Publications by authors named "Anca Nica"

Article Synopsis
  • The paper addresses the challenge of accurately identifying the location and electrical activity of brain sources in epilepsy using EEG recordings due to the complexity of the problem.
  • A new approach using simulation-driven deep learning is proposed, which incorporates a patient-specific model trained on high-resolution EEG simulations and utilizes neural networks to analyze spatial and temporal features.
  • The performance of this method shows significant improvements in dipole localization accuracy compared to existing deep learning and classical techniques, tested on both synthetic and real EEG data from patients with drug-resistant epilepsy.
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Identifying factors whose fluctuations are associated with choice inconsistency is a major issue for rational decision theory. Here, we investigated the neuro-computational mechanisms through which mood fluctuations may bias human choice behavior. Intracerebral EEG data were collected in a large group of subjects (n=30) while they were performing interleaved quiz and choice tasks that were designed to examine how a series of unrelated feedbacks affect decisions between safe and risky options.

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Mechanical ventilation is a last resort solution for patients presenting with acute respiratory distress syndrome produced by SARS-CoV-2. Spontaneous pneumomediastinum is a rare pathology associated with invasive mechanical ventilation. The objective of our research was to highlight the increased incidence of spontaneous pneumomediastinum during the COVID-19 pandemics in our hospital.

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Objective: The semiology of temporo-basal epilepsy has rarely been analysed in the literature. In this paper, we report three patients with proven basal temporal epilepsy with somatomotor or somatosensory facial ictal semiology, highly suggestive of insulo-opercular onset.

Methods: The three patients had a temporobasal lesion and their drugresistant epilepsy was cured with resection of the lesion (follow-up duration: 7-17 years).

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Epilepsy presurgical investigation may include focal intracortical single-pulse electrical stimulations with depth electrodes, which induce cortico-cortical evoked potentials at distant sites because of white matter connectivity. Cortico-cortical evoked potentials provide a unique window on functional brain networks because they contain sufficient information to infer dynamical properties of large-scale brain connectivity, such as preferred directionality and propagation latencies.  Here, we developed a biologically informed modelling approach to estimate the neural physiological parameters of brain functional networks from the cortico-cortical evoked potentials recorded in a large multicentric database.

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The COVID-19 pandemic has led to a marked decrease in surgical procedures performed worldwide and to numerous other changes in medical practice. We investigated the effect of these changes on surgical trainees. Method: We searched medical records and asked a total of 67 surgical residents from different specialities (general surgery, obstetrics-gynecology, orthopedics-traumatology, neurosurgery) to answer a questionnaire investigating how the total number of surgical procedures and operative role varied for each respondent during the pandemic, the number of medical congresses and handson courses they attended during this time, how much study time was available to them and how the changes in their training modules affected them.

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Aim: KCNB1 encephalopathy encompasses a broad phenotypic spectrum associating intellectual disability, behavioral disturbances, and epilepsies of various severity. Using standardized parental questionnaires, we aimed to capture the heterogeneity of the adaptive and behavioral features in a series of patients with KCNB1 pathogenic variants.

Methods: We included 25 patients with a KCNB1 encephalopathy, aged from 3.

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In this paper, a new method to track brain effective connectivity networks in the context of epilepsy is proposed. It relies on the combination of partial directed coherence with a constrained low-rank canonical polyadic tensor decomposition. With such combination being established, the most dominating directed graph structures underlying each time window of intracerebral electroencephalographic signals are optimally inferred.

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Objective: We aimed to test whether patients who died of sudden unexpected death in epilepsy (SUDEP) had an abnormal cardiac autonomic response to sympathetic stimulation by hyperventilation.

Methods: We conducted a retrospective, observational, case-control study of a group of patients who died of SUDEP and controls who were matched to the patients for epilepsy type, drug resistance, sex, age at EEG recording, age at onset of epilepsy, and duration of epilepsy. We analyzed the heart rate (HR) and HR variability (HRV) at rest and during and after hyperventilation performed during the patient's last EEG recording before SUDEP.

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Article Synopsis
  • The SEEG International Course in 2017 focused on diagnosing and surgically treating insulo-perisylvian epilepsies through a detailed case study of a patient with reflex seizures who initially showed inconclusive MRI and non-invasive investigation results.
  • A second SEEG exploration provided a clearer understanding of the patient's epileptogenic zone, which was identified in the lateral inferior premotor cortex, leading to successful tailored surgery.
  • The patient remains seizure-free for five years, experiencing no cognitive or motor deficits, although they are reliant on one antiepileptic drug (AED).
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Objective: We aimed to delineate the phenotypic spectrum and long-term outcome of individuals with KCNB1 encephalopathy.

Methods: We collected genetic, clinical, electroencephalographic, and imaging data of individuals with KCNB1 pathogenic variants recruited through an international collaboration, with the support of the family association "KCNB1 France." Patients were classified as having developmental and epileptic encephalopathy (DEE) or developmental encephalopathy (DE).

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Purpose: Posttraumatic epilepsy (PTE) is a common cause of drug-resistant epilepsy, especially in young adults. Nevertheless, such patients are not common candidates for intracranial presurgical evaluation. We investigated the role of stereoelectroencephalography (SEEG) in defining epileptogenicity and surgical strategy in patients with PTE.

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Article Synopsis
  • - Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPO), involves significant dilation of the large bowel without any mechanical blockage, primarily affecting patients in intensive care with severe underlying conditions.
  • - The exact cause of ACPO is not fully understood, but it's believed that disturbances in the autonomic nervous system can impair the colon's motor function.
  • - Early detection and treatment are crucial to prevent serious complications like ischemia or perforation, and the study aims to provide insights into effective management strategies for critically ill patients at risk of developing this condition.
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Article Synopsis
  • Burnout is a critical issue for resident doctors, particularly heightened during the COVID-19 pandemic due to increased stress and workload.
  • The article reviews literature on burnout in medical residents and explains its prevalence across different specialties, revealing that some are at higher risk.
  • It also discusses a study conducted in a non-Covid emergency hospital in Romania, exploring the impact of burnout and suggesting potential solutions to alleviate this growing concern.
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Article Synopsis
  • Developmental and epileptic encephalopathies (DEE) are complex neurodevelopmental disorders linked to various genetic variations, with recent focus on KCNB1 gene mutations.
  • This study reviews 37 patients with KCNB1 variants, identifying 18 novel mutations and emphasizing the presence of mostly de novo missense changes affecting key protein regions.
  • Patients frequently experience severe neurodevelopmental issues, particularly language and behavioral challenges, with 85% developing epilepsy; notably, those with truncating variants have milder symptoms.
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The population of France and the world is aging with an increase in the population of people aged over 65 years old. Old people are the second largest population affected by seizures. Hence, neurologists and geriatricians have to be able to identify and treat elderly that suffer from seizures.

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Epilepsy treatment in the elderly.

Geriatr Psychol Neuropsychiatr Vieil

March 2019

Article Synopsis
  • The global population is aging, leading to an increase in elderly patients with epilepsy, which brings about unique challenges in diagnosis and treatment.
  • Age-related physiological changes affect drug metabolism, and many elderly patients have multiple health issues (comorbidities) that complicate their treatment regimens.
  • While new anti-epileptic drugs have shown better tolerance and compliance and require less complex monitoring, managing epilepsy in older adults remains intricate, allowing for more tailored treatment approaches.
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In patients with pharmaco-resistant focal epilepsies investigated with intracranial electroencephalography (iEEG), direct electrical stimulations of a cortical region induce cortico-cortical evoked potentials (CCEP) in distant cerebral cortex, which properties can be used to infer large scale brain connectivity. In 2013, we proposed a new probabilistic functional tractography methodology to study human brain connectivity. We have now been revisiting this method in the F-TRACT project (f-tract.

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Objective: In this study we aim to identify the key (patho)physiological mechanisms and biophysical factors which impact the observability and spectral features of High Frequency Oscillations (HFOs).

Methods: In order to accurately replicate HFOs we developed virtual-brain/virtual-electrode simulation environment combining novel neurophysiological models of neuronal populations with biophysical models for the source/sensor relationship. Both (patho)physiological mechanisms (synaptic transmission, depolarizing GABA effect, hyperexcitability) and physical factors (geometry of extended cortical sources, size and position of electrodes) were taken into account.

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The interpretation of SEEG recordings is a crucial step. It must be carried out by an epileptologist/neurophysiologist with sufficient training and qualification in this field. The objectives of the interpretation are to define the brain topography of interictal activities (irritative zone) and the epileptogenic zone, defined as the site of primary organization of ictal discharges.

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Article Synopsis
  • Stereoelectroencephalography (SEEG), developed in the 1960s in France, is an invasive technique used for evaluating drug-resistant focal epilepsy, providing detailed three-dimensional insights into epileptic activity.
  • Recently, its usage has expanded globally, transitioning from a purely diagnostic tool to also offering therapeutic options like thermocoagulation.
  • A working group of French experts formulated clinical practice guidelines covering topics such as indications, management, surgical techniques, and interpretation of SEEG, aiming to establish a standardized approach for centers adopting SEEG, especially those new to the method.
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Article Synopsis
  • High-frequency oscillations (HFOs) are recognized as potential markers for identifying epileptogenic tissues in the brain but their effectiveness in individual patients is less understood.
  • In a study analyzing SEEG data from 30 patients, researchers compared the predictive abilities of HFOs and spikes for determining seizure onset zones (SOZ).
  • The findings indicated that HFOs alone weren't superior to spikes, but combining HFOs and spikes using a cross-rate measure improved predictive accuracy for identifying epileptogenic regions.
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Objective: We aimed to (1) assess the concordance between various polymicrogyria (PMG) types and the associated epileptogenic zone (EZ), as defined by stereoelectroencephalography (SEEG), and (2) determine the postsurgical seizure outcome in PMG-related drug-resistant epilepsy.

Methods: We retrospectively analyzed 58 cases: 49 had SEEG and 39 corticectomy or hemispherotomy.

Results: Mean age at SEEG or surgery was 28.

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Appendiceal diverticulitis is a very rare cause for pain in the right iliac fossa. Whether it is simptomatic or discovered randomly during an appendectomy or barium enema, understanding its clinical evolution is important for having a good management. In this report we present the case of a 50 year old female who underwent an open appendectomy during which we discovered appendiceal diverticulitis.

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Goal: Interictal high-frequency oscillations (HFOs [30-600 Hz]) have proven to be relevant biomarkers in epilepsy. In this paper, four categories of HFOs are considered: Gamma ([30-80 Hz]), high-gamma ([80-120 Hz]), ripples ([120-250 Hz]), and fast-ripples ([250-600 Hz]). A universal detector of the four types of HFOs is proposed.

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