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Simulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment

Kumar, Avisha; Martin, Reese; Chen, William; Bauerschmidt, Andrew; Youngblood, Mark W; Cunningham, Courtney; Si, Yang; Ezeani, Cel; Kratochvil, Zachary; Bronen, Jared; Thomson, James; Riordan, Katherine; Yoo, Ji Yeoun; Shirka, Romina; Manganas, Louis; Krestel, Heinz; Hirsch, Lawrence J; Blumenfeld, Hal
People with epilepsy face serious driving restrictions, determined using retrospective studies. To relate seizure characteristics to driving impairment, we aimed to study driving behavior during seizures with a simulator. Patients in the Yale New Haven Hospital undergoing video-electroencephalographic monitoring used a laptop-based driving simulator during ictal events. Driving function was evaluated by video review and analyzed in relation to seizure type, impairment of consciousness/responsiveness, or motor impairment during seizures. Fifty-one seizures in 30 patients were studied. In terms of seizure type, we found that focal to bilateral tonic-clonic or myoclonic seizures (5/5) and focal seizures with impaired consciousness/responsiveness (11/11) always led to driving impairment; focal seizures with spared consciousness/responsiveness (0/10) and generalized nonmotor (generalized spike-wave bursts; 1/19) usually did not lead to driving impairment. Regardless of seizure type, we found that seizures with impaired consciousness (15/15) or with motor involvement (13/13) always led to impaired driving, but those with spared consciousness (0/20) or spared motor function (5/38) usually did not. These results suggest that seizure types with impaired consciousness/responsiveness and abnormal motor function contribute to impaired driving. Expanding this work in a larger cohort could further determine how results with a driving simulator may translate into real world driving safety.
PMID: 34816425
ISSN: 1528-1167
CID: 5391242

Author Correction: BASP1 labels neural stem cells in the neurogenic niches of mammalian brain

Manganas, Louis N; Durá, Irene; Osenberg, Sivan; Semerci, Fatih; Tosun, Mehmet; Mishra, Rachana; Parkitny, Luke; Encinas, Juan M; Maletic-Savatic, Mirjana
PMID: 34608270
ISSN: 2045-2322
CID: 5391222

BASP1 labels neural stem cells in the neurogenic niches of mammalian brain

Manganas, Louis N; Durá, Irene; Osenberg, Sivan; Semerci, Fatih; Tosun, Mehmet; Mishra, Rachana; Parkitny, Luke; Encinas, Juan M; Maletic-Savatic, Mirjana
The mechanisms responsible for determining neural stem cell fate are numerous and complex. To begin to identify the specific components involved in these processes, we generated several mouse neural stem cell (NSC) antibodies against cultured mouse embryonic neurospheres. Our immunohistochemical data showed that the NSC-6 antibody recognized NSCs in the developing and postnatal murine brains as well as in human brain organoids. Mass spectrometry revealed the identity of the NSC-6 epitope as brain abundant, membrane-attached signal protein 1 (BASP1), a signaling protein that plays a key role in neurite outgrowth and plasticity. Western blot analysis using the NSC-6 antibody demonstrated multiple BASP1 isoforms with varying degrees of expression and correlating with distinct developmental stages. Herein, we describe the expression of BASP1 in NSCs in the developing and postnatal mammalian brains and human brain organoids, and demonstrate that the NSC-6 antibody may be a useful marker of these cells.
PMID: 33692421
ISSN: 2045-2322
CID: 5391212

Parkinson's Disease With Visual Hallucinations Is Associated With Epileptiform Activity on EEG

Fry, Adam; Singh, Dharampreet; Manganas, Louis; Gordon, Marc L; Christodoulou, Christopher; Leung, Hoi-Chung; Schwartz, Guy J
PMCID:8787040
PMID: 35087470
ISSN: 1664-2295
CID: 5391252

Multiple Cranial Nerve Palsies in a Pediatric Case of Lemierre's Syndrome due to Streptococcus viridans [Case Report]

Novotny, Samantha; Serrano, Kenneth; Bazer, Danielle; Manganas, Louis
BACKGROUND:infection, atypical cases associated with other pathogens have been reported. OBJECTIVE:. Both antibiotics and anticoagulation were effective management for this Lemierre's syndrome patient with cavernous sinus thrombosis. Early diagnosis and treatment of Lemierre's syndrome is essential. A multidisciplinary treatment team is beneficial for managing the sequelae of this condition.
PMCID:8564190
PMID: 34745672
ISSN: 2090-6668
CID: 5391232

A Systematic Review of the Efficacy of Levetiracetam in Neonatal Seizures

McHugh, Daryl C; Lancaster, Shannon; Manganas, Louis N
OBJECTIVE:Seizures are the most common neurological complication in neonatal intensive care units. Phenobarbital (PB) remains the first-line antiepileptic drug (AED) for neonatal seizures despite known neurotoxicity. Levetiracetam (LEV) is a newer AED not approved for neonates. Retrospective and pilot studies have investigated the use of LEV in neonatal seizures. Our objective was to compare the efficacy of LEV to PB in neonatal seizures based upon published data. METHODS:We searched PubMed to perform a systematic review. We found no studies of LEV with comparison or control groups; therefore, we utilized data from two randomized controlled trials of PB as our comparison group. RESULTS:Five studies of LEV met all inclusion/exclusion criteria. The pooled sample size for LEV was 102 (48 received primary LEV, 54 received secondary LEV). The pooled sample size for primary PB was 52. Complete or near-complete seizure cessation was achieved as follows: primary LEV 37/48 (77%), secondary LEV 34/54 (63%), and primary PB 24/52 (46%). CONCLUSION:Our findings suggest that LEV may be at least as or more effective for neonatal seizures as PB. Our review, though limited, is the first to examine LEV efficacy compared with PB in neonates.
PMID: 29179233
ISSN: 1439-1899
CID: 5391202

A novel inherited SCN1A mutation associated with GEFS+ in benign and encephalopathic epilepsy [Case Report]

Gauthier, Angela C; Manganas, Louis N; Mattson, Richard H
Generalized epilepsy with febrile seizures plus (GEFS+) is an autosomal dominant condition often caused by mutations in SCN1A that usually first manifests as childhood simple febrile seizures but may progress to a variety of afebrile generalized seizure types. Here, we describe the case of an 8-year-old boy with a novel SCN1A mutation who developed febrile seizures at 10months of age which eventually advanced to frequent afebrile tonic-clonic seizures. His condition was unresponsive to several antiepileptic drugs and the ketogenic diet, and he experienced gradual cognitive decline. The patient's father carries the same novel mutation, but he only experienced childhood simple febrile seizures. SCN1A mutations display incomplete penetrance and variable expressivity, and the resulting severity may depend on the location and type of mutation, whether the mutation was spontaneous or inherited, and the effect of modifying alleles. The identification of novel pathogenic SCN1A mutations may eventually advance therapeutic development and prognostic capabilities.
PMID: 28262406
ISSN: 1532-2653
CID: 5391182

Case 1: Vertigo and Episodes of Slurred Speech in a 5-year-old Girl [Case Report]

Malhotra, Ashwin; Manganas, Louis; Downs, Traci; Chang, Sunny; Chandran, Latha
PMID: 28364049
ISSN: 1526-3347
CID: 5391192

Undiagnosed Coarctation of the Aorta and Cerebral Infarction [Case Report]

Kaur, Gurcharanjeet; Peyster, Robert G; Manganas, Louis N
PMID: 27839824
ISSN: 1873-5150
CID: 5391172

Clinical Correlates and Prognostic Significance of Lateralized Periodic Discharges in Patients Without Acute or Progressive Brain Injury: A Case-Control Study

Sainju, Rup K; Manganas, Louis N; Gilmore, Emily J; Petroff, Ognen A; Rampal, Nishi; Hirsch, Lawrence J; Gaspard, Nicolas
PURPOSE/OBJECTIVE:Lateralized periodic discharges (LPDs, also known as periodic lateralized epileptiform discharges) in conjunction with acute brain injuries are known to be associated with worse prognosis but little is known about their importance in absence of such acute injuries. We studied the clinical correlates and outcome of patients with LPDs in the absence of acute or progressive brain injury. METHODS:This is a case-control study of 74 patients with no acute brain injury undergoing continuous EEG monitoring, half with LPDs and half without, matched for age and etiology of remote brain injury, if any, or history of epilepsy. RESULTS:Lateralized periodic discharges were found in 145/1785 (8.1%) of subjects; 37/145 (26%) had no radiologic evidence of acute or progressive brain injury. Those with LPDs were more likely to have abnormal consciousness (86% vs. 57%; P = 0.005), seizures (70% vs. 24%; P = 0.0002), and functional decline (62% vs. 27%; P = 0.005), and were less likely to be discharged home (24% vs. 62%; P = 0.002). On multivariate analysis, LPDs and status epilepticus were associated with abnormal consciousness (P = 0.009; odds ratio = 5.2, 95% CI = 1.60-20.00 and P = 0.017; odds ratio = 5.0, 95% CI = 1.4-21.4); and LPDs were independently associated with functional decline (P = 0.001; odds ratio = 4.8, 95% CI = 1.6-15.4) and lower likelihood of being discharged home (P = 0.009; odds ratio = 0.2, 95% CI = 0.04-0.6). CONCLUSIONS:Despite absence of acute or progressive brain injury, LPDs were independently associated with abnormal consciousness and worse outcome at hospital discharge.
PMID: 26200591
ISSN: 1537-1603
CID: 5391162