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Responsive Neurostimulation for People With Drug-Resistant Epilepsy and Autism Spectrum Disorder

Fields, Madeline C; Marsh, Christina; Eka, Onome; Johnson, Emily A; Marcuse, Lara V; Kwon, Churl-Su; Young, James J; LaVega-Talbott, Maite; Kurukumbi, Mohankumar; Von Allmen, Gretchen; Zempel, John; Friedman, Daniel; Jette, Nathalie; Singh, Anuradha; Yoo, Ji Yeoun; Blank, Leah; Panov, Fedor; Ghatan, Saadi
PURPOSE/OBJECTIVE:Individuals with autism spectrum disorder (ASD) have comorbid epilepsy at much higher rates than the general population, and about 30% will be refractory to medication. Patients with drug-resistant epilepsy (DRE) should be referred for surgical evaluation, yet many with ASD and DRE are not resective surgical candidates. The aim of this study was to examine the response of this population to the responsive neurostimulator (RNS) System. METHODS:This multicenter study evaluated patients with ASD and DRE who underwent RNS System placement. Patients were included if they had the RNS System placed for 1 year or more. Seizure reduction and behavioral outcomes were reported. Descriptive statistics were used for analysis. RESULTS:Nineteen patients with ASD and DRE had the RNS System placed at 5 centers. Patients were between the ages of 11 and 29 (median 20) years. Fourteen patients were male, whereas five were female. The device was implanted from 1 to 5 years. Sixty-three percent of all patients experienced a >50% seizure reduction, with 21% of those patients being classified as super responders (seizure reduction >90%). For the super responders, two of the four patients had the device implanted for >2 years. The response rate was 70% for those in whom the device was implanted for >2 years. Improvements in behaviors as measured by the Clinical Global Impression Scale-Improvement scale were noted in 79%. No complications from the surgery were reported. CONCLUSIONS:Based on the authors' experience in this small cohort of patients, the RNS System seems to be a promising surgical option in people with ASD-DRE.
PMID: 35512185
ISSN: 1537-1603
CID: 5216342

The Sensitivity of Scalp EEG at Detecting Seizures-A Simultaneous Scalp and Stereo EEG Study

Casale, Marc J; Marcuse, Lara V; Young, James J; Jette, Nathalie; Panov, Fedor E; Bender, H Allison; Saad, Adam E; Ghotra, Ravi S; Ghatan, Saadi; Singh, Anuradha; Yoo, Ji Yeoun; Fields, Madeline C
PURPOSE/OBJECTIVE:Compare the detection rate of seizures on scalp EEG with simultaneous intracranial stereo EEG (SEEG) recordings. METHODS:Twenty-seven drug-resistant epilepsy patients undergoing SEEG with simultaneous scalp EEG as part of their surgical work-up were included. A total of 172 seizures were captured. RESULTS:Of the 172 seizures detected on SEEG, 100 demonstrated scalp ictal patterns. Focal aware and subclinical seizures were less likely to be seen on scalp, with 33% of each observed when compared with focal impaired aware (97%) and focal to bilateral tonic-clonic seizures (100%) (P < 0.001). Of the 72 seizures without ictal scalp correlate, 32 demonstrated an abnormality during the SEEG seizure that was identical to an interictal abnormality. Seizures from patients with MRI lesions were statistically less likely to be seen on scalp than seizures from nonlesional patients (P = 0.0162). Stereo EEG seizures not seen on scalp were shorter in duration (49 seconds) compared with SEEG seizures seen on scalp (108.6 seconds) (P < 0.001). CONCLUSIONS:Scalp EEG is not a sensitive tool for the detection of focal aware and subclinical seizures but is highly sensitive for the detection of focal impaired aware and focal to bilateral tonic-clonic seizures. Longer duration of seizure and seizures from patients without MRI lesions were more likely to be apparent on scalp. Abnormalities seen interictally may at times represent an underlying seizure. The cognitive, affective, and behavioral long-term effects of ongoing difficult-to-detect seizures are not known.
PMID: 32925173
ISSN: 1537-1603
CID: 4592542

International Post Stroke Epilepsy Research Consortium (IPSERC): A consortium to accelerate discoveries in preventing epileptogenesis after stroke [Editorial]

Mishra, Nishant K; Engel, Jerome; Liebeskind, David S; Sharma, Vijay K; Hirsch, Lawrence J; Kasner, Scott E; French, Jacqueline A; Devinsky, Orrin; Friedman, Alon; Dawson, Jesse; Quinn, Terence J; Selim, Magdy; de Havenon, Adam; Yasuda, Clarissa L; Cendes, Fernando; Benninger, Felix; Zaveri, Hitten P; Burneo, Jorge G; Srivastava, Padma; Bhushan Singh, Mamta; Bhatia, Rohit; Vishnu, V Y; Bentes, Carla; Ferro, Jose; Weiss, Shennan; Sivaraju, Adithya; Kim, Jennifer A; Galovic, Marian; Gilmore, Emily J; Pitkänen, Asla; Davis, Kathryn; Sansing, Lauren H; Sheth, Kevin N; Paz, Jeanne T; Singh, Anuradha; Sheth, Sunil; Worrall, Bradford B; Grotta, James C; Casillas-Espinos, Pablo M; Chen, Zhibin; Nicolo, John-Paul; Yan, Bernard; Kwan, Patrick
PMID: 34968775
ISSN: 1525-5069
CID: 5108272

Utility of 7 tesla MRI brain in 16 "MRI Negative" epilepsy patients and their surgical outcomes

Sharma, Himanshu K; Feldman, Rebecca; Delman, Bradley; Rutland, John; Marcuse, Lara V; Fields, Madeline C; Ghatan, Saadi; Panov, Fedor; Singh, Anuradha; Balchandani, Priti
The objective is to quantitatively assess surgical outcomes in epilepsy patients who underwent scanning at 7T MRI whose lesions were undetectable at conventional field strengths (1.5T/3T). 16 patients who underwent an initial 1.5T/3T scan that was marked as non-lesional by a neuroradiologist and were candidates for epilepsy surgery were scanned at 7T. The 7T findings were evaluated by an expert neuroradiologist blinded to the suspected seizure onset zone (sSOZ). The relation of the neuroradiologist's findings compared with the sSOZ was classified as non-definite (no 7T lesion or lesion of no epileptogenic significance, or lesion of epileptogenic potential which localizes to the patient's sSOZ but is not the definitive cause), or definite (7T lesion of epileptogenic potential that highly localizes to the sSOZ and is confirmed through surgical intervention).. Each patient underwent neurosurgical intervention and postoperative Engel outcomes were obtained through retrospective chart review by an epileptologist. Of the 16 patients, 7 had imaging findings of definite epileptogenic potential at 7T while 9 had non-definite imaging findings. 15 out of 16 patients had Engel I, II, or III outcomes indicating worthwhile improvement. Patients with definite lesion status achieved Engel I surgical outcomes at higher rates (57.1%) than patients with non-definite lesion status (33.3%). Patients with normal clinical diagnostic scans at lower field strengths who have definite radiological findings on 7T corresponding to the sSOZ may experience worthwhile improvement from surgical intervention.
PMCID:7820379
PMID: 33521618
ISSN: 2589-9864
CID: 4775872

Comparative transcriptomic and metabolic analysis of wild and domesticated wheat genotypes reveals differences in chemical and physical defense responses against aphids

Batyrshina, Zhaniya S; Yaakov, Beery; Shavit, Reut; Singh, Anuradha; Tzin, Vered
BACKGROUND:Young wheat plants are continuously exposed to herbivorous insect attack. To reduce insect damage and maintain their growth, plants evolved different defense mechanisms, including the biosynthesis of deterrent compounds named benzoxazinoids, and/or trichome formation that provides physical barriers. It is unclear whether both of these mechanisms are equally critical in providing an efficient defense for wheat seedlings against aphids-an economically costly pest in cereal production. RESULTS:In this study, we compared the transcriptome, metabolome, benzoxazinoids, and trichome density of three selected wheat genotypes, with a focus on differences related to defense mechanisms. We chose diverse wheat genotypes: two tetraploid wheat genotypes, domesticated durum 'Svevo' and wild emmer 'Zavitan,' and one hexaploid bread wheat, 'Chinese Spring.' The full transcriptomic analysis revealed a major difference between the three genotypes, while the clustering of significantly different genes suggested a higher similarity between the two domesticated wheats than between either and the wild wheat. A pathway enrichment analysis indicated that the genes associated with primary metabolism, as well as the pathways associated with defense such as phytohormones and specialized metabolites, were different between the three genotypes. Measurement of benzoxazinoid levels at the three time points (11, 15, and 18 days after germination) revealed high levels in the two domesticated genotypes, while in wild emmer wheat, they were below detection level. In contrast to the benzoxazinoid levels, the trichome density was dramatically higher in the wild emmer than in the domesticated wheat. Lastly, we tested the bird cherry-oat aphid's (Rhopalosiphum padi) performance and found that Chinese Spring is more resistant than the tetraploid genotypes. CONCLUSIONS:Our results show that benzoxazinoids play a more significant defensive role than trichomes. Differences between the abundance of defense mechanisms in the wild and domesticated plants were observed in which wild emmer possesses high physical defenses while the domesticated wheat genotypes have high chemical defenses. These findings provide new insights into the defense adaptations of wheat plants against aphids.
PMCID:6958765
PMID: 31931716
ISSN: 1471-2229
CID: 4630152

Inflammatory theory of diseases: What has it got to do with late-onset LGS? [Editorial]

Singh, Anuradha
PMCID:6276355
PMID: 30564489
ISSN: 2163-0402
CID: 3556572

Deaths in Epilepsy: What We Are Missing

Devinsky, Orrin; Singh, Anuradha; Friedman, Daniel
PMID: 29630704
ISSN: 2168-6157
CID: 3029122

A Resident-driven Intervention To Decrease Door-to-needle Time And Increase Resident Satisfaction In A Resource-limited Setting [Meeting Abstract]

Sequeira, Alexandra J. Lloyd-Smith; Fara, Michael; McMenamy, John; Chan, Monica; Ishida, Koto; Torres, Jose; Zhang, Cen; Favate, Albert; Singh, Anuradha; Zhou, Ting; Rostanski, Sara
ISI:000453090805219
ISSN: 0028-3878
CID: 3561692

A Resident-Driven Intervention to Decrease Door-to-Needle Time and Increase Resident Satisfaction in a Resource-Limited Setting [Meeting Abstract]

Fara, Michael G; Lloyd-Smith, Alexandra J; McMenamy, John; Chan, Monica; Ishida, Koto; Torres, Jose; Zhang, Cen; Favate, Albert; Singh, Anuradha; Rostanski, Sara K
ORIGINAL:0012460
ISSN: 1524-4628
CID: 2931932

Epilepsy

Chapter by: Singh, Anuradha; Trevick, Stephen
in: Medical aspects of disability for the rehabilitation professionals by Moroz, Alex; Flanagan, Steven R; Zaretsky, Herbert H [Eds]
[New York] : Springer Publishing Company, 2017
pp. 213-228
ISBN: 9780826133199
CID: 2558842