporal lobectomy.

Anterior temporal lobectomy (ATL) is a safe and well-validated procedure in the treatment of temporal lobe epilepsy (TLE), but is a challenging technique to master and still confers a risk of morbidity and mortality due to the complex anatomy of the mesial temporal lobe structures. Automated robotic 3D exoscopes have been developed to address limitations traditionally associated with microscopic visualization, allowing for ergonomic, high-definition 3D visualization with hands-free control of the robot. Given the potential advantages of using such a system for visualization of complex anatomy seen during mesial structure resection in ATL, this group sought to investigate impact on the percentage of hippocampal resection in both exoscope and microscope guided procedures. We conducted a retrospective analysis of 20 consecutive patients undergoing standard ATL for treatment of medically refractory TLE at our institution. Using pre-operative and post-operative imaging, the coronal plane cuts in which either the head, body, or tail of the hippocampus appeared were counted. The number of cuts in which the hippocampus appeared were multiplied by slice thickness to estimate hippocampal length. Mean percentage of hippocampal resection was 61.1 (SD 13.1) and 76.5 (SD 6.5) for microscope and exoscope visualization, respectively (p = 0.0037). Use of exoscope for mesial resection during ATL has provided good visualization for those in the operating room and the potential for a safe increase in hippocampal resection in our series. Further investigation of its applications should be evaluated to see if it will improve outcomes.

Understanding the problems with recruitment in surgical randomized trials: A lesson from landmark trials on temporal lobe epilepsy

BackgroundSurgical randomized trials are difficult to accomplish. One major problem is recruitment of a sufficient number of patients to address the clinical problem. MethodsWe review the various ways patient recruitment in surgical RCTs can be promoted. We examine two landmark trials on the surgical treatment of temporal lobe epilepsy (TLE), one that was successful, and one which did not attain the target number of participants. DiscussionBoth designs of the Canadian and American trials of surgery for TLE included a benefit to participants: the Canadian trial gave a chance to have immediate access to investigation and treatment, as compared to a 1 year delay (considered ‘standard care’ in that center), while the American trial offered free surgical management to both arms. Patients were recruited and treatments randomly allocated prior to knowing for certain whether they were surgical candidates or not. This design choice may have helped circumvent the ‘equipoise problem’. The Canadian trial offered participation to drug-resistant patients that were already routinely referred to surgical centers, while the success of the American trial which limited recruitment to the early period of drug resistance was dependent on a change of practice of referring clinicians which did not materialize. ConclusionThe surgical treatment of drug-resistant temporal lobe epilepsy has been validated using RCT methods. Ways to promote participation in surgical trials should be further investigated.

Pathway-specific inhibition of critical projections from the mediodorsal thalamus to the frontal cortex controls kindled seizures.

There is a large unmet need for improved treatment for temporal lobe epilepsy (TLE); circuit-specific manipulation that disrupts the initiation and propagation of seizures is promising in this regard. The midline thalamus, including the mediodorsal nucleus (MD) is a critical distributor of seizure activity, but its afferent and efferent pathways that mediate seizure activity are unknown. Here, we used chemogenetics to silence input and output projections of the MD to discrete regions of the frontal cortex in the kindling model of TLE in rats. Chemogenetic inhibition of the projection from the amygdala to the MD abolished seizures, an effect that was replicated using optogenetic inhibition. Chemogenetic inhibition of projections from the MD to the prelimbic cortex likewise abolished seizures. By contrast, inhibition of projections from the MD to other frontal regions produced partial (orbitofrontal cortex, infralimbic cortex) or no (cingulate, insular cortex) attenuation of behavioral or electrographic seizure activity. These results highlight the particular importance of projections from MD to prelimbic cortex in the propagation of amygdala-kindled seizures.

Evidence supporting deep brain stimulation of the medial septum in the treatment of temporal lobe epilepsy.

Electrical brain stimulation has become an essential treatment option for more than one third of epilepsy patients who are resistant to pharmacological therapy and are not candidates for surgical resection. However, currently approved stimulation paradigms achieve only moderate success, on average providing approximately 75% reduction in seizure frequency and extended periods of seizure freedom in nearly 20% of patients. Outcomes from electrical stimulation may be improved through the identification of novel anatomical targets, particularly those with significant anatomical and functional connectivity to the epileptogenic zone. Multiple studies have investigated the medial septal nucleus (i.e., medial septum) as such a target for the treatment of mesial temporal lobe epilepsy. The medial septum is a small midline nucleus that provides a critical functional role in modulating the hippocampal theta rhythm, a 4-7-Hz electrophysiological oscillation mechanistically associated with memory and higher order cognition in both rodents and humans. Elevated theta oscillations are thought to represent a seizure-resistant network activity state, suggesting that electrical neuromodulation of the medial septum and restoration of theta-rhythmic physiology may not only reduce seizure frequency, but also restore cognitive comorbidities associated with mesial temporal lobe epilepsy. Here, we review the anatomical and physiological function of the septohippocampal network, evidence for seizure-resistant effects of the theta rhythm, and the results of stimulation experiments across both rodent and human studies, to argue that deep brain stimulation of the medial septum holds potential to provide an effective neuromodulation treatment for mesial temporal lobe epilepsy. We conclude by discussing the considerations necessary for further evaluating this treatment paradigm with a clinical trial.

Adjustable shunt-current intensity circuit and system for current conduction treatment of epilepsy

In this paper, we developed a shunt-current intensity self-adjustable closed-loop control circuit system for current conduction treatment in temporal lobe epilepsy. To examine the dose-response relationship between conductive intensity and therapeutic outcomes of current conduction treatment, the control system consists of neural signal recording module for high-speed data rate acquisition, signal amplification and pre-processing, current shunt module for current conduction, data transmission and control module for real-time data communication with the personal computer and on-off of current conduction. Multithread and queue software architecture was implemented to ensure real-time data transmission, display and analysis by LabVIEW software. Results indicate that the input noise of the system is less than 2 [Formula: see text]Vrms, signal frequency bandwidth range is 1 Hz[Formula: see text]10 kHz, and the shunt-current detection range is 0.1–3000 [Formula: see text]A with the accuracy of above 99.985%, meeting the requirements for the detection of neural electrophysiological signal and the research on the dose-response relationship between conductive intensity and therapeutic outcomes of electronic conduction treatment.

Anti-Epileptic Effect of Crocin on Experimental Temporal Lobe Epilepsy in Mice.

Temporal lobe epilepsy (TLE) is a common kind of refractory epilepsy. More than 30% TLE patients were multi-drug resistant. Some patients may even develop into status epilepticus (SE) because of failing to control seizures. Thus, one of the avid goals for anti-epileptic drug development is to discover novel potential compounds to treat TLE or even SE. Crocin, an effective component of Crocus sativus L., has been applied in several epileptogenic models to test its anti-epileptic effect. However, it is still controversial and its effect on TLE remains unclear. Therefore, we investigated the effects of crocin on epileptogenesis, generalized seizures (GS) in hippocampal rapid electrical kindling model as well as SE and spotaneous recurrent seizure (SRS) in pilocarpine-induced TLE model in ICR mice in this study. The results showed that seizure stages and cumulative afterdischarge duration were significantly depressed by crocin (20 and 50 mg/kg) during hippocampal rapid kindling acquisition. And crocin (100 mg/kg) significantly reduced the incidence of GS and average seizure stages in fully kindled animals. In pilocarpine-induced TLE model, the latency of SE was significantly prolonged and the mortality of SE was significantly decreased by crocin (100 mg/kg), which can also significantly suppress the number of SRS. The underlying mechanism of crocin may be involved in the protection of neurons, the decrease of tumor necrosis factor-α in the hippocampus and the increase of brain derived neurotrophic factor in the cortex. In conclusion, crocin may be a potential and promising anti-epileptic compound for treatment of TLE.