Publications by authors named "Chien-Chen Chou"

21 Publications

  • Page 1 of 1

Acute withdrawal of new-generation antiepileptic drugs in epilepsy monitoring units: Safety and efficacy.

Epilepsy Behav 2021 04 21;117:107846. Epub 2021 Feb 21.

Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.

Introduction: Acute withdrawal of antiepileptic drugs (AEDs) is a safe and effective approach to provoking seizures in order to complete video-electroencephalogram (V-EEG) studies in a timely manner. Previous studies have focused only on withdrawal from conventional AEDs, and the effects of withdrawal from new-generation AEDs have not been extensively studied.

Materials And Methods: This study examined adult patients with drug-resistant epilepsy admitted to an epilepsy monitoring unit between 2015 and 2018. Patients were classified according to whether they received conventional AEDs (Con; n = 13) or new-generation AEDs (N-Gen; n = 26). We then compared the effects of withdrawing these two types of AEDs over a period of one week in terms of efficacy (time to complete V-EEG monitoring) and safety, including the incidence of cluster seizures (CS), focal to bilateral tonic-clonic seizures (FBTCS) and status epilepticus (SE).

Results: In both groups, approximately one week was required to complete V-EEG analysis: N-Gen group (5.6 days) and Con group (6.3 days). No differences were observed between the two groups in terms of the median number of seizures, the onset of the 1st seizure, the distribution of CS, FBTCS, or SE. Following acute withdrawal of medication, a high percentage of patients with a history of CS or FBTCS, respectively, presented CS or FBTCS.

Conclusions: We did not observe significant differences between patients taking new-generation AEDs and those taking conventional AEDs following withdrawal during V-EEG recording. In the current study, we employed a standard protocol for the rapid withdrawal of AEDs (daily dose reduction of 50%), which was sufficient for 80% of patients to complete V-EEG monitoring within one week.
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http://dx.doi.org/10.1016/j.yebeh.2021.107846DOI Listing
April 2021

Outcomes of hippocampus-sparing lesionectomy for temporal lobe epilepsy and the significance of intraoperative hippocampography.

Clin Neurophysiol 2021 Mar 31;132(3):746-755. Epub 2020 Dec 31.

Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan.

Objectives: We investigated hippocampal-sparing lesionectomy (HSL) outcomes in temporal lobe epilepsy (TLE) and the significance of high-frequency oscillations (HFOs) detected by hippocampography in HSL.

Methods: We retrospectively reviewed data from patients who underwent HSL for lesional TLE. Patients were included when MRI confirmed (i) a lesion limited to the temporal lobe with normal hippocampi preoperatively and (ii) hippocampal integrity postoperatively. Factors possibly related to outcomes were collected. Intraoperative hippocampography was reviewed, and spikes, ripples, and fast ripples were marked. Seizure outcomes were tracked ≥ 2 years. Postoperative neuropsychological tests were performed and analyzed.

Results: We included 67 patients (35 males/32 females, median age at surgery 28 years, 57 seizure-free). Complete resection was significantly associated with being seizure-free without aura, an outcome achieved by 32 (69.6%) patients with complete resection vs 1 (12.5%) with incomplete resection (p = 0.004). Spikes/ripples/fast ripples appeared frequently in the hippocampus, occurring in 86.4%/82.4%/75.0% of cases before resection and 76.7%/78.1%/63.0% after resection. The presence and rate were unconnected to seizure outcome. Postoperative neuropsychological outcomes in intelligence and visual memory improved overall.

Conclusions: HSL in lesional TLE can produce satisfactory seizure and cognitive outcomes. Intraoperative hippocampography-guided resection of apparently normal hippocampi should be performed cautiously and might not be necessary.

Significance: This study provided evidence in decision making for patients with lesional TLE with a radiologically normal hippocampus.
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http://dx.doi.org/10.1016/j.clinph.2020.12.008DOI Listing
March 2021

Distributed source modeling of intracranial stereoelectro-encephalographic measurements.

Neuroimage 2021 04 14;230:117746. Epub 2021 Jan 14.

Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan; Brain Research Center, National Yang Ming University, Taipei, Taiwan. Electronic address:

Intracranial stereoelectroencephalography (sEEG) provides unsurpassed sensitivity and specificity for human neurophysiology. However, functional mapping of brain functions has been limited because the implantations have sparse coverage and differ greatly across individuals. Here, we developed a distributed, anatomically realistic sEEG source-modeling approach for within- and between-subject analyses. In addition to intracranial event-related potentials (iERP), we estimated the sources of high broadband gamma activity (HBBG), a putative correlate of local neural firing. Our novel approach accounted for a significant portion of the variance of the sEEG measurements in leave-one-out cross-validation. After logarithmic transformations, the sensitivity and signal-to-noise ratio were linearly inversely related to the minimal distance between the brain location and electrode contacts (slope≈-3.6). The signa-to-noise ratio and sensitivity in the thalamus and brain stem were comparable to those locations at the vicinity of electrode contact implantation. The HGGB source estimates were remarkably consistent with analyses of intracranial-contact data. In conclusion, distributed sEEG source modeling provides a powerful neuroimaging tool, which facilitates anatomically-normalized functional mapping of human brain using both iERP and HBBG data.
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http://dx.doi.org/10.1016/j.neuroimage.2021.117746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044004PMC
April 2021

Reliability and validity of the Taiwanese version of the Neurological Disorders Depression Inventory for Epilepsy (Tw-NDDI-E).

Seizure 2020 Oct 28;81:53-57. Epub 2020 Jul 28.

Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Brain Research Centre, National Yang-Ming University, Taipei, Taiwan. Electronic address:

Introduction: Depression is the most commonly seen psychiatric co-morbidity of epilepsy. Depression in patients with epilepsy (PWE) is underrecognized. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a useful tool to screen for major depressive episodes (MDEs) in PWE. This study validated the Taiwanese version of the NDDI-E using data from adult PWE in our hospital.

Method: PWE were recruited from the Taipei Veterans General Hospital from April 2017 to December 2019. The Chinese version of the NDDI-E for the Taiwanese population and the Beck Depression Inventory-II (BDI-II) were completed as part of the self-rated psychiatric assessments. The mood disorder module of the Mini International Neuropsychiatric Interview (MINI) was completed as part of the psychiatric assessment before the self-rated assessment. Internal consistency, external validation, and receiver operator characteristic (ROC) curve analysis were used to assess the utility of the Taiwanese version of the NDDI-E.

Results: We recruited 109 patients during the 33-month study period. The mean age was 33.1 ± 8.94 years old. The mean NDDI-E score was 12.32 ± 4.96. The mean BDI-II score was 13.26 ± 12.77. All NDDI-E items were significantly positively associated with the corrected overall NDDI-E score (Cronbach's alpha = 0.902, r = 0.825, p < 0.0001). The cut-off point for the NDDI-E determined with receiver operating characteristic (ROC) curve analysis is 15 (sensitivity = 85.0%, specificity = 87.64%).

Conclusion: The Chinese version of the NDDI-E adapted for the Taiwanese population is a reliable and valid self-reported questionnaire for detecting MDE in Taiwanese PWE.
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http://dx.doi.org/10.1016/j.seizure.2020.07.025DOI Listing
October 2020

Cingulate gyrus epilepsy: semiology, invasive EEG, and surgical approaches.

Neurosurg Focus 2020 04;48(4):E8

1School of Medicine and.

Objective: The semiology of cingulate gyrus epilepsy is varied and may involve the paracentral area, the adjacent limbic system, and/or the orbitofrontal gyrus. Invasive electroencephalography (iEEG) recording is usually required for patients with deeply located epileptogenic foci. This paper reports on the authors' experiences in the diagnosis and surgical treatment of patients with focal epilepsy originating in the cingulate gyrus.

Methods: Eighteen patients (median age 24 years, range 5-53 years) with a mean seizure history of 23 years (range 2-32 years) were analyzed retrospectively. The results of presurgical evaluation, surgical strategy, and postoperative pathology are reported, as well as follow-up concerning functional morbidity and seizures (median follow-up 7 years, range 2-12 years).

Results: Patients with cingulate gyrus epilepsy presented with a variety of semiologies and scalp EEG patterns. Prior to ictal onset, 11 (61%) of the patients presented with aura. Initial ictal symptoms included limb posturing in 12 (67%), vocalization in 5, and hypermotor movement in 4. In most patients (n = 16, 89%), ictal EEG presented as widespread patterns with bilateral hemispheric origin, as well as muscle artifacts obscuring the onset of EEG during the ictal period in 11 patients. Among the 18 patients who underwent resection, the pathology revealed mild malformation of cortical development in 2, focal cortical dysplasia (FCD) Ib in 4, FCD IIa in 4, FCD IIb in 4, astrocytoma in 1, ganglioglioma in 1, and gliosis in 2. The seizure outcome after surgery was satisfactory: Engel class IA in 12 patients, IIB in 3, IIIA in 1, IIIB in 1, and IVB in 1 at the 2-year follow-up.

Conclusions: In this study, the authors exploited the improved access to the cingulate epileptogenic network made possible by the use of 3D electrodes implanted using stereoelectroencephalography methodology. Under iEEG recording and intraoperative neuromonitoring, epilepsy surgery on lesions in the cingulate gyrus can result in good outcomes in terms of seizure recurrence and the incidence of postoperative permanent deficits.
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http://dx.doi.org/10.3171/2020.1.FOCUS19914DOI Listing
April 2020

Social functioning and health-related quality of life trajectories in people with epilepsy after epilepsy surgery.

Epilepsy Behav 2020 02 27;103(Pt A):106849. Epub 2019 Dec 27.

Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Objective: An improvement in quality of life (QoL) over time after epilepsy surgery has been demonstrated in people with epilepsy; however, social functioning has been less investigated. We conducted this study to examine whether postsurgical improvement is parallel between QoL and social functioning in patients with epilepsy.

Methods: We retrospectively reviewed patients who underwent epilepsy surgery. All participants completed a comprehensive neuropsychological assessment, the Quality of Life in Epilepsy Inventory (QOLIE-89) questionnaire, and the Social and Occupational Functioning Scale for Epilepsy (SOFSE) before surgery and at 3 months, 6 months, and 1 year after surgery. Demographic and epilepsy-related information was also collected. Generalized estimating equations with identity links were used to model the QOLIE-89 and SOFSE over time and possible associated factors. A p < 0.05 was considered statistically significant.

Results: A total of 76 patients, including 36 males and 43 females aged 18 to 62 years were collected. Both total QOLIE-89 and overall SOFSE improved over time after epilepsy surgery (adjusted p value < 0.001 and 0.002, respectively, with Bonferroni's correction). Total QOLIE-89 improved 3 months after surgery, while overall SOFSE showed no significant improvement until 6 months after surgery. The presurgical Full-Scale Intelligence Quotient (FSIQ) of the Wechsler Adult Intelligence Scale-III and years of education were significantly associated with time-dependent improvement for both total QOLIE-89 and overall SOFSE (p value < 0.001). At one year after surgery, overall SOFSE and total QOLIE-89 scores were significantly higher in the seizure-free group than in the nonseizure-free group (p value = 0.040 and 0.032, respectively).

Conclusion: Social functioning significantly improved in people with epilepsy after surgery as QoL, but it took more time to exhibit improvement. People with better FSIQ and more years of education had better improvement in social functioning over time. The early intervention of rehabilitation programs after epilepsy surgery might be necessary to facilitate the improvement in social functioning.
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http://dx.doi.org/10.1016/j.yebeh.2019.106849DOI Listing
February 2020

Gamma Knife radiosurgery for cerebral cavernous malformation.

Sci Rep 2019 12 24;9(1):19743. Epub 2019 Dec 24.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

This is a retrospective study examining the efficacy and safety of Gamma Knife radiosurgery (GKS) in treating patients with cerebral cavernous malformations (CCMs). Between 1993 and 2018, 261 patients with 331 symptomatic CCMs were treated by GKS. The median age was 39.9 years and females were predominant (54%). The median volume of CCMs was 3.1 mL. The median margin dose was 11.9 Gy treat to a median isodose level of 59%. Median clinical and imaging follow-up times were 69 and 61 months, respectively. After the initial hemorrhage that led to CCM diagnosis, 136 hemorrhages occurred in the period prior to GKS (annual incidence = 23.6%). After GKS, 15 symptomatic hemorrhages occurred within the first 2 years of follow-up (annual incidence = 3.22%), and 37 symptomatic hemorrhages occurred after the first 2 years of follow-up (annual incidence = 3.16%). Symptomatic radiation-induced complication was encountered in 8 patients (3.1%). Mortality related to GKS occurred in 1 patient (0.4%). In conclusion, GKS decreased the risk of hemorrhage in CCM patients presenting with symptomatic hemorrhage. GKS is a viable alternative treatment option for patients with surgically-inaccessible CCMs or significant medical comorbidities.
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http://dx.doi.org/10.1038/s41598-019-56119-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930272PMC
December 2019

Modulation of Motor Cortical Activities by Action Observation and Execution in Patients with Stroke: An MEG Study.

Neural Plast 2019 30;2019:8481371. Epub 2019 Oct 30.

Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Action observation therapy has recently attracted increasing attention; however, the mechanisms through which action observation and execution (AOE) modulate neural activity in stroke patients remain unclear. This study was aimed at investigating the effects of action observation and two types of AOE on motor cortical activations after stroke using magnetoencephalography. Twenty patients with stroke and 20 healthy controls were recruited for the collection of data on the beta oscillatory activity in the primary motor cortex (M1). All participants performed the conditions of resting, observation only, and video observation combined with execution (video AOE). Stroke patients performed one additional condition of affected hand observation combined with execution (affected hand AOE). The relative change index of beta oscillations was calculated, and nonparametric tests were used to examine the differences in conditions. In stroke patients, the relative change index of M1 beta oscillatory activity under the video AOE condition was significantly lower than that under the observation only and affected hand AOE conditions. Moreover, M1 cortical activity did not significantly differ under the observation only and affected hand AOE conditions. For healthy controls, the relative change index under the video AOE condition was significantly lower than that under the observation only condition. In addition, no significant differences in relative change indices were found under the observation only and video AOE conditions between the 2 groups. This study provides new insight into the neural mechanisms underlying AOE, which supports the use of observing videos of normal movements during action observation therapy in stroke rehabilitation.
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http://dx.doi.org/10.1155/2019/8481371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875039PMC
July 2020

Procedure-Related Temporal Infarct After Retractorless Transsylvian Selective Amygdalohippocampectomy and Impact on 2-Year Epilepsy Outcome.

Oper Neurosurg (Hagerstown) 2020 04;18(4):430-437

Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Background: Selective amygdalohippocampectomy (SAH) is designed to treat patients with mesial temporal lobe epilepsy (MTLE).

Objective: To determine the volume and impact of temporal lobe infarction after retractorless transsylvian SAH (en bloc resection of the hippocampus) that have not been reported.

Methods: A retrospective analysis of patients treated with retractorless transsylvian SAH. Infarctions were detected by magnetic resonance imaging (MRI) within the first week after the operation. Neuropsychological testing was performed preoperatively and 6 mo later. Seizure outcome was evaluated 2 yr after epilepsy surgery.

Results: Between 2010 and 2014, a total of 30 patients were included in this study. Analysis of postoperative MRI showed the following: (1) mean removal volume of the hippocampus-parahippocampus was 5.72 cm3, and (2) mean volumes of temporal and insular infarctions were 1.71 and 0.25 cm3, respectively. Twenty-five patients (83.3%) were free of disabling seizures (Engel class I) at 2 yr of outcome. Neuropsychological testing revealed improvement in Perceptual Organization Index (P = .036) and verbal paired associates II (P = .014) after the operation. Neither infarction volume nor removal volume was related to epilepsy outcome in linear regression model.

Conclusion: Transsylvian SAH has comparable seizure outcomes but bears inherent risks of vasospasm/vascular injury. Immediate postoperative small infarction volume around resection cavity or along surgical corridor was noticed after retractorless transsylvian SAH, which did not cause neuropsychological deteriorations, in contrast to previous study with the use of self-sustaining rigid retraction system. Further study should be performed to compare procedure-related infarctions and their impacts on neuropsychological outcomes in different selective approaches.
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http://dx.doi.org/10.1093/ons/opz192DOI Listing
April 2020

Ictal networks of temporal lobe epilepsy: views from high-frequency oscillations in stereoelectroencephalography.

J Neurosurg 2018 Nov 1:1-9. Epub 2018 Nov 1.

4Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and.

OBJECTIVEIn this study, the authors investigated high-frequency oscillation (HFO) networks during seizures in order to determine how HFOs spread from the focal cerebral cortex and become synchronized across various areas of the brain.METHODSAll data were obtained from stereoelectroencephalography (SEEG) signals in patients with drug-resistant temporal lobe epilepsy (TLE). The authors calculated intercontact cross-coefficients between all pairs of contacts to construct HFO networks in 20 seizures that occurred in 5 patients. They then calculated HFO network topology metrics (i.e., network density and component size) after normalizing seizure duration data by dividing each seizure into 10 intervals of equal length (labeled I1-I10).RESULTSFrom the perspective of the dynamic topologies of cortical and subcortical HFO networks, the authors observed a significant increase in network density during intervals I5-I10. A significant increase was also observed in overall energy during intervals I3-I8. The results of subnetwork analysis revealed that the number of components continuously decreased following the onset of seizures, and those results were statistically significant during intervals I3-I10. Furthermore, the majority of nodes were connected to a single dominant component during the propagation of seizures, and the percentage of nodes within the largest component grew significantly until seizure termination.CONCLUSIONSThe consistent topological changes that the authors observed suggest that TLE is affected by common epileptogenic patterns. Indeed, the findings help to elucidate the epileptogenic network that characterizes TLE, which may be of interest to researchers and physicians working to improve treatment modalities for epilepsy, including resection, cortical stimulation, and neuromodulation treatments that are responsive to network topologies.
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http://dx.doi.org/10.3171/2018.6.JNS172844DOI Listing
November 2018

Aberrant Sensory Gating of the Primary Somatosensory Cortex Contributes to the Motor Circuit Dysfunction in Paroxysmal Kinesigenic Dyskinesia.

Front Neurol 2018 15;9:831. Epub 2018 Oct 15.

Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.

Paroxysmal kinesigenic dyskinesia (PKD) is conventionally regarded as a movement disorder (MD) and characterized by episodic hyperkinesia by sudden movements. However, patients of PKD often have sensory aura and respond excellently to antiepileptic agents. mutations, the most common genetic etiology of PKD, could cause epilepsy syndromes as well. Standing in the twilight zone between MDs and epilepsy, the pathogenesis of PKD is unclear. Gamma oscillations arise from the inhibitory interneurons which are crucial in the thalamocortical circuits. The role of synchronized gamma oscillations in sensory gating is an important mechanism of automatic cortical inhibition. The patterns of gamma oscillations have been used to characterize neurophysiological features of many neurological diseases, including epilepsy and MDs. This study was aimed to investigate the features of gamma synchronizations in PKD. In the paired-pulse electrical-stimulation task, we recorded the magnetoencephalographic data with distributed source modeling and time-frequency analysis in 19 patients of newly-diagnosed PKD without receiving pharmacotherapy and 18 healthy controls. In combination with the magnetic resonance imaging, the source of gamma oscillations was localized in the primary somatosensory cortex. Somatosensory evoked fields of PKD patients had a reduced peak frequency ( < 0.001 for the first and the second response) and a prolonged peak latency (the first response = 0.02, the second response = 0.002), indicating the synchronization of gamma oscillation is significantly attenuated. The power ratio between two responses was much higher in the PKD group ( = 0.013), indicating the incompetence of activity suppression. Aberrant gamma synchronizations revealed the defective sensory gating of the somatosensory area contributes the pathogenesis of PKD. Our findings documented disinhibited cortical function is a pathomechanism common to PKD and epilepsy, thus rationalized the clinical overlaps of these two diseases and the therapeutic effect of antiepileptic agents for PKD. There is a greater reduction of the peak gamma frequency in -related PKD than the non- PKD group ( = 0.028 for the first response, = 0.004 for the second response). Loss-of-function mutations could lead to synaptic dysfunction. The disinhibiton change on neurophysiology reflected the impacts of mutations on human neurophysiology.
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http://dx.doi.org/10.3389/fneur.2018.00831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198142PMC
October 2018

Lumbar Dorsal Root Ganglion Block as a Prognostic Tool Before Pulsed Radiofrequency: A Randomized, Prospective, and Comparative Study on Cost-Effectiveness.

World Neurosurg 2018 Apr 6;112:e157-e164. Epub 2018 Jan 6.

Institute of Brain Research, National Yang-Ming University, Taipei, Taiwan; Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan. Electronic address:

Objectives: In the study, we discuss the predictive value and cost-effectiveness of dorsal root ganglion (DRG) blocks before using dorsal root ganglion pulsed radiofrequency (DRG-PRF) in the treatment of low back pain.

Methods: The study comprised 60 patients with low back pain who were randomly assigned into 2 groups. Patients in group 1 were screened using DRG block before DRG-PRF treatment for responders. Patients in group 2 underwent DRG-PRF treatment without DRG block. Successful outcome was defined as patient satisfaction, improvement in numerical rating scale, and medication use reduction.

Results: In group 1 (n = 30), 24 patients demonstrated good response to DRG block, and 20 patients had successful outcome at 6 months after DRG-PRF therapy. In group 2 (n = 30), 25 of the patients had successful outcome at 6 months after DRG-PRF therapy. The mean medical costs were NT$ 19,245 and NT$ 16,375 for each successful case in groups 1 and 2, respectively.

Conclusions: In this comparative cost-effectiveness study, the application of diagnostic DRG blocks before DRG-PRF did not have a significant impact on patient satisfaction, pain index score, or pain medication reduction. Furthermore, the application of diagnostic DRG blocks resulted in overall greater medical costs. These findings suggest that DRG-PRF without screening by DRG block is more cost-effective and less invasive.
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http://dx.doi.org/10.1016/j.wneu.2017.12.183DOI Listing
April 2018

Prognostic significance of postoperative spikes varied in different surgical procedures for mesial temporal sclerosis.

Seizure 2017 Nov 3;52:71-75. Epub 2017 Oct 3.

Department of Neurology, Taipei Veterans General Hospital, and National Yang-Ming University, Taiwan.

Purpose: We conducted this study to compare the occurrence and prognostic significance of early postoperative interictal epileptiform discharges (IEDs) on seizure outcomes between corticoamygdalohippocampectomy (CAH) and selective amygdalohippocampectomy (SAH).

Methods: We reviewed our database of patients who had epilepsy surgery with hippocampus atrophy or signal changes on brain MRIs and pathology of mesial temporal sclerosis. One hundred and seventy-seven CAH and 39 SAH patients were enrolled. Postoperative EEG within 30days, other preoperative variables and seizure outcome 2years after surgery were obtained for analysis. Engel's IA and IB were defined as seizure-free.

Results: There was no significant difference in the seizure-free rate between the two procedures (127 (71.8%) of CAH vs 30 (76.9%) of SAH, p=0.51). Postoperative IEDs were more frequently seen in the SAH group (64.1%) than in the CAH group (29.9%), p<0.001. The IEDs in the SAH group did not show correlation with the seizure outcome 2 years after surgery. In the CAH group, patients who had no postoperative IEDs showed a higher seizure-free rate compared to those with IEDs (78.2% vs 56.6%, p=0.003; OR 2.267, 95% CI 1.09-4.73, p=0.029 in multivariate logistic regression).

Conclusions: Early postoperative IEDs are more frequently seen in SAH than in CAH. Unlike in patients with CAH, the presence of IEDs after SAH was not a predictor of seizure recurrence. The type of surgery should be considered while utilizing postoperative IEDs for evaluating the prognosis.
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http://dx.doi.org/10.1016/j.seizure.2017.09.018DOI Listing
November 2017

Exploring resting-state EEG complexity before migraine attacks.

Cephalalgia 2018 06 29;38(7):1296-1306. Epub 2017 Sep 29.

3 Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Objective Entropy-based approaches to understanding the temporal dynamics of complexity have revealed novel insights into various brain activities. Herein, electroencephalogram complexity before migraine attacks was examined using an inherent fuzzy entropy approach, allowing the development of an electroencephalogram-based classification model to recognize the difference between interictal and preictal phases. Methods Forty patients with migraine without aura and 40 age-matched normal control subjects were recruited, and the resting-state electroencephalogram signals of their prefrontal and occipital areas were prospectively collected. The migraine phases were defined based on the headache diary, and the preictal phase was defined as within 72 hours before a migraine attack. Results The electroencephalogram complexity of patients in the preictal phase, which resembled that of normal control subjects, was significantly higher than that of patients in the interictal phase in the prefrontal area (FDR-adjusted p < 0.05) but not in the occipital area. The measurement of test-retest reliability (n = 8) using the intra-class correlation coefficient was good with r1 = 0.73 ( p = 0.01). Furthermore, the classification model, support vector machine, showed the highest accuracy (76 ± 4%) for classifying interictal and preictal phases using the prefrontal electroencephalogram complexity. Conclusion Entropy-based analytical methods identified enhancement or "normalization" of frontal electroencephalogram complexity during the preictal phase compared with the interictal phase. This classification model, using this complexity feature, may have the potential to provide a preictal alert to migraine without aura patients.
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http://dx.doi.org/10.1177/0333102417733953DOI Listing
June 2018

Selective Serotonin Reuptake Inhibitors and Poststroke Epilepsy: A Population-Based Nationwide Study.

Mayo Clin Proc 2017 02;92(2):193-199

Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan. Electronic address:

Objective: To investigate the effects of selective serotonin reuptake inhibitors (SSRIs) on poststroke epilepsy in a population-based nationwide study.

Patients And Methods: The SSRI group included patients who received a stroke diagnosis from January 1, 2000, through December 31, 2009, and were prescribed SSRIs after stroke. The non-SSRI group enrolled patients with stroke who were not prescribed SSRIs from the Taiwan National Health Insurance Research Database and used propensity score matching based on the index year, duration time, sex, age, type of stroke, and duration of hospitalization. Cox proportional hazards models were used to estimate the risk of epilepsy between the SSRI and comparison groups.

Results: A total of 4688 patients with stroke (2344 in each of the SSRI and non-SSRI cohorts) were enrolled. The cumulative incidence of epilepsy in the SSRI group was significantly higher than that in the comparison group (log-rank P<.001). In the SSRI group, the risk of poststroke epilepsy increased 2.45-fold (95% CI, 1.69- to 3.57-fold) compared with that in the comparison group. Furthermore, the risk of poststroke epilepsy increased with the defined daily dose of SSRIs. For patients with ischemic stroke, SSRIs users had a 2.74-fold higher risk of epilepsy than non users (95% CI, 1.79- to 4.22-fold).

Conclusion: In this study, SSRI users had a higher risk of poststroke epilepsy than nonusers. Further study is warranted to investigate the causal relationship between SSRI exposure and poststroke epilepsy.
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http://dx.doi.org/10.1016/j.mayocp.2016.10.011DOI Listing
February 2017

Varied responses to benzodiazepine treatment in cephalosporin-related generalized periodic discharges.

Epileptic Disord 2016 Dec;18(4):399-407

Department of Neurology, Neurological Institute, Taipei Veterans General Hospital,, Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Although benzodiazepines (BZDs) are used as the first-line treatment for status epilepticus, previous studies have shown inconsistent responses to BZDs in patients with cephalosporin-related non-convulsive status epilepticus. In this study, we investigated nine patients with cephalosporin-related impaired consciousness and their EEGs all showed generalized periodic discharges (GPDs). One of the patients received repetitive BZD injections without discontinuing cephalosporins, and neither his clinical symptoms nor GPDs on EEG responded to BZDs. Seven of the patients received BZDs after discontinuation of cephalosporins, but only two of them responded immediately to BZD administration. One of the patients did not receive BZDs or antiepileptic drugs, and this patient spontaneously recovered consciousness in one day after cephalosporins were discontinued. The changes in consciousness were reversible in all of the nine patients after cephalosporins were withdrawn. The administration of intravenous BZDs in cases with impairment of consciousness and GPDs secondary to cephalosporins may help in only a small number of patients. Cephalosporin withdrawal is ultimately mandatory in these patients.
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http://dx.doi.org/10.1684/epd.2016.0867DOI Listing
December 2016

Cascade of neural processing orchestrates cognitive control in human frontal cortex.

Elife 2016 Feb 18;5. Epub 2016 Feb 18.

Program in Biophysics, Harvard University, Boston, United States.

Rapid and flexible interpretation of conflicting sensory inputs in the context of current goals is a critical component of cognitive control that is orchestrated by frontal cortex. The relative roles of distinct subregions within frontal cortex are poorly understood. To examine the dynamics underlying cognitive control across frontal regions, we took advantage of the spatiotemporal resolution of intracranial recordings in epilepsy patients while subjects resolved color-word conflict. We observed differential activity preceding the behavioral responses to conflict trials throughout frontal cortex; this activity was correlated with behavioral reaction times. These signals emerged first in anterior cingulate cortex (ACC) before dorsolateral prefrontal cortex (dlPFC), followed by medial frontal cortex (mFC) and then by orbitofrontal cortex (OFC). These results disassociate the frontal subregions based on their dynamics, and suggest a temporal hierarchy for cognitive control in human cortex.
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http://dx.doi.org/10.7554/eLife.12352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811762PMC
February 2016

Long-term health-related quality of life in drug-resistant temporal lobe epilepsy after anterior temporal lobectomy.

Epileptic Disord 2015 Jun;17(2):177-83

Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Department of Neurology, School of Medicine, National Yang-Ming University.

Epilepsy surgery is beneficial to patients suffering from drug-resistant temporal lobe epilepsy in the short term, but fewer reports of long-term outcomes have been published. To clarify the long-term outcomes of seizure control and health-related quality of life after epilepsy surgery, we enrolled 48 patients suffering from drug-resistant temporal lobe epilepsy. All of the patients received comprehensive presurgical evaluations, including the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) questionnaire to measure their health-related quality of life. Among the patients, 28 patients received surgery (surgical group) and 20 patients remained under medication (medical group). Eight years later, the seizure frequency and QOLIE-89 were evaluated. The seizure-free rate was much higher in the surgical group (53.6%) than in the medical group (5%), eight years after the initial evaluation. The follow-up QOLIE-89 score was significantly higher in the surgical group than in the medical group. Moreover, the seizure frequency inversely correlated to the QOLIE-89 score, regardless of the treatment group. Our results provide evidence that epilepsy surgery confers benefits with respect to seizure control and health-related quality of life for drug-resistant temporal lobe epilepsy patients based on long-term follow-up.
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http://dx.doi.org/10.1684/epd.2015.0744DOI Listing
June 2015

Monocyte chemoattractant protein-1 affects migration of hippocampal neural progenitors following status epilepticus in rats.

J Neuroinflammation 2013 Jan 22;10:11. Epub 2013 Jan 22.

Institute of Physiology, National Yang-Ming University, No,155, Sec, 2, Linong Street, Taipei, 112, Taiwan.

Background: Epilepsy is a common brain disorder characterized by a chronic predisposition to generate spontaneous seizures. The mechanisms for epilepsy formation remain unknown. A growing body of evidence suggests the involvement of inflammatory processes in epileptogenesis. In the present study, we investigated the involvement of monocyte chemoattractant protein-1 (MCP-1) in aberrant migration of hippocampal progenitors in rats after the insult of status epilepticus (SE).

Methods: SE was induced with pilocarpine in Sprague-Dawley rats. Transcriptional expression of MCP-1 in the dentate gyrus (DG) was measured using quantitative real-time PCR. From 1 to 28 days after SE, the temporal profiles of MCP-1 protein expression in DG were evaluated using enzyme-linked immunosorbent assay. Chemokine (C-C motif) receptor 2 (CCR2) expression in doublecortin-positive neuronal progenitors was examined using double-labeling immunohistochemistry. The involvement of MCP-1/CCR2 signaling in aberrant neuronal progenitor migration in the epileptic hippocampus was assessed in the SE rats using a CCR2 antagonist, RS102895, and the ectopic migration of neuronal progenitors was determined using Prox1/doublecortin double immunostaining.

Results: After SE, MCP-1 gene was significantly upregulated and its corresponding protein expression in the DG was significantly increased on days 1 and 3. Some hilar ectopic progenitor cells of SE rats expressed the MCP-1 receptor, CCR2. Notably, the ectopic migration of neuronal progenitors into hilus was attenuated by a blockade of the MCP-1/CCR2 interaction with a selective CCR2 inhibitor, RS102895.

Conclusions: An increase in dentate MCP-1 is associated with seizure-induced aberrant migration of neuronal progenitors through the interaction with CCR2. The upregulation of MCP-1 after an insult of SE may play a role in the generation of epilepsy.
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http://dx.doi.org/10.1186/1742-2094-10-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563591PMC
January 2013

Treatment-seeking behavior of people with epilepsy in Taiwan: a preliminary study.

Epilepsy Behav 2011 Oct 2;22(2):308-12. Epub 2011 Aug 2.

Department of Neurology, Neurological Institute, Taipei Veterans General Hospital and National Yan-Ming University, Taipei, Taiwan.

To understand the treatment-seeking behavior of people with epilepsy (PWE), 403 PWE were surveyed using structured face-to-face interviews. Nearly half (49.1%) of them had previously tried complementary and alternative medicine (CAM); traditional Chinese medicine (51.5%) and temple worship (48.0%) were the most frequently used forms of CAM. In the 155 patients with adult-onset epilepsy, seeking CAM was substantially more common among females (OR=2.11, 95% CI=1.05-4.24, P=0.036), patients with frequent seizures (OR=2.68, 95% CI=1.30-5.53, P=0.008), patients with less educated parents (OR=2.16, 95% CI=1.06-4.41, P=0.034), and patients with religious beliefs (OR=2.84, 95% CI=1.23-6.56, P=0.015). In the 248 patients with childhood-onset epilepsy, frequent seizures (OR=2.23, 95% CI=1.32-3.77, P=0.003) and lower level of parental education (OR=2.71, 95% CI=1.45-5.06, P=0.002) were significantly associated with CAM use. The patients who seek CAM before receiving conventional medical treatment decreased after implementation of the National Health Insurance (NHI) (34/188 before NHI vs 22/215 after NHI, P=0.023). This study showed that the prevalence of CAM use by PWE in Taiwan is high and that a convenient NHI program can affect treatment-seeking behavior.
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http://dx.doi.org/10.1016/j.yebeh.2011.06.034DOI Listing
October 2011

Congenital chloride diarrhea in a child.

J Formos Med Assoc 2003 Jun;102(6):424-8

Department of Pediatrics, Chang Gung Memory Hospital, Kaohsiung, Taiwan.

Congenital chloride diarrhea (CLD) is a rare autosomal recessive disease characterized by persistent, lifelong, watery diarrhea with high fecal chloride concentration. It results from a defect of the bicarbonate/chloride exchange system in the distal ileum and colon. Polyhydramnios, premature birth, ileus without meconium passage, hypochloremia, and hyponatremia are typical features of CLD in the neonate, followed by chronic metabolic alkalosis, hypokalemia, hypochloremia, retarded growth, and renal impairment in older children and adults if the disease is not adequately treated. The diagnosis of CLD is highly dependent on the alertness of physicians. Prompt recognition and adequate replacement of fecal loss of chloride, sodium, potassium, and water are mandatory for satisfactory disease outcome. We report a case of CLD complicated with recurrent episodes of ileus, metabolic alkalosis, and hypokalemia causing frequent hospitalization in a 4-year-old boy. Normalized electrolytes and gasometric parameters, decreased abdominal circumference, and growth catch-up were achieved after education of the parents about daily care, and provision of adequate fluid and electrolyte supplementation.
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June 2003