Publications by authors named "Jafar Mehvari-Habibabadi"

26 Publications

  • Page 1 of 1

Temporal and extratemporal atrophic manifestation of temporal lobe epilepsy using voxel-based morphometry and corticometry: clinical application in lateralization of epileptogenic zone.

Neurol Sci 2021 Jan 3. Epub 2021 Jan 3.

Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran.

Background: Advances in MRI acquisition and data processing have become important for revealing brain structural changes. Previous studies have reported widespread structural brain abnormalities and cortical thinning in patients with temporal lobe epilepsy (TLE), as the most common form of focal epilepsy.

Methods: In this research, healthy control cases (n = 20) and patients with left TLE (n = 19) and right TLE (n = 14) were recruited, all underwent 3.0 T MRI with magnetization-prepared rapid gradient echo sequence to acquire T1-weighted images. Morphometric alterations in gray matter were identified using voxel-based morphometry (VBM). Volumetric alterations in subcortical structures and cortical thinning were also determined.

Results: Patients with left TLE demonstrated more prevailing and widespread changes in subcortical volumes and cortical thickness than right TLE, mainly in the left hemisphere, compared to the healthy group. Both VBM analysis and subcortical volumetry detected significant hippocampal atrophy in ipsilateral compared to contralateral side in TLE group. In addition to hippocampus, subcortical volumetry found the thalamus and pallidum bilaterally vulnerable to the TLE. Furthermore, the TLE patients underwent cortical thinning beyond the temporal lobe, affecting gray matter cortices in frontal, parietal, and occipital lobes in the majority of patients, more prevalently for left TLE cases. Exploiting volume changes in individual patients in the hippocampus alone led to 63.6% sensitivity and 100% specificity for lateralization of TLE.

Conclusion: Alteration of gray matter volumes in subcortical regions and neocortical temporal structures and also cortical gray matter thickness were evidenced as common effects of epileptogenicity, as manifested by the majority of cases in this study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10072-020-05003-2DOI Listing
January 2021

Comparison of non-invasive imaging modalities in presurgical evaluation of temporal lobe epilepsy patients: a multicenter study.

Acta Neurol Belg 2020 Nov 23. Epub 2020 Nov 23.

Comprehensive Epilepsy Program, Epilepsy Monitoring Unit, Pars Hospital, Tehran, Iran.

Intractable drug-resistant magnetic resonance imaging (MRI) negative epilepsy in one of the complicated issues in neurology. Epilepsy surgery is beneficial treatment of intractable seizures, but precise localization of epileptogenic zone is a major concern. Thirty-four MRI negative drug-resistant epilepsy patients underwent video electroencephalography (EEG), positron emission tomography (PET) scan, and voxel-based morphometry (VBM) MRI from 2014 to 2019. Then, the findings of PET scan and VBM were compared with semiology and long-term electrophysiology. Cohen's kappa-coefficient (k) test was utilized to measure the agreement between our modalities. Among 34 patients with age ranging from 8 to 49 (mean: 29.00 ± standard deviation: 10.35), 19 were male (55.9%) and 15 were female (44.1%). Twenty-one patients (61.76%) had right temporal, 12 patients (35.3%) had left and one patient had bilateral temporal ictal focus according to video EEG. Inter-rater agreement analysis showed that the kappa index between video EEG and PET scan was of almost acceptable (more than 0.4) and there was poor agreement between video EEG and VBM (kappa index = 0.099). PET is highly concordant with video EEG in temporal lobe epilepsy (TLE) and has a considerable agreement in localizing epileptogenic zone while VBM is less.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13760-020-01550-9DOI Listing
November 2020

Dynamic functional connectivity in temporal lobe epilepsy: a graph theoretical and machine learning approach.

Neurol Sci 2020 Oct 14. Epub 2020 Oct 14.

Research Center for Molecular and Cellular Imaging, Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences, Tehran, Iran.

Purpose: Functional magnetic resonance imaging (fMRI) in resting state can be used to evaluate the functional organization of the human brain in the absence of any task or stimulus. The functional connectivity (FC) has non-stationary nature and consented to be varying over time. By considering the dynamic characteristics of the FC and using graph theoretical analysis and a machine learning approach, we aim to identify the laterality in cases of temporal lobe epilepsy (TLE).

Methods: Six global graph measures are extracted from static and dynamic functional connectivity matrices using fMRI data of 35 unilateral TLE subjects. Alterations in the time trend of the graph measures are quantified. The random forest (RF) method is used for the determination of feature importance and selection of dynamic graph features including mean, variance, skewness, kurtosis, and Shannon entropy. The selected features are used in the support vector machine (SVM) classifier to identify the left and right epileptogenic sides in patients with TLE.

Results: Our results for the performance of SVM demonstrate that the utility of dynamic features improves the classification outcome in terms of accuracy (88.5% for dynamic features compared with 82% for static features). Selecting the best dynamic features also elevates the accuracy to 91.5%.

Conclusion: Accounting for the non-stationary characteristics of functional connectivity, dynamic connectivity analysis of graph measures along with machine learning approach can identify the temporal trend of some specific network features. These network features may be used as potential imaging markers in determining the epileptogenic hemisphere in patients with TLE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10072-020-04759-xDOI Listing
October 2020

Graph theory application with functional connectivity to distinguish left from right temporal lobe epilepsy.

Epilepsy Res 2020 11 6;167:106449. Epub 2020 Sep 6.

Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences(TUMS), Tehran, Iran; Research Center for Molecular and Cellular Imaging, Research Center for Science and Technology in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Electronic address:

Objective: To investigate the application of graph theory with functional connectivity to distinguish left from right temporal lobe epilepsy (TLE).

Methods: Alterations in functional connectivity within several brain networks - default mode (DMN), attention (AN), limbic (LN), sensorimotor (SMN) and visual (VN) - were examined using resting-state functional MRI (rs-fMRI). The study accrued 21 left and 14 right TLE as well as 17 nonepileptic control subjects. The local nodal degree, a feature of graph theory, was calculated foreach of the brain networks. Multivariate logistic regression analysis was performed to determine the accuracy of identifying seizure laterality based on significant differences in local nodal degree in the selected networks.

Results: Left and right TLE patients showed dissimilar patterns of alteration in functional connectivity when compared to control subjects. Compared with right TLE, patients with left TLE exhibited greater nodal degree' (i.e. hyperconnectivity) with right superomedial frontal gyrus (in DMN), inferior frontal gyrus pars triangularis (in AN), right caudate and left superior temporal gyrus (in LN) and left paracentral lobule (in SMN), while showing lesser nodal degree (i.e. hypoconnectivity) with left temporal pole (in DMN), right insula (in LN), left supplementary motor area (in SMN), and left fusiform gyrus (in VN). The LN showed the highest accuracy of 82.9% among all considered networks in determining laterality of the TLE. By combinations of local degree attributes in the DMN, AN, LN, and VN, logistic regression analysis demonstrated an accuracy of 94.3% by comparison.

Conclusion: Our study demonstrates the utility of graph theory application to brain network analysis as a potential biomarker to assist in the determination of TLE laterality and improve the confidence in presurgical decision-making in cases of TLE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eplepsyres.2020.106449DOI Listing
November 2020

Distinct patterns of hippocampal subfield volume loss in left and right mesial temporal lobe epilepsy.

Neurol Sci 2021 Apr 12;42(4):1411-1421. Epub 2020 Aug 12.

Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Objective: To investigate the pattern and severity of hippocampal subfield volume loss in patients with left and right mesial temporal lobe epilepsy (mTLE) using quantitative MRI volumetric analysis.

Methods: A total of 21 left and 14 right mTLE subjects, as well as 15 healthy controls, were enrolled in this cross-sectional study. A publically available magnetic resonance imaging (MRI) brain volumetry system (volBrain) was used for volumetric analysis of hippocampal subfields. The T1-weighted images were processed with a HIPS pipeline.

Results: A distinct pattern of hippocampal subfield atrophy was found between left and right mTLE patients when compared with controls. Patients with left mTLE exhibited ipsilateral hippocampal atrophy and segmental volume depletion of the Cornu Ammonis (CA) 2/CA3, CA4/dentate gyrus (DG), and strata radiatum-lacunosum-moleculare (SR-SL-SM). Those with right mTLE exhibited similar ipsilateral hippocampal atrophy but with additional segmental CA1 volume depletion. More extensive bilateral subfield volume loss was apparent with right mTLE patients.

Conclusion: We demonstrate that left and right mTLE patients show a dissimilar pattern of hippocampal subfield atrophy, suggesting the pathophysiology of epileptogenesis in left and right mTLE to be different.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10072-020-04653-6DOI Listing
April 2021

The correlation between cluster seizures and findings of magnetic resonance imaging in drug refractory epilepsy patients.

Am J Clin Exp Immunol 2020 15;9(3):47-52. Epub 2020 Jun 15.

Department of Emergency, Abadan University of Medical Science Abadan, Iran.

Background: Epilepsy is a chronic neurologic condition and affects peoples at all ages. Seizure clusters are generally referred to seizures that occur at close intervals with complete recovery between attacks. Various studies have reported a variety of frequencies and risk factors for this condition.

Method: We designed a study to determine the frequency of seizure cluster and to determine neuroimaging findings in these patients and also to evaluate the Correlation between Cluster Seizures and Findings of Magnetic Resonance Imaging in Drug Refractory Epilepsy patients.

Results: After analyzing data from 568 refractory epilepsy patients, we found that the prevalence of cluster seizure variant is 14.43%. 29.26% of patients with a history of cluster seizure had no obvious abnormal MRI findings whereas 14.40 % of patients without history of cluster seizure had no obvious abnormal MRI findings (-value <0.05). Compared to Drug Refractory Epilepsy patients without history of seizure clusters, patients with a history of seizure clusters had less abnormal MRI findings, less Mesial Temporal Sclerosis, and more Focal Cortical Dysplasia in Magnetic Resonance Imaging ( value <0.05).

Conclusions: Seizure cluster has a significant negative impact on the quality of life of patients. According to results of this study it seems that brain MRI findings of drug refractory epilepsy patients with a history of seizure clusters are different from brain MRI findings of drug refractory epilepsy patients without a history of seizure clusters. mesial temporal sclerosis is less frequent and focal cortical dysplasia is more frequent in brain MRI of drug refractory epilepsy patients with a history of seizure clusters compared to drug refractory epilepsy patients without a history of seizure clusters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364372PMC
June 2020

Altered ANRIL Methylation in Epileptic Patients.

J Mol Neurosci 2021 Jan 13;71(1):193-199. Epub 2020 Jul 13.

Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Long non-coding RNAs (lncRNAs) have regulatory roles in several aspects of cellular physiology. Recent studies have also revealed their role in neuronal differentiation and the pathophysiology of neurologic disorders such as epilepsy. We have recently reported altered expression of a number of lncRNAs in the peripheral blood of epileptic patients in association with their response to antiepileptic drugs. One the most significantly altered lncRNAs in epileptic patients is the antisense non-coding RNA in the INK4 locus (ANRIL), whose expression has been found to be higher in both refractory and non-refractory groups compared with controls. In the current study, we aimed to identify the methylation status of this lncRNA to suggest a potential mechanism for deregulated ANRIL expression. Thus, we assessed the methylation status of the ANRIL promoter in 40 patients with refractory epilepsy, 40 patients with non-refractory epilepsy and 40 normal controls using the high-resolution melting (HRM) method. The HRM results showed hypomethylation of the ANRIL promoter region in both refractory epilepsy and non-refractory epilepsy patients compared with normal controls. This methylation pattern was consistent with the recently reported upregulation of this lncRNA in patients with epilepsy. Thus, we suggest altered methylation of the ANRIL promoter as a potential cause of its aberrant expression in peripheral blood of epileptic patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12031-020-01666-wDOI Listing
January 2021

Frequency of menstrual abnormalities and their associated neuroimaging findings in women with focal refractory epilepsy.

Acta Neurol Belg 2020 Jun 7. Epub 2020 Jun 7.

Neurology Department, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Patients with refractory epilepsy can suffer from psychological and physical problems. Epilepsy can also be associated with menstruation abnormalities in women. In this paper, we aim to survey women with focal refractory epilepsy who also suffer from menstrual abnormalities. This cross-sectional study was performed in 2018 in Tertiary Epilepsy Center in Kashani Hospital, Isfahan, Iran and Milad hospital, Isfahan, Iran. A total number of 381 patients diagnosed with refractory epilepsy joined the study based on an inclusion and exclusion criteria. Clinical characteristics of epilepsy, menstrual issues and brain MRI findings were assessed. Among 381 women with refractory epilepsy, 250 had refractory focal epilepsy (65.61%), and the others (34.39%) had generalized refractory epilepsy. 132 patients out of 381 had menstrual abnormalities (34.65%). Among 132 women with coexisting refractory epilepsy and menstrual abnormalities, 86 (65.15%) were diagnosed with refractory focal epilepsy, and 46 (34.86%) had generalized refractory epilepsy (p value = 0.041). Oligomenorrhea-hypomenorrhea was the most common type of menstrual abnormality in women with refractory epilepsy seen in 83 (62.87%) (p value = 0.039). The most common brain MRI pathology in women with refractory focal epilepsy was mesial temporal sclerosis (MTS) (39.20%, p = 0.00). We report that almost one-third of women with refractory epilepsy suffer from menstrual disorders, and the most common disorder was Oligomenorrhea-hypomenorrhea, and the most common brain pathology was MTS. It has also been a hypothesis that reproductive dysfunctions are connected to temporal lobe malfunctions, and more specific studies are required in this issue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13760-020-01374-7DOI Listing
June 2020

Frequency of Seizure Clusters and Their Associated Risk Factors in Adult Patients with Epilepsy Referred to Epilepsy Center of Kashani Hospital in Isfahan from 2011 to 2016.

Int J Prev Med 2020 17;11:19. Epub 2020 Feb 17.

Department of Emergency, Abadan University of Medical Science, Abadan, Iran.

Background: Epilepsy is a chronic neurologic condition and affects people of all ages. Seizure clusters are generally referred to seizures that occur at close intervals with complete recovery between attacks. Various studies have reported a variety of frequencies and risk factors for this condition.

Methods: We designed a study to determine the frequency of seizure cluster and their associated risk factors in Iranian population for the first time.

Results: Among 40 variables analyzed, 18 of them were significantly associated with seizure clustering. Risk factors including educational level, age of onset, number of drugs, seizure types, perinatal complication, developmental delay, other illnesses, parental consanguinity, systemic diseases, number of drugs used, mentation, motor signs, sensory signs, cranial nerves signs, cerebellar signs, seizure duration, existence of magnetic resonance imaging (MRI) lesion, and type of MRI pathology are significantly associated with clustering of seizures. When associated risk factors were analyzed with multivariate analysis, age of onset of seizures, number of antiepileptic drugs currently used, lack of seizure-free periods, seizure frequency, and type of MRI pathology are significantly defining for anticipating clustering of seizures.

Conclusions: Seizure cluster has a significant negative impact on the quality of life of patients. Important risk factors that are found to be associated are age of onset, parental consanguinity, frequency of seizure, lack of have seizure-free period or periods, pathologies in neurological examination, and MRI findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijpvm.IJPVM_238_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050217PMC
February 2020

The Relationship between Aura and Postoperative Outcomes of Epilepsy Surgery in Patients with Mesial Temporal Sclerosis.

Adv Biomed Res 2020 21;9. Epub 2020 Jan 21.

Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: We conducted a study to evaluate the relationship between aura types and postoperative outcomes in patients with mesial temporal sclerosis (MTS) to predict the prognosis of patients, accordingly.

Materials And Methods: In this cross-sectional study, 99 patients with MTS-temporal lobe epilepsy were enrolled based on inclusion and exclusion criteria. The types of aura were evaluated, and the outcomes were categorized according to the Engel scale. Preoperative and postoperative results of patients were compared and analyzed with the Kruskal-Wallis test.

Results: About 73.7% of patients had seizure-free after their surgeries. The most of patients ( = 81) were in Class I of Evaluating Engel criteria. About 36.3% had not experienced any aura before their seizures, and among those with aura, the most prevalent aura was abdominal aura in 29 patients (29.3%) followed by other types of aura and affective aura. Most of the patients in Class I, II, III, and IV of Engel scale had an abdominal aura, without aura, effective aura, and abdominal aura, respectively, but this difference was not statistically significant ( = 0.691).

Conclusion: According to this study, the type of aura cannot predict postoperative outcomes in MTS patients. More studies are needed to evaluate this relation in better-planned studies with greater sample size.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/abr.abr_25_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003553PMC
January 2020

Evolution of Graph Theory in Dynamic Functional Connectivity for Lateralization of Temporal Lobe Epilepsy.

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;2019:628-631

Resting-state functional magnetic resonance imaging (rsfMRI) has described the functional architecture of the human brain in the absence of any task or stimulus. Since the functional connectivity (FC), has non-stationary nature, it is evidenced to be varying over time. Using dynamic functional connectivity, six graph theoretical characteristics were measured and compared between left and right temporal lobe epilepsy (TLE). We also obtain a trend for each characteristic in the time course of experiments. The results demonstrated that the static connectivity analysis failed to fully separate the left and right TLE patients for some characteristics, whereby the dynamic analysis has been shown capable of identifying the laterality. Furthermore, the results suggest that the temporal trend of some graph theoretical characteristics can be exploited as a novel marker for TLE laterality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1109/EMBC.2019.8856717DOI Listing
July 2019

Expression Analysis of lncRNAs in Refractory and Non-Refractory Epileptic Patients.

J Mol Neurosci 2020 May 3;70(5):689-698. Epub 2020 Jan 3.

Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Long non-coding RNAs (lncRNAs) have been demonstrated to be involved in the pathogenesis of neuropsychiatric disorders such as epilepsy. In the current study, we evaluated expression of eight lncRNAs in 80 epileptic patients (40 refractory and 40 non-refractory ones) and 40 normal individual using quantitative real-time PCR. Bayesian regression model showed significant higher expression of UCA1 in both refractory and non-refractory groups compared with controls (posterior beta of relative expression (RE) = 2.03, P value = 0.003, and posterior beta of RE = 4.05, P value < 0.0001, respectively). Besides, expression of UCA1 was higher in non-refractory patients compared with refractory ones (posterior beta of RE = 2.008, P value = 0.019). When repeating statistical analyses in a gender-based manner, differences in expression of UCA1 were significant in all subgroup analyses except for male non-refractory vs. refractory subgroups analysis. Expression levels of NKILA and ANRIL were higher in both refractory and non-refractory groups compared with controls (posterior beta of RE = 1.565, P value = 0.018, and posterior beta of RE = 1.902, P value = 0.006 for NKILA; posterior beta of RE = 1.304, P value < 0.0001, and posterior beta of RE = 1.603, P value = 0.019 for ANRIL, respectively). However, expression levels of these two lncRNAs were not different between refractory and non-refractory groups. Gender-based analysis for these two lncRNAs revealed similar results except for lack of difference in ANRIL expression between male refractory group and controls. Expression of THRIL was significantly lower in both refractory and non-refractory groups compared with controls (posterior beta of RE = - 0.842, P value = 0.044 and posterior beta of RE = - 1.969, P value < 0.0001, respectively). Furthermore, expression of this lncRNA was lower in non-refractory patients compared with refractory ones (posterior beta of RE = - 1.129, P value = 0.002). However, no significant difference was detected between non-refractory and refractory patients either in males or females. The interactions between gender and relative expressions of PACER, DILC, and MALAT1 were significant, so the results were assessed in gender-based manner. In females, expression of DILC was higher in non-refractory patients compared with refractory ones (posterior beta of RE = 0.959, P value = 0.044). Expression of MALAT1 was lower in female non-refractory patients compared with controls and in female non-refractory patients compared with refractory ones (posterior beta of RE = - 1.35, P value = 0.002, and posterior beta of RE = - 0.942, P value = 0.045, respectively). Finally, expression of PACER was higher in refractory patients vs. controls and non-refractory patients vs. controls in both male and female subgroups. However, comparison between non-refractory and refractory patients revealed significant results only among females. Expression of none of the assessed lncRNAs was correlated with age of study participants. There were robust correlations between expression levels of lncRNAs. The most robust correlations were detected between UCA1 and PACER (r = 0.84, P < 0.0001) and between UCA1 and ANRIL (r = 0.75, P < 0.0001). Taken together, our study demonstrated dysregulation of lncRNAs in peripheral blood of epileptic patients and potentiated them as biomarkers for this neurologic condition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12031-019-01477-8DOI Listing
May 2020

Epilepsy Is Associated With Dysregulation of Long Non-coding RNAs in the Peripheral Blood.

Front Mol Biosci 2019 23;6:113. Epub 2019 Oct 23.

Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Long non-coding RNAs (lncRNAs) are a group of functional transcripts that are not translated to proteins. Recent investigations have underscored their role in the pathogenesis of neurodevelopmental disorders. In the current investigation, we quantified expression levels of four lncRNAs (, and ) in peripheral blood of epileptic patients and normal controls. Expression of was significantly higher in patients compared with controls (Posterior beta = 1.982, = 0.001). We detected interaction effects of gender on expression of ( = 0.012). Further analyses showed over-expression of in male patients compared with male controls ( = 0.003), in spite of similar levels of expression between female cases and female controls ( = 0.77). Expression of was higher in total patients compared with total controls (Posterior beta = 1.27, = 0.02). Such difference was only observed between male patients and male controls when dividing study participants based on their gender ( = 0.012). There was no significant difference in expression of and between patients and controls. Expression levels of all lncRNAs were correlated with each other with r values ranging from 0.61 to 0.76 ( < 0.0001). However, expressions of none of lncRNAs were correlated with age of study participants. The current data implies a putative role for two lncRNAs in the pathogenesis of epilepsy and warrants future functional studies to verify the observed association.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fmolb.2019.00113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819822PMC
October 2019

Outcome of lesional epilepsy surgery: Report of the first comprehensive epilepsy program in Iran.

Neurol Clin Pract 2019 Aug;9(4):286-295

Kashani Comprehensive Epilepsy Center (JMH, MZ), Kashani Hospital, School of Medicine, Isfahan University of Medical Sciences; Departments of Neurology (JMH, SB, BZ, NM, MZ), Isfahan Neurosciences Research Center and Neurosurgery (HM), Department of Radiology (RB), Students' Research Center (SB, NM), and Department of Psychiatry (MB), Psychosomatic Research Center, School of Medicine, Isfahan University of Medical Sciences; Shefa Neuroscience Research Center (ER), Tehran, Iran; Students' Research Center (AMH), School of Medicine, Shahrekord University of Medical Sciences, Iran; Department of Neurology (PM), University of Tennessee Health Science Center, Memphis, TN; Department of Clinical Neurosciences (YA), University of Calgary, Calgary, Alberta, Canada; and Epilepsy Center (SA, SL), Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.

Background: We investigated the utility of epilepsy surgery and postoperative outcome in patients with lesional epilepsy in Iran, a relatively resource-poor setting.

Methods: This prospective longitudinal study was conducted during 2007-2017 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with a diagnosis of intractable focal epilepsy, with MRI lesions, who underwent epilepsy surgery and were followed up ≥ 24 months, were included and evaluated for postoperative outcome.

Results: A total of 214 patients, with a mean age of 26.90 ± 9.82 years (59.8% men) were studied. Complex partial seizure was the most common type of seizure (85.9%), and 54.2% of the cases had auras. Temporal lobe lesions (75.2%) and mesial temporal sclerosis (48.1%) were the most frequent etiologies. With a mean follow-up of 62.17 ± 19.33 months, 81.8% of patients became seizure-free postoperatively. Anticonvulsants were reduced in 86% of the cases and discontinued in 40.7%. In keeping with previous studies, we found that seizure freedom rates were lower among patients with longer follow-up periods.

Conclusions: We found high rates of seizure freedom after surgery in lesional epilepsy patients despite limited facilities and infrastructure; antiepileptic medications were successfully tapered in almost half of the patients. Considering the favorable outcome of epilepsy surgery in our series, we believe that it is a major treatment option, even in less resource-intensive settings, and should be encouraged. Strategies to allow larger scale utility of epilepsy surgery in such settings in the developing world and dissemination of such knowledge may be considered an urgent clinical need, given the established mortality and morbidity in refractory epilepsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/CPJ.0000000000000627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745744PMC
August 2019

The Role of Interictal Epileptiform Discharges in Epilepsy Surgery Outcome.

Int J Prev Med 2019 7;10:101. Epub 2019 Jun 7.

Department of Neurology, Medical School, Mazandaran University of Medical Sciences, Sari, Iran.

Background: Epilepsy surgery is a fundamental treatment in refractory epilepsy. Video electroencephalographic (v-EEG) monitoring plays an essential role in presurgical evaluation of patients. However there are reports of favorable outcome based on interictal and magnetic resonance imaging (MRI) findings without any need for v-EEG monitoring in patients with temporal lobe epilepsy (TLE). This study aimed to investigate the prognostic effect of concordance between interictal findings and ictal and MRI data on postsurgical outcome of TLE and extratemporal lobe epilepsy (ETLE).

Methods: A retrospective study was conducted on 199 patients with refractory focal epilepsy who were admitted for presurgical evaluation. The concordance between irritative zone (IZ) and seizure onset zone (SOZ) and also IZ and MRI lesion was registered, and subsequently the prognostic effect of relevancy on 1-year follow-up result based on Engel criteria was investigated.

Results: In TLE and ETLE regarding relevancy between IZ and SOZ, 77.8% and 73.2% were concordant, 2.5% and 0% were discordant, and 19.6% and 26.8% had overlap, respectively. Concordance between IZ and MRI lesion was found in 76.6% and 51.2% of patients with TLE and ETLE while discordance was recorded in 2.5% and 12.2% and overlap registered in 20.9% and 36.6%, respectively. The concordance of interictal findings had no effect on postsurgical outcome of patients with TLE and ETLE.

Conclusions: Our study showed that concordance of IZ with SOZ and MRI has no independent effect on postsurgical outcome of patients with TLE and ETLE. We suggest that excluding exceptional cases, v-EEG monitoring should be considered as the mainstay of presurgical evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijpvm.IJPVM_237_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592222PMC
June 2019

Management of seizures in patients with multiple sclerosis; an Iranian consensus.

Epilepsy Behav 2019 07;96:244-248

Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: Cooccurrence of a seizure in a patient with multiple sclerosis (MS) may complicate the management process. Questions, which may complicate the management process of a patient with MS and seizure, include "how should we approach to the patient", "how should we treat the patient", "how should we modify the patient's MS treatment strategy", etc. METHODS: We searched the electronic database PubMed on March 30, 2018 for articles in English that included the following search terms: "epilepsy" AND "multiple sclerosis" or "seizure" AND "multiple sclerosis" since 2013, to obtain the best recent relevant scientific evidence on the topic. A working group of 6 epilepsy and 5 MS experts took part in two consensus workshops in Tehran, Iran, in 2018. The final consensus manuscript was prepared and approved by all participants.

Results: The search with words "seizure" and "multiple sclerosis" yielded 121 entries; 10 were relevant to the topic. The search with words "epilepsy" and "multiple sclerosis" yielded 400 entries; 7 were relevant to the topic. We reviewed these 17 articles and also some other references, derived from these articles or relevant to the topic, for the purpose of our review.

Conclusion: Cooccurrence of a seizure in a patient with MS may complicate the management process. In this review, we tried to provide answers to the frequently asked questions, considering the best available scientific evidence and expert opinion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yebeh.2019.04.032DOI Listing
July 2019

Component-related BOLD response to localize epileptic focus using simultaneous EEG-fMRI recordings at 3T.

J Neurosci Methods 2019 07 23;322:34-49. Epub 2019 Apr 23.

Isfahan Neurosciences Research Center, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Simultaneous EEG-fMRI experiments record spatiotemporal dynamics of epileptic activity. A shortcoming of spike-based EEG-fMRI studies is their inability to provide information about behavior of epileptic generators when no spikes are visible.

New Method: We extract time series of epileptic components identified on EEG and fit them with Generalized Linear Model (GLM) model. This allows a precise and reliable localization of epileptic foci in addition to predicting generator's behavior. The proposed method works in the source domain and delineates generators considering spatial correlation between spike template and candidate components in addition to patient's medical records.

Results: The proposed method was applied on 20 patients with refractory epilepsy and 20 age- and gender-matched healthy controls. The identified components were examined statistically and threshold of localization accuracy was determined as 86% based on Receiver Operating Characteristic (ROC) curve analysis. Accuracy, sensitivity, and specificity were found to be 88%, 85%, and 95%, respectively. Contribution of EEG-fMRI and concordance between EEG and fMRI were also evaluated. Concordance was found in 19 patients and contribution in 17.

Comparison With Existing Methods: We compared the proposed method with conventional methods. Our comparisons showed superiority of the proposed method. In particular, when epileptogenic zone was located deep in the brain, the method outperformed existing methods.

Conclusions: This study contributes substantially to increasing the yield of EEG-fMRI and presents a realistic estimate of the neural behavior of epileptic generators, to the best of our knowledge, for the first time in the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jneumeth.2019.04.010DOI Listing
July 2019

Evaluation of dual pathology among drug-resistant epileptic patients with hippocampal sclerosis.

Neurol Sci 2019 Mar 11;40(3):495-502. Epub 2018 Dec 11.

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: Dual pathology (DP) is defined as simultaneous presence of hippocampal sclerosis (HS) and any other pathology in the brain. Since this is a less probed concept, we aimed to evaluate the frequency and characteristics of DP among drug-resistant epileptic patients with HS.

Methods: This is a cross-sectional study conducted during 2007-2016 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with diagnosis of drug-resistant epilepsy and HS were enrolled in the study, and demographic data, seizure semiology, EEG findings, and MRI findings were collected. We compared these variables between three groups of DP, unilateral HS, and bilateral HS.

Results: Of the 200 enrolled cases, 29 patients (14.5%) had DP and 21 patients (10.5%) had bilateral HS; the remaining patients had unilateral HS. The average age of patients with DP was 30.03, and 65.5% of them were male. Patients with DP had more EEG discharges from regional and multi-focal sites compared to unilateral HS (P value < 0.001). Also, complex partial seizure (CPS) was more commonly presented in patients with unilateral HS (96.8%). Comparison of disease characteristics between DP and bilateral HS showed no difference in most categories (P > 0.05).

Conclusions: We found DP among 14.5% of our drug-resistant epileptic patients with HS. DP patients mostly presented with CPS and had high proportion of ictal and interictal EEG discharges from regional and multi-focal areas. Gliosis and focal cortical dysplasia were the most common pathologies among DP patients. Patients with DP showed a similar behavior to bilateral HS in many features.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10072-018-3677-7DOI Listing
March 2019

Seizure in cerebral venous and sinus thrombosis.

Epilepsia Open 2018 Sep 8;3(3):316-322. Epub 2018 Jun 8.

Department of Neurology Mazandaran University of Medical Sciences Sari Iran.

Many conflicting issues exist about seizure in the setting of cerebral venous and sinus thrombosis (CVST). In this article we aimed to address the existing data regarding incidence, characteristics, predictors, treatment, and prognosis of acute and late seizures in patients with CVST and to prepare more practical information for clinicians. PubMed, Embase, Web of science and Cochrane databases were searched within 1966-2016 using relevant keywords. A total of 63 papers met the inclusion criteria. Seizures are classified as acute symptomatic seizures (ASS; first 14 days) and post-CVST epilepsy (PCE; after 14 days). The incidence had been reported in a wide range of 6.9-76% for ASS and 4-16% for PCE. Focal and generalized seizures were observed with different predominance. ASS commonly occurred in patients with loss of consciousness, focal neurological deficits, supratentorial lesions and thrombosis in superior sagittal sinus, straight sinus, and cortical veins. PCE had been predisposed by occurrence of ASS, motor deficit, and supratentorial lesions, particularly hemorrhage. Most experts believe that primary prophylaxis with antiepileptic drugs in the acute phase is not indicated. However, the initiation of prophylaxis after the first seizure in patients with supratentorial lesions or focal neurological deficit should be recommended. The quality of current evidence is low and most conclusions are based on expert opinions. More accurate reports of seizure semiology, detailed antiepileptic treatment plans, and outcomes are necessary to answer the existing questions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/epi4.12229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119760PMC
September 2018

Prognostic value of ictal onset patterns in postsurgical outcome of temporal lobe epilepsy.

Iran J Neurol 2017 Oct;16(4):185-191

Isfahan University of Medical Sciences, Isfahan, Iran.

To investigate ictal onset patterns (IOP) in scalp electroencephalography (EEG) of patients with temporal lobe epilepsy (TLE) and their prognostic effect on the postoperative outcome. We conducted a retrospective cohort study between 2011 and 2015 in our referral Epilepsy Surgery Center enrolling adult patients with refractory TLE and a visible epileptogenic lesion in magnetic resonance imaging (MRI), who underwent epilepsy surgery. Demographic, clinical and MRI findings were collected and ictal findings during video-EEG monitoring were reviewed in detail. The correlation between preoperative findings and the postsurgical outcome was analyzed. We reviewed 303 seizures in 93 patients. Rhythmic theta and rhythmic spike/sharp and wave were respectively the most common initial ictal pattern and late significant discharges. Engel class I outcome was observed in 88.2% of patients. Female sex, aura, the absence of secondary generalization, rhythmic theta as initial ictal pattern and concordance of ictal-interictal EEG findings were correlated with favorable 1-year postsurgical outcome. Preoperative clinical and EEG findings can provide valuable information regarding postsurgical prognosis in TLE patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937004PMC
October 2017

An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation.

Case Rep Med 2017 26;2017:2432315. Epub 2017 Jan 26.

Isfahan Neurosciences Research Center, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Kashani Comprehensive Epilepsy Center, Kashani Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. . We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. . In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2017/2432315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299200PMC
January 2017

1H-MRS metabolite's ratios show temporal alternation in temporal lobe seizure: Comparison between interictal and postictal phases.

Epilepsy Res 2016 12 9;128:158-162. Epub 2016 Sep 9.

Isfahan Neurosciences Research Center, Neurology Department, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

Purposes: To determine H-MRSI metabolites changes in interictal and postictal phases of patients suffering from mesial temporal lobe epilepsy with hippocampal sclerosis and lateralization of seizure foci.

Materials And Methods: MR spectroscopic imaging was performed in 5 adult patients with refractory temporal lobe epilepsy interictally and immediately after the seizure and in 4 adult control subjects. All patients underwent MR imaging and VideoEEG Monitoring.

Results: The results showed statistically significant decreases in N-acetylaspartate/Creatine, N-acetylaspartate/Choline and N-acetylaspartate/(creatine+choline) immediately after ictus in ipsilateral hippocampus as compared with control data and contralateral hippocampus of patients while no statistically significant difference was presented in interictal phase.

Conclusion: The present study clearly indicates H-MRS abnormalities following an ictus of temporal lobe epilepsy with metabolite recovery in interictal phase. This finding suggests postictal H-MRS as a possible useful tool to assist in lateralizing and localizing of seizure foci in epileptic patients with structural lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eplepsyres.2016.08.015DOI Listing
December 2016

A quick review of carbamazepine pharmacokinetics in epilepsy from 1953 to 2012.

J Res Med Sci 2013 Mar;18(Suppl 1):S81-5

Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Carbamazepine has been used as AEDs since 1965, and is most effective against partial seizures. Two basic mechanisms of action have been proposed: 1) enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials, 2) and action on synaptic transmission. The aim of this study was to provide a review of carbamazepine pharmacokinetics and its management guidelines in Iranian epileptic population.

Materials And Methods: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO), Web of Science were searched; 1600, 722 and 167 research and review articles relevant to the topics; carbamazepine pharmacokinetics, carbamazepine pharmacokinetics in epilepsy and review on carbamazepine pharmacokinetics in epilepsy were found, respectively.

Results: Carbamazepine is highly bound to plasma proteins. In patients the protein-bound fraction ranged from 75-80% of the total plasma concentration. Bioavailability ranges from 75-85%. The rate or extent of absorption was not be affected by food. It is completely metabolized and the main metabolite is carbamazepine-epoxide (CBZ-E). Carbamazepine induces its own metabolism, leading to increased clearance, shortened serum half-life, and progressive decrease in serum levels. Increases in daily dosage are necessary to maintain plasma concentration. Severe liver dysfunction may cause disordered pharmacokinetics. In cardiac failure, congestion of major vital organs, including kidneys, may result in abnormally slow absorption and metabolism.

Conclusion: Carbamazepine shows variability due to its narrow therapeutic window. Therefore clinical management in a3n Iranian epileptic population should focus on results derived from therapeutic drug monitoring in order to reduce inter and intra- individual variability in plasma drug concentrations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743329PMC
March 2013

Antiepileptic drugs: a consideration of clinical and biochemical outcome in patients with epilepsy.

Int J Prev Med 2013 May;4(Suppl 2):S330-7

Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The challenge of antiepileptic drugs (AEDs) management is to attain the best compromise between the desire to maximize seizure control and the need to keep side-effects within tolerable limits for the individual patient. To reduce devastation in Iranian epileptic patients, the aim of this study was to explore the overall outcome following AEDs prescription.

Methods: A cross-sectional study of 36 patients located at the epilepsy ward, conducted to Isfahan Neurosciences Research Centre was carried out during the year 2011. Female (n = 17) and male subjects (n = 19) with a mean age of 27 years (range; 7-74 years) were studied. Variables including, sex, age, age of seizure onset, type, and number of AEDs, biochemical and hematological data were recorded in d-Base and statistical analyses were performed using SPSS (version 18) for windows.

Results: The main drug to control seizure attack was carbamazepine and valproic-acid. The following tests were the most frequently influenced; alkaline phosphatase (AP), lymphocyte (Lymph), white blood cell (WBC) counts and hemoglobin (Hgb). There was a significant increase in (AP) (mean; 534.6 u/l(↑); [P = 0.02] in three patients and (Lymph) (55%(↑); [43-84] %(↑); [P = 0.04] in seven patients. WBC was lower than 4400 mm(3↓) (P = 0.02) in six patients. Hgb was significantly lower in 70.6% of women (11.8(↓); [10-14.2] g/dl(↓); [P = 0.04] and 68.4% of men population (12.3(↓); [9.7-13.8] g/dl(↓); [P = 0.01]. Mean age of epilepsy onset was 15.6 years (range: Birth-74 years). Analysis of drug prescriptions showed that the incidence of monotherapy and polypharmacy (2 up to six AEDs simultaneously) was 19.4% plus 80.6% respectively.

Conclusions: In Iranian epileptic population, effectiveness of treatment should be attributed by the close supervising of AEDs in relation to clinical circumstance, laboratory data, and therapeutic drug monitoring. Any significant change in patients' biochemical and hematological data may require close verifying for the rapid detection of severe anemia, leukopenia, lymphocytosis, osteomalacia, or liver failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678241PMC
May 2013

Bumetanide reduces seizure frequency in patients with temporal lobe epilepsy.

Epilepsia 2013 Jan 12;54(1):e9-12. Epub 2012 Oct 12.

Cellular and Molecular Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Alterations in the balance of K-Na-2Cl cotransporter (NKCC1) and Na-Cl cotransporter (KCC2) activity may cause depolarizing effect of γ-aminobutyric Acid (GABA), and contribute to epileptogenesis in human temporal lobe epilepsy. NKCC1 facilitates accumulation of chloride inside neurons and favors depolarizing responses to GABA. In the current pilot study we provide the first documented look at efficacy of bumetanide, a specific NKCC1 antagonist, on reduction of seizure frequency in adult patients with temporal lobe epilepsy. According to our results, seizure frequency was reduced considerably in these patients. Furthermore, epileptiform discharges decreased in two of our patients. If the efficacy of bumetanide is proven in large scale studies, it can be used as a supplemental therapy in temporal lobe epilepsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1528-1167.2012.03654.xDOI Listing
January 2013

On the discrimination of patho-physiological states in epilepsy by means of dynamical measures.

Comput Biol Med 2009 Dec 31;39(12):1073-82. Epub 2009 Oct 31.

Islamic Azad University, Tehran, Iran.

In the present paper a number of techniques were applied to determine the effects of epileptic seizure on spontaneous ongoing EEG. The idea is that seizure represents transitions of an epileptic brain from its normal (chaotic) state to an abnormal (more ordered) state. Some nonlinear measures including correlation dimension, maximum Lyapunov exponent and wavelet entropy and a graphical tool, named recurrence plot, as well as a novel technique that collects some statistics of the state space organization were used to characterize interictal, preictal and ictal states and derivate a phase transition. The novelty of this work includes of introducing new types of indicators base upon some nonlinear features besides of proposing a new feature of point distribution in phase space. Our results show that (1) these three states are separable in 3-D feature space of nonlinear measures with a gradual decrease of their quantity in seizure evolution, (2) strong rhythmicity, which manifests in recurrence plots and recurrence quantification analysis measures, appears in dynamic while having entered into seizure and (3) different volumes of state space are occupied during each phase of epileptic disorder. The significance of the work is that this information is a step into the detection of a preictal state and consequently is helpful in the prediction and control of epileptic seizures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.compbiomed.2009.09.001DOI Listing
December 2009