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Christopher F A Benjamin, Alexa X Li, Hal Blumenfeld, R Todd Constable, Rafeed Alkawadri, Stephan Bickel, Christoph Helmstaedter, Stefano Meletti, Richard Bronen, Simon K Warfield, Jurriaan M Peters, David Reutens, Monika Połczyńska, Dennis D Spencer, Lawrence J Hirsch
The goal of this study was to document current clinical practice and report patient outcomes in presurgical language functional MRI (fMRI) for epilepsy surgery. Epilepsy surgical programs worldwide were surveyed as to the utility, implementation, and efficacy of language fMRI in the clinic; 82 programs responded. Respondents were predominantly US (61%) academic programs (85%), and evaluated adults (44%), adults and children (40%), or children only (16%). Nearly all (96%) reported using language fMRI. Surprisingly, fMRI is used to guide surgical margins (44% of programs) as well as lateralize language (100%)...
March 12, 2018: Human Brain Mapping
Christoph Helmstaedter, Babette Winter, Nico Melzer, Hubertus Lohmann, Juri-Alexander Witt
RATIONALE: Accelerated long-term forgetting (ALF) is a phenomenon found in late onset epilepsy and in transient epileptic amnesia (TEA). Here we evaluated ALF in patients with focal epilepsies and limbic encephalitis (LE) in particular. METHODS: ALF was assessed in 36 patients with focal epilepsy and 154 healthy subjects using an extended version of the Verbal Learning and Memory Test (VLMT), with free recall after 30 min and again after one week. From these patients, 89% had temporal lobe epilepsy; 42% left-lateralized; 39% right; 19% bilateral; 17% were diagnosed with hippocampal sclerosis; 64% displayed features indicating LE; 52% with amygdala pathology, and 61% were antibody positive...
January 31, 2018: Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
Christoph Helmstaedter, Gerrit H Gielen, Juri-Alexander Witt
In contrast to previous studies, Ljung et al. provide evidence of permanent cognitive consequences of bilateral intrahippocampal depth electrodes for verbal memory in patients who were not operated or operated in the right temporal lobe. Stimulated by this, we provide historical confirmatory and supplementary evidence of the detrimental effect of bilateral depth electrodes implanted along the longitudinal axis of the hippocampus on verbal learning and especially on delayed verbal memory and recognition performance...
February 7, 2018: Epilepsia
M Yasuda-Yamahara, M Rogg, J Frimmel, P Trachte, M Helmstaedter, P Schroder, M Schiffer, C Schell, T B Huber
Simplification and retraction of podocyte protrusions, generally termed as foot process effacement, is a uniform pathological pattern observed in the majority of glomerular disease, including focal segmental glomerulosclerosis. However, it is still incompletely understood how the interaction of cortical actin structures, actomyosin contractility and focal adhesions, is being orchestrated to control foot process morphology in health and disease. By uncovering the functional role of fermitin family member 2 (FERMT2 or kindlin-2) in podocytes, we provide now evidence, how cell-extracellular matrix (ECM) interactions modulate membrane tension and actomyosin contractility...
January 11, 2018: Matrix Biology: Journal of the International Society for Matrix Biology
Viola Lara Vogt, Daniel Delev, Alexander Grote, Johannes Schramm, Marec von Lehe, Christian Erich Elger, Juri-Alexander Witt, Christoph Helmstaedter
OBJECTIVE: To compare the effects of different surgical approaches for selective amygdalohippocampectomy in patients with pharmacoresistant mesial temporal lobe epilepsy with regard to the neuropsychological outcome and to replicate an earlier study employing a matched-pair design. METHOD: 47 patients were randomised to subtemporal versus transsylvian approaches. Memory, language, attentional and executive functions were assessed before and 1 year after surgery...
December 22, 2017: Journal of Neurology, Neurosurgery, and Psychiatry
Victor Helmstaedter, Thomas Lenarz, Peter Erfurt, Andrej Kral, Peter Baumhoff
OBJECTIVE: For the increasing number of cochlear implantations in subjects with residual hearing, hearing preservation, and thus the prevention of implantation trauma, is crucial. A method for monitoring the intracochlear position of a cochlear implant (CI) and early indication of imminent cochlear trauma would help to assist the surgeon to achieve this goal. The aim of this study was to evaluate the reliability of the different electric components recorded by an intracochlear electrocochleography (ECochG) as markers for the cochleotopic position of a CI...
December 14, 2017: Ear and Hearing
Helene Schmidt, Anjali Gour, Jakob Straehle, Kevin M Boergens, Michael Brecht, Moritz Helmstaedter
Research on neuronal connectivity in the cerebral cortex has focused on the existence and strength of synapses between neurons, and their location on the cell bodies and dendrites of postsynaptic neurons. The synaptic architecture of individual presynaptic axonal trees, however, remains largely unknown. Here we used dense reconstructions from three-dimensional electron microscopy in rats to study the synaptic organization of local presynaptic axons in layer 2 of the medial entorhinal cortex, the site of grid-like spatial representations...
September 28, 2017: Nature
Christoph Helmstaedter, Renata Vaz Pandolfo, Christian Hoppe, Juri-Alexander Witt
PURPOSE: To validate the Cognitive Problems in Children and Adolescents Questionnaire (KOPKIJ, German: Kognitive Probleme bei Kindern und Jugendlichen), a proxy report measure for recognizing cognitive problems in pediatric patients with epilepsy. METHODS: Anonymized data sets from 279 pediatric epilepsy patients were standardized in regard to the KOPKIJ results of 352 healthy children and adolescents. The KOPKIJ was related to objective routine neuropsychological assessment (NPY), and to two subjective measures, the Child Behavior Checklist questionnaire (CBCL), a proxy rating by the parents, and a questionnaire for self-perceived health-related quality of life in children and adolescents (KINDL)...
October 2017: Seizure: the Journal of the British Epilepsy Association
Juri-Alexander Witt, Christian Hoppe, Christoph Helmstaedter
Pharmacoresistant mesial temporal lobe epilepsy (mTLE) represents the major indication for epilepsy surgery. Since epilepsy surgery is an elective treatment option, preserving cognition is a high priority. Given the essential role of temporomesial structures in declarative long-term memory formation, surgical treatment for mTLE is primarily associated with a risk of material-specific memory decline, but other cognitive domains may be affected as well. The major determinants for the neuropsychological outcome are the functional integrity of surgically affected tissues, the functional reserve capacities of the remnant brain, the postoperative seizure outcome, as well as the quantitative and qualitative changes of antiepileptic drugs...
September 1, 2017: Epilepsy Research
Benedikt Staffler, Manuel Berning, Kevin M Boergens, Anjali Gour, Patrick van der Smagt, Moritz Helmstaedter
Nerve tissue contains a high density of chemical synapses, about 1 per µm(3) in the mammalian cerebral cortex. Thus, even for small blocks of nerve tissue, dense connectomic mapping requires the identification of millions to billions of synapses. While the focus of connectomic data analysis has been on neurite reconstruction, synapse detection becomes limiting when datasets grow in size and dense mapping is required. Here, we report SynEM, a method for automated detection of synapses from conventionally en-bloc stained 3D electron microscopy image stacks...
July 14, 2017: ELife
Kevin M Boergens, Manuel Berning, Tom Bocklisch, Dominic Bräunlein, Florian Drawitsch, Johannes Frohnhofen, Tom Herold, Philipp Otto, Norman Rzepka, Thomas Werkmeister, Daniel Werner, Georg Wiese, Heiko Wissler, Moritz Helmstaedter
We report webKnossos, an in-browser annotation tool for 3D electron microscopic data. webKnossos provides flight mode, a single-view egocentric reconstruction method enabling trained annotator crowds to reconstruct at a speed of 1.5 ± 0.6 mm/h for axons and 2.1 ± 0.9 mm/h for dendrites in 3D electron microscopic data from mammalian cortex. webKnossos accelerates neurite reconstruction for connectomics by 4- to 13-fold compared with current state-of-the-art tools, thus extending the range of connectomes that can realistically be mapped in the future...
July 2017: Nature Methods
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...
May 2017: Seizure: the Journal of the British Epilepsy Association
Juri-Alexander Witt, Christoph Helmstaedter
No abstract text is available yet for this article.
April 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...
August 15, 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)...
April 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...
March 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
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