Perampanel for epilepsy with partial-onset seizures: a pharmacokinetic and pharmacodynamic evaluation.

Introduction: Epilepsies are among the most common diseases of the CNS. As available antiepileptic drugs do not successfully control seizures in one-third of these patients, the development of drugs with new mechanisms of action is an urgent requirement.

Areas Covered: Preclinical and clinical data of the recently released antiepileptic drug perampanel are reviewed based on search in medical databases with special reference to its mechanism of action and to its pharmacokinetic properties relevant for clinical treatment.

Collaborating and sharing data in epilepsy research.

Technological advances are dramatically advancing translational research in Epilepsy. Neurophysiology, imaging, and metadata are now recorded digitally in most centers, enabling quantitative analysis. Basic and translational research opportunities to use these data are exploding, but academic and funding cultures prevent this potential from being realized.

Early Seizure Detection Algorithm Based on Intracranial EEG and Random Forest Classification.

The goal of this study is to provide a seizure detection algorithm that is relatively simple to implement on a microcontroller, so it can be used for an implantable closed loop stimulation device. We propose a set of 11 simple time domain and power bands features, computed from one intracranial EEG contact located in the seizure onset zone. The classification of the features is performed using a random forest classifier.

Selective amygdalohippocampectomy versus standard temporal lobectomy in patients with mesiotemporal lobe epilepsy and unilateral hippocampal sclerosis: post-operative facial emotion recognition abilities.

Surgical treatment of mesial temporal lobe epilepsy (mTLE) patients involves the removal either of the left or the right hippocampus. Since the mesial temporal lobe is responsible for emotion recognition abilities, we aimed to assess facial emotion recognition (FER) in two homogeneous patient cohorts that differed only in the administered surgery design since anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH) were performed independently of the underlying electroclinical conditions. The patient selection for the two respective surgical procedures was carried out retrospectively between 2000 and 2009 by two independent epilepsy centres, the Kork Epilepsy Centre, Germany and the University Hospital of Strasbourg, France.

Temporal and spatial characteristics of high frequency oscillations as a new biomarker in epilepsy.

Objective: Interictal high frequency oscillations (HFOs) are a promising candidate as a biomarker in epilepsy as well as for defining the seizure-onset zone as for the prediction of the surgical outcome after epilepsy surgery. The purpose of the study is to investigate properties of HFOs in long-term recordings with respect to the sleep-wake cycle and anatomic regions to verify previous results based on observations from short intervals and patients mainly with temporal lobe epilepsy to the analysis of hours of recordings and focal epilepsies with extratemporal origin.

Methods: Automatic HFO detection using a radial basis function neural network detector was performed in long-term recordings of 15 presurgical patients investigated with subdural strip, grid, and depth contacts.

Long-term seizure outcome in 211 patients with focal cortical dysplasia.

Objective: Focal cortical dysplasia (FCD) is currently recognized as the most common cause of neocortical pharmacoresistant epilepsy. Epilepsy surgery has become an increasingly successful treatment option. Herein, the largest patient cohort reported to date is analyzed regarding long-term outcome and factors relevant for long-term seizure control.

Negative BOLD in default-mode structures measured with EEG-MREG is larger in temporal than extra-temporal epileptic spikes.

Introduction: EEG-fMRI detects BOLD changes associated with epileptic interictal discharges (IED) and can identify epileptogenic networks in epilepsy patients. Besides positive BOLD changes, negative BOLD changes have sometimes been observed in the default-mode network, particularly using group analysis. A new fast fMRI sequence called MREG (Magnetic Resonance Encephalography) shows increased sensitivity to detect IED-related BOLD changes compared to the conventional EPI sequence, including frequent occurrence of negative BOLD responses in the DMN.

Electrical stimulation for cortical mapping reduces the density of high frequency oscillations.

Background: High frequency oscillations (HFOs, 80-500 Hz) are EEG biomarkers for epileptogenic areas. HFOs are also indicators of disease activity as HFO rates increase after reduction of antiepileptic medication. Electrical stimulation (ES) can be used for diagnostic purposes as well as therapy in patients with refractory epilepsy.

Memory outcome one year after stereotactic interstitial radiosurgery in patients with epilepsy due to hypothalamic hamartomas.

Epileptic seizures caused by hypothalamic hamartomas (HHs) are highly pharmacoresistant. Resective surgical approaches have shown some efficacy in controlling seizures; however, they bear a significant risk of postoperative mnemonic deterioration due to the close anatomical proximity of the HHs to structures essential for memory functions. We report on cognitive outcome in 26 patients with structural epilepsy due to HHs one year after interstitial radiosurgery.

From speech to thought: the neuronal basis of cognitive units in non-experimental, real-life communication investigated using ECoG.

Exchange of thoughts by means of expressive speech is fundamental to human communication. However, the neuronal basis of real-life communication in general, and of verbal exchange of ideas in particular, has rarely been studied until now. Here, our aim was to establish an approach for exploring the neuronal processes related to cognitive "idea" units (IUs) in conditions of non-experimental speech production.

The preoperative evaluation and surgical treatment of epilepsy.

Background: One-third of all patients with epilepsy have persistent seizures despite medical treatment. If the origin of the seizures can be localized to a particular site in the brain, epilepsy surgery is a treatment option that addresses the cause of the problem.

Method: The presurgical assessment and surgical treatment of epilepsy are discussed on the basis of a selective literature review and the authors' clinical experience.

A multicenter survey of clinical experiences with perampanel in real life in Germany and Austria.

Perampanel (PER) has been approved by the European Medicines Agency (EMA) for adjunctive treatment of patients with partial-onset seizures from age 12 years on. It has been introduced to the market in Germany and Austria in 2012. This cross-sectional observational study summarizes the clinical experience of nine centers with adjunctive PER.

Slow modulations of high-frequency activity (40-140-Hz) discriminate preictal changes in human focal epilepsy.

Recent evidence suggests that some seizures are preceded by preictal changes that start from minutes to hours before an ictal event. Nevertheless an adequate statistical evaluation in a large database of continuous multiday recordings is still missing. Here, we investigated the existence of preictal changes in long-term intracranial recordings from 53 patients with intractable partial epilepsy (in total 531 days and 558 clinical seizures).

Verbal fluency in focal epilepsy: a systematic review and meta-analysis.

Testing of verbal fluency is currently part of standard presurgical neuropsychological assessment for patients with focal epilepsy. However, to date no systematic review has been conducted on semantic (SVF) and phonemic verbal fluency (PVF) in this patient group. The present review compares verbal fluency between healthy control subjects and subgroups of adult presurgical patients with focal epilepsy according to lateralisation and localisation of the dysfunction.

Epileptic seizure predictors based on computational intelligence techniques: a comparative study with 278 patients.

The ability of computational intelligence methods to predict epileptic seizures is evaluated in long-term EEG recordings of 278 patients suffering from pharmaco-resistant partial epilepsy, also known as refractory epilepsy. This extensive study in seizure prediction considers the 278 patients from the European Epilepsy Database, collected in three epilepsy centres: Hôpital Pitié-là-Salpêtrière, Paris, France; Universitätsklinikum Freiburg, Germany; Centro Hospitalar e Universitário de Coimbra, Portugal. For a considerable number of patients it was possible to find a patient specific predictor with an acceptable performance, as for example predictors that anticipate at least half of the seizures with a rate of false alarms of no more than 1 in 6 h (0.

Visualization of the amygdalo-hippocampal border and its structural variability by 7T and 3T magnetic resonance imaging.

The amygdala and the hippocampus are two adjacent structures in the medial temporal lobe that have been broadly investigated in functional and structural neuroimaging due to their central importance in sensory perception, emotion, and memory. Exact demarcation of the amygdalo-hippocampal border (AHB) is, however, difficult in conventional structural imaging. Recent evidence suggests that, due to this difficulty, functional activation sites with high probability of being located in the hippocampus may erroneously be assigned to the amygdala, and vice versa.

Epilepsy surgery for glioneuronal tumors in childhood: avoid loss of time.

Background: In contrast to the abundance of seizure outcome reports in epilepsy surgery for glioneuronal tumors in childhood and adolescence, there is a dearth of information regarding cognitive outcomes.

Objective: To investigate the seizure and cognitive outcome of children and adolescents that underwent resective surgery for glioneuronal tumor-associated refractory epilepsy and determine their predictive factors.

Methods: We retrospectively analyzed the presurgical findings, resection types, and outcomes over 1.

[Visual field defects after epilepsy surgery: implications for driving license tenure].

Background: Epilepsy surgery is an effective and established therapy in medically uncontrollable seizure disorders. In the course of such operations lesions of the visual pathway are often unavoidable. The resultant visual field defects can conflict with the legal requirements for a driving license.

Simultaneous subdural and scalp EEG correlates of frontal lobe epileptic sources.

Objective: To assess the visibility and detectability in scalp electroencephalography (EEG) of cortical sources in frontal lobe epilepsy (FLE) as to their localization, and the extent and amplitude of activation.

Methods: We analyzed the simultaneous subdural and scalp interictal EEG recordings of 14 patients with refractory frontal lobe epilepsy (FLE) associated with focal cortical dysplasia. Subdural spike types were identified and averaged for source localization and detection of their scalp EEG correlates.

Differentiation of specific ripple patterns helps to identify epileptogenic areas for surgical procedures.

Objective: High frequency oscillations (HFOs) at 80-500 Hz are promising markers of epileptic areas. Several retrospective studies reported that surgical removal of areas generating HFOs was associated with a good seizure outcome. Recent reports suggested that ripple (80-200 Hz) HFO patterns co-existed with different background EEG activities.

Neural activity in human hippocampal formation reveals the spatial context of retrieved memories.

In many species, spatial navigation is supported by a network of place cells that exhibit increased firing whenever an animal is in a certain region of an environment. Does this neural representation of location form part of the spatiotemporal context into which episodic memories are encoded? We recorded medial temporal lobe neuronal activity as epilepsy patients performed a hybrid spatial and episodic memory task. We identified place-responsive cells active during virtual navigation and then asked whether the same cells activated during the subsequent recall of navigation-related memories without actual navigation.

Disorganization of neocortical lamination in focal cortical dysplasia is brain-region dependent: evidence from layer-specific marker expression.

Background: Focal cortical dysplasias (FCD) are local disturbances of neocortical architecture and a common cause of pharmaco-resistant focal epilepsy. Little is known about the pathomechanisms leading to architectural abnormalities associated with FCD.

Results: In the present study we compared 52 FCD cases originating from the frontal or temporal lobe with or without Ammon's horn sclerosis (AHS) with regard to structural and molecular differences.