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Centrotemporal spikes during NREM sleep: The promoting action of thalamus revealed by simultaneous EEG and fMRI coregistration.

Mirandola L, Cantalupo G, Vaudano AE, Avanzini P, Ruggieri A, Pisani F, Cossu G, Tassinari CA, Nichelli PF, Benuzzi F, Meletti S - Epilepsy Behav Case Rep (2013)

Bottom Line: In this patient, who fulfilled neither the diagnostic criteria for BECTS nor that for electrical status epilepticus in sleep (ESES), the transition from wakefulness to sleep was related to the involvement of a widespread cortical-subcortical network related to CTS.In particular, the involvement of a thalamic-perisylvian neural network similar to the one previously observed in patients with ESES suggests a common sleep-related network dysfunction even in cases with milder phenotypes without seizures.This finding, if confirmed in a larger cohort of patients, could have relevant therapeutic implication.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Sciences, Metabolism, and Neuroscience, University of Modena and Reggio Emilia, Italy.

ABSTRACT
Benign childhood epilepsy with centrotemporal spikes (BECTS) has been investigated through EEG-fMRI with the aim of localizing the generators of the epileptic activity, revealing, in most cases, the activation of the sensory-motor cortex ipsilateral to the centrotemporal spikes (CTS). In this case report, we investigated the brain circuits hemodynamically involved by CTS recorded during wakefulness and sleep in one boy with CTS and a language disorder but without epilepsy. For this purpose, the patient underwent EEG-fMRI coregistration. During the "awake session", fMRI analysis of right-sided CTS showed increments of BOLD signal in the bilateral sensory-motor cortex. During the "sleep session", BOLD increments related to right-sided CTS were observed in a widespread bilateral cortical-subcortical network involving the thalamus, basal ganglia, sensory-motor cortex, perisylvian cortex, and cerebellum. In this patient, who fulfilled neither the diagnostic criteria for BECTS nor that for electrical status epilepticus in sleep (ESES), the transition from wakefulness to sleep was related to the involvement of a widespread cortical-subcortical network related to CTS. In particular, the involvement of a thalamic-perisylvian neural network similar to the one previously observed in patients with ESES suggests a common sleep-related network dysfunction even in cases with milder phenotypes without seizures. This finding, if confirmed in a larger cohort of patients, could have relevant therapeutic implication.

No MeSH data available.


Related in: MedlinePlus

Patient's EEG trace while awake and asleep and ESI results. Panel A: representative page of the EEG during wakefulness. Rare independently and isolated CTS from the left and right hemispheres are evident. Panel B: representative page of the EEG recorded during sleep (phase 2 NREM). Note the increase in CTS frequency compared to wakefulness. CTS appear isolated or in brief discharges, synchronous or asynchronous over the two hemispheres. Sleep spindles and vertex spike are evident. The EEG traces are shown in bipolar montage. Panel C: spike averaging and topographic map related to the left CTS events (top image); ESI (bottom image) related to the left CTS demonstrates a main source over the left sensory–motor cortex. The electric potential field used by the sLORETA software was computed using the boundary element method applied to the MNI152 template. The MNI brain volume was scanned at 5-mm resolution obtaining a source space of 6239 cortical gray matter voxels. The sLORETA algorithm returns the current density measure (in [A/m2]) for each of the cortical voxels, indicating the MNI coordinates of the best fit, i.e., the voxel with the maximum current density value. Panel D: Spike averaging and topographic map related to the right CTS events (top image); ESI (bottom image) related to the right CTS demonstrates a main source over the right sensory–motor cortex.
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f0005: Patient's EEG trace while awake and asleep and ESI results. Panel A: representative page of the EEG during wakefulness. Rare independently and isolated CTS from the left and right hemispheres are evident. Panel B: representative page of the EEG recorded during sleep (phase 2 NREM). Note the increase in CTS frequency compared to wakefulness. CTS appear isolated or in brief discharges, synchronous or asynchronous over the two hemispheres. Sleep spindles and vertex spike are evident. The EEG traces are shown in bipolar montage. Panel C: spike averaging and topographic map related to the left CTS events (top image); ESI (bottom image) related to the left CTS demonstrates a main source over the left sensory–motor cortex. The electric potential field used by the sLORETA software was computed using the boundary element method applied to the MNI152 template. The MNI brain volume was scanned at 5-mm resolution obtaining a source space of 6239 cortical gray matter voxels. The sLORETA algorithm returns the current density measure (in [A/m2]) for each of the cortical voxels, indicating the MNI coordinates of the best fit, i.e., the voxel with the maximum current density value. Panel D: Spike averaging and topographic map related to the right CTS events (top image); ESI (bottom image) related to the right CTS demonstrates a main source over the right sensory–motor cortex.

Mentions: The patient underwent scalp EEG while awake and asleep, demonstrating the presence of CTS occurring independently in the right and left hemispheres which were significantly increased during slow-wave sleep (Fig. 1A–B). A complete overnight video-EEG recording confirmed an increase in CTS frequency during non-REM sleep but without reaching the criteria for ESES (spike index > 85%).


Centrotemporal spikes during NREM sleep: The promoting action of thalamus revealed by simultaneous EEG and fMRI coregistration.

Mirandola L, Cantalupo G, Vaudano AE, Avanzini P, Ruggieri A, Pisani F, Cossu G, Tassinari CA, Nichelli PF, Benuzzi F, Meletti S - Epilepsy Behav Case Rep (2013)

Patient's EEG trace while awake and asleep and ESI results. Panel A: representative page of the EEG during wakefulness. Rare independently and isolated CTS from the left and right hemispheres are evident. Panel B: representative page of the EEG recorded during sleep (phase 2 NREM). Note the increase in CTS frequency compared to wakefulness. CTS appear isolated or in brief discharges, synchronous or asynchronous over the two hemispheres. Sleep spindles and vertex spike are evident. The EEG traces are shown in bipolar montage. Panel C: spike averaging and topographic map related to the left CTS events (top image); ESI (bottom image) related to the left CTS demonstrates a main source over the left sensory–motor cortex. The electric potential field used by the sLORETA software was computed using the boundary element method applied to the MNI152 template. The MNI brain volume was scanned at 5-mm resolution obtaining a source space of 6239 cortical gray matter voxels. The sLORETA algorithm returns the current density measure (in [A/m2]) for each of the cortical voxels, indicating the MNI coordinates of the best fit, i.e., the voxel with the maximum current density value. Panel D: Spike averaging and topographic map related to the right CTS events (top image); ESI (bottom image) related to the right CTS demonstrates a main source over the right sensory–motor cortex.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150635&req=5

f0005: Patient's EEG trace while awake and asleep and ESI results. Panel A: representative page of the EEG during wakefulness. Rare independently and isolated CTS from the left and right hemispheres are evident. Panel B: representative page of the EEG recorded during sleep (phase 2 NREM). Note the increase in CTS frequency compared to wakefulness. CTS appear isolated or in brief discharges, synchronous or asynchronous over the two hemispheres. Sleep spindles and vertex spike are evident. The EEG traces are shown in bipolar montage. Panel C: spike averaging and topographic map related to the left CTS events (top image); ESI (bottom image) related to the left CTS demonstrates a main source over the left sensory–motor cortex. The electric potential field used by the sLORETA software was computed using the boundary element method applied to the MNI152 template. The MNI brain volume was scanned at 5-mm resolution obtaining a source space of 6239 cortical gray matter voxels. The sLORETA algorithm returns the current density measure (in [A/m2]) for each of the cortical voxels, indicating the MNI coordinates of the best fit, i.e., the voxel with the maximum current density value. Panel D: Spike averaging and topographic map related to the right CTS events (top image); ESI (bottom image) related to the right CTS demonstrates a main source over the right sensory–motor cortex.
Mentions: The patient underwent scalp EEG while awake and asleep, demonstrating the presence of CTS occurring independently in the right and left hemispheres which were significantly increased during slow-wave sleep (Fig. 1A–B). A complete overnight video-EEG recording confirmed an increase in CTS frequency during non-REM sleep but without reaching the criteria for ESES (spike index > 85%).

Bottom Line: In this patient, who fulfilled neither the diagnostic criteria for BECTS nor that for electrical status epilepticus in sleep (ESES), the transition from wakefulness to sleep was related to the involvement of a widespread cortical-subcortical network related to CTS.In particular, the involvement of a thalamic-perisylvian neural network similar to the one previously observed in patients with ESES suggests a common sleep-related network dysfunction even in cases with milder phenotypes without seizures.This finding, if confirmed in a larger cohort of patients, could have relevant therapeutic implication.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Sciences, Metabolism, and Neuroscience, University of Modena and Reggio Emilia, Italy.

ABSTRACT
Benign childhood epilepsy with centrotemporal spikes (BECTS) has been investigated through EEG-fMRI with the aim of localizing the generators of the epileptic activity, revealing, in most cases, the activation of the sensory-motor cortex ipsilateral to the centrotemporal spikes (CTS). In this case report, we investigated the brain circuits hemodynamically involved by CTS recorded during wakefulness and sleep in one boy with CTS and a language disorder but without epilepsy. For this purpose, the patient underwent EEG-fMRI coregistration. During the "awake session", fMRI analysis of right-sided CTS showed increments of BOLD signal in the bilateral sensory-motor cortex. During the "sleep session", BOLD increments related to right-sided CTS were observed in a widespread bilateral cortical-subcortical network involving the thalamus, basal ganglia, sensory-motor cortex, perisylvian cortex, and cerebellum. In this patient, who fulfilled neither the diagnostic criteria for BECTS nor that for electrical status epilepticus in sleep (ESES), the transition from wakefulness to sleep was related to the involvement of a widespread cortical-subcortical network related to CTS. In particular, the involvement of a thalamic-perisylvian neural network similar to the one previously observed in patients with ESES suggests a common sleep-related network dysfunction even in cases with milder phenotypes without seizures. This finding, if confirmed in a larger cohort of patients, could have relevant therapeutic implication.

No MeSH data available.


Related in: MedlinePlus