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Christian Hoppe, Juri-Alexander Witt, Christoph Helmstaedter, Thomas Gasser, Hartmut Vatter, Christian E Elger
Besides other innovative stereotactic procedures (radiofrequency thermocoagulation, focused ultrasound, gamma knife) laser interstitial thermotherapy (LiTT) provides minimally invasive destruction of pathological soft tissues which could be especially relevant for epilepsy surgeries involving adult and pediatric patients. Unlike standard resections, no craniotomy is required; just a tiny borehole trepanation is sufficient. Damage to cortical areas when accessing deep lesions can be minimized or completely avoided, and treating epileptogenic foci near eloquent or even vital brain areas becomes possible...
April 6, 2017: Seizure: the Journal of the British Epilepsy Association
Juri-Alexander Witt, Christoph Helmstaedter
No abstract text is available yet for this article.
March 27, 2017: Expert Opinion on Pharmacotherapy
Luke Edward Rogerson, Christian Behrens, Thomas Euler, Philipp Berens, Timm Schubert
Photoreceptors form a sophisticated synaptic complex with bipolar and horizontal cells, transmitting the signals generated by the phototransduction cascade to downstream retinal circuitry. The cone photoreceptor synapse shows several characteristic anatomical connectivity motifs that shape signal transfer: Typically, ON-cone bipolar cells receive photoreceptor input through invaginating synapses; OFF-cone bipolar cells form basal synapses with photoreceptors. Both ON- and OFF-cone bipolar cells are believed to sample from all cone photoreceptors within their dendritic span...
March 10, 2017: Journal of Physiology
Christoph Helmstaedter, Juri-Alexander Witt
Cognitive comorbidities are very common in epilepsy and often seen as secondary to epilepsy or caused by epilepsy. The implicit and sometimes explicit assumption is that epilepsy (i.e. having seizures) damages the brain and thus leads to functional deterioration and behavioral alterations. This article highlights the historical background surrounding this viewpoint which is characterized by old reports on 'epileptic dementia' and the fact that most cognitive research in chronic epilepsies is done retrospectively...
March 1, 2017: Seizure: the Journal of the British Epilepsy Association
C Hoppe, J-A Witt, C Helmstaedter, T Gasser, H Vatter, C E Elger
In common with other stereotactic procedures, stereotactic laser thermocoagulation (SLT) promises gentle destruction of pathological tissue, which might become especially relevant for epilepsy surgery in the future. Compared to standard resection, no large craniotomy is necessary, cortical damage during access to deep-seated lesions can be avoided and interventions close to eloquent brain areas become possible. We describe the history and rationale of laser neurosurgery as well as the two available SLT systems (Visualase® and NeuroBlate®; CE marks pending)...
February 10, 2017: Der Nervenarzt
Barbara Blachut, Christian Hoppe, Rainer Surges, Christian Elger, Christoph Helmstaedter
PURPOSE: Self-reported seizure counts of patients with epilepsy guide individual treatment decisions and often represent the primary outcome measure of pharmacological trial in epileptology. The validity of these data has recently been challenged and the question is whether this applies to participants of clinical studies as well. Here we compared self-estimated seizure counting and documentation accuracy in participants and nonparticipants of former epilepsy clinical drug trials. METHODS: Adult participants (N=100) from a total of twenty-two phase II, III or IV clinical drug studies performed at our unit (2002-2015) underwent a structured telephone interview on self-estimated seizure awareness and seizure documentation accuracy...
February 2017: Epilepsy & Behavior: E&B
Juri-Alexander Witt, Christoph Helmstaedter
PURPOSE OF REVIEW: This review provides an update and summary of recent neuropsychological findings in epilepsy focusing on three major clinical topics among the many developments in the field. We will critically outline the current state with regard to cognition in new-onset epilepsies, social cognition in epilepsy, and the long-term outcome of epilepsy surgery and the cognitive outcomes of superselective surgical procedures. RECENT FINDINGS: Current studies indicate that neuropsychological impairments are prevalent already at the onset of epilepsy and even before, social cognition (i...
April 2017: Current Opinion in Neurology
Viola Lara Vogt, Marja Äikiä, Antonio Del Barrio, Paul Boon, Csaba Borbély, Ema Bran, Kees Braun, Evelien Carette, Maria Clark, Judith Helen Cross, Petia Dimova, Daniel Fabo, Nikolaos Foroglou, Stefano Francione, Anna Gersamia, Antonio Gil-Nagel, Alla Guekht, Sue Harrison, Hrvoje Hecimovic, Einar Heminghyt, Edouard Hirsch, Alena Javurkova, Reetta Kälviäinen, Nicole Kavan, Anna Kelemen, Vasilios K Kimiskidis, Margarita Kirschner, Catherine Kleitz, Teia Kobulashvili, Mary H Kosmidis, Selin Yagci Kurtish, Mathieu Lesourd, Sofia Ljunggren, Morten Ingvar Lossius, Kristina Malmgren, Ruta Mameniskiené, Patricia Martin-Sanfilippo, Petr Marusic, Marijke Miatton, Çiğdem Özkara, Federica Pelle, Guido Rubboli, Sarah Rudebeck, Philippe Ryvlin, Monique van Schooneveld, Elisabeth Schmid, Pia-Magdalena Schmidt, Margitta Seeck, Bernhard J Steinhoff, Sara Shavel-Jessop, Oana Tarta-Arsene, Eugen Trinka, Gerd Viggedal, Anne-Sophie Wendling, Juri-Alexander Witt, Christoph Helmstaedter
We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup...
January 9, 2017: Epilepsia
N Hansen, G Widman, J-A Witt, J Wagner, A J Becker, C E Elger, C Helmstaedter
OBJECTIVE: To determine the efficacy of immunotherapy in limbic encephalitis (LE) associated epilepsies with autoantibodies against intracellular antigens in the forms of paraneoplastic autoantibodies versus glutamic acid decarboxylase 65 (GAD)-autoantibodies. METHODS: Eleven paraneoplastic-antibodies+ and eleven age- and gender-matched GAD-antibodies+ patients with LE were compared regarding EEG, seizure frequency, MRI volumetry of the brain, and cognition. All patients received immunotherapy with corticosteroids add-on to antiepileptic therapy...
December 2016: Epilepsy & Behavior: E&B
Victor Helmstaedter, Eva Bueltmann, Thomas Lenarz, Magnus Teschner
INTRODUCTION: With the aim of preventing migration of cochlear implantation electrodes in the postoperative course, an electrode fixation clip has been developed. It is characterized by two clips of double U-geometry. The bone fixation clip will be clamped on the bony incus bridge, and the electrode fixation clip is clamped to the electrode lead. Although made of titanium, the detectability in radiologic imaging appears limited. MATERIALS AND METHODS: Six patients, who received a cochlear implant between August 2014 and March 2015, were retrospectively analyzed for the detectability of the Med-El Electrode Fixation Clip in postoperative cone beam CT scans...
November 2016: Cochlear Implants International
Christoph Helmstaedter, Juri-Alexander Witt
Some of the roots of current clinical neuropsychology go back to the early days of epilepsy surgery. Looking back a huge number of publications have dealt with cognition in epilepsy. The major factors driving this work were questions relating to surgery, antiepileptic drugs and, more recently, also to underlying pathology. However, most factors affecting cognition in epilepsy have been discerned many years ago. The body of neuropsychological literature in this field has accumulated much knowledge, raising the question why, apart from epilepsy surgery settings, neuropsychology has still not been fully integrated in the routine care of patients with epilepsy...
January 2017: Seizure: the Journal of the British Epilepsy Association
Markus Reuber, Christoph Helmstaedter, Weiping Liao, Tobias Loddenkemper, Rhys Thomas, Reetta Kälviäinen, Michael Mann
No abstract text is available yet for this article.
October 2016: Seizure: the Journal of the British Epilepsy Association
Michael P Malter, Guido Widman, Norbert Galldiks, Winfried Stoecker, Christoph Helmstaedter, Christian E Elger, Jan Wagner
OBJECTIVE: Recent reports define temporal lobe epilepsy with amygdala enlargement (TLE-AE) as a distinct electroclinical syndrome comparable to TLE with hippocampal sclerosis. In this retrospective observational study, we present the largest consecutive series of patients with new-onset TLE-AE to date and describe clinical characteristics and seizure outcome, and we aim to explore underlying autoimmune mechanisms within this syndrome. METHODS: We reviewed all consecutive patients between 2004 and 2014 at our tertiary epilepsy center at the University of Bonn, Germany, with new-onset (<5 years) TLE-AE, negative serum antibody (ab) test results, and with available follow-up data for at least 12 months...
September 2016: Epilepsia
Felix Rosenow, Thomas Bast, Thomas Czech, Martha Feucht, Volkmar H Hans, Christoph Helmstaedter, Hans-Jürgen Huppertz, Soheyl Noachtar, Frank Oltmanns, Tilman Polster, Margitta Seeck, Eugen Trinka, Kathrin Wagner, Adam Strzelczyk
The definition of minimal standards remains pivotal as a basis for a high standard of care and as a basis for staff allocation or reimbursement. Only limited publications are available regarding the required staffing or methodologic expertise in epilepsy centers. The executive board of the working group (WG) on presurgical epilepsy diagnosis and operative epilepsy treatment published the first guidelines in 2000 for Austria, Germany, and Switzerland. In 2014, revised guidelines were published and the WG decided to publish an unaltered English translation in this report...
August 2016: Epilepsia
Florian Grahammer, Suresh K Ramakrishnan, Markus M Rinschen, Alexey A Larionov, Maryam Syed, Hazim Khatib, Malte Roerden, Jörn Oliver Sass, Martin Helmstaedter, Dorothea Osenberg, Lucas Kühne, Oliver Kretz, Nicola Wanner, Francois Jouret, Thomas Benzing, Ferruh Artunc, Tobias B Huber, Franziska Theilig
Renal proximal tubular cells constantly recycle nutrients to ensure minimal loss of vital substrates into the urine. Although most of the transport mechanisms have been discovered at the molecular level, little is known about the factors regulating these processes. Here, we show that mTORC1 and mTORC2 specifically and synergistically regulate PTC endocytosis and transport processes. Using a conditional mouse genetic approach to disable nonredundant subunits of mTORC1, mTORC2, or both, we showed that mice lacking mTORC1 or mTORC1/mTORC2 but not mTORC2 alone develop a Fanconi-like syndrome of glucosuria, phosphaturia, aminoaciduria, low molecular weight proteinuria, and albuminuria...
January 2017: Journal of the American Society of Nephrology: JASN
Teia Kobulashvili, Julia Höfler, Judith Dobesberger, Florian Ernst, Philippe Ryvlin, J Helen Cross, Kees Braun, Petia Dimova, Stefano Francione, Hrvoje Hecimovic, Christoph Helmstaedter, Vasilios K Kimiskidis, Morten Ingvar Lossius, Kristina Malmgren, Petr Marusic, Bernhard J Steinhoff, Paul Boon, Dana Craiu, Norman Delanty, Daniel Fabo, Antonio Gil-Nagel, Alla Guekht, Edouard Hirsch, Reetta Kalviainen, Ruta Mameniskiené, Çiğdem Özkara, Margitta Seeck, Guido Rubboli, Pavel Krsek, Sylvain Rheims, Eugen Trinka
PURPOSE: The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers. METHOD: A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement...
May 2016: Seizure: the Journal of the British Epilepsy Association
Klaus Lehnertz, Henning Dickten, Stephan Porz, Christoph Helmstaedter, Christian E Elger
Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only...
April 19, 2016: Scientific Reports
Brian E Mouthaan, Matea Rados, Péter Barsi, Paul Boon, David W Carmichael, Evelien Carrette, Dana Craiu, J Helen Cross, Beate Diehl, Petia Dimova, Daniel Fabo, Stefano Francione, Vladislav Gaskin, Antonio Gil-Nagel, Elena Grigoreva, Alla Guekht, Edouard Hirsch, Hrvoje Hecimovic, Christoph Helmstaedter, Julien Jung, Reetta Kalviainen, Anna Kelemen, Vasilios Kimiskidis, Teia Kobulashvili, Pavel Krsek, Giorgi Kuchukhidze, Pål G Larsson, Markus Leitinger, Morten I Lossius, Roman Luzin, Kristina Malmgren, Ruta Mameniskiene, Petr Marusic, Baris Metin, Cigdem Özkara, Hrvoje Pecina, Carlos M Quesada, Fergus Rugg-Gunn, Bertil Rydenhag, Philippe Ryvlin, Julia Scholly, Margitta Seeck, Anke M Staack, Bernhard J Steinhoff, Valentin Stepanov, Oana Tarta-Arsene, Eugen Trinka, Mustafa Uzan, Viola L Vogt, Sjoerd B Vos, Serge Vulliémoz, Geertjan Huiskamp, Frans S S Leijten, Pieter Van Eijsden, Kees P J Braun
OBJECTIVE: In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. METHODS: A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium...
May 2016: Epilepsia
Ido Amit, David Baker, Roger Barker, Bonnie Berger, Carolyn Bertozzi, Sangeeta Bhatia, Alessandra Biffi, Francesca Demichelis, Jennifer Doudna, Steven F Dowdy, Drew Endy, Moritz Helmstaedter, Howard Junca, Carl June, Sasha Kamb, Anastasia Khvorova, Dae-Hyeong Kim, Jin-Soo Kim, Yamuna Krishnan, Melike Lakadamyali, Tuuli Lappalainen, Sharon Lewin, James Liao, Nick Loman, Emma Lundberg, Lee Lynd, Cathie Martin, Ira Mellman, Atsushi Miyawaki, Christine Mummery, Karen Nelson, Jeanne Paz, Pamela Peralta-Yahya, Paola Picotti, Kornelia Polyak, Kristala Prather, Jun Qin, Stephen Quake, Aviv Regev, John A Rogers, Reshma Shetty, Morten Sommer, Molly Stevens, Gustavo Stolovitzky, Masayo Takahashi, Fuchou Tang, Sarah Teichmann, Maria-Elena Torres-Padilla, Leena Tripathi, Praveen Vemula, Greg Verdine, Frank Vollmer, Jun Wang, Jackie Y Ying, Feng Zhang, Tian Zhang
No abstract text is available yet for this article.
March 2016: Nature Biotechnology
Christoph Helmstaedter, Christian Erich Elger, Juri-Alexander Witt
PURPOSE: Epilepsy surgery is associated with a risk of cognitive deterioration, but improvement has also been reported. Improvements have mostly been attributed to seizure control, neglecting changes in drug treatment during the observation period. We evaluated whether changes of antiepileptic treatment affect cognitive outcome one year after epilepsy surgery. METHODS: This retrospective study evaluated the impact of quantitative and qualitative antiepileptic drug changes on postoperative outcome on cognition (executive functions, episodic memory) and mood in 116 epilepsy surgery patients, controlling the results for seizure outcome (seizure free yes/no) and site of surgery (87 temporal lobe, 29 extratemporal lobe resections)...
March 2016: Seizure: the Journal of the British Epilepsy Association
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