Interictal waking and sleep electrophysiological properties of the thalamus in focal epilepsies.

Epilepsy is a cortico-subcortical network disease. Thalamo-cortical relationships in focal epilepsies, studied by stereoelectroencephalography in complex patients during pre-surgical evaluation, might help refine epilepsy surgery prognostic indicators and patient-specific treatments (i.e.

Determinants of substance use patterns in patients with narcolepsy type 1: A multi-center comparative cross-sectional study.

Objectives: In this multi-center cross-sectional study, we compared substance use patterns (SUPs) between patients with narcolepsy type 1 (NT1) and controls, and investigated, among patients, factors associated with the consumption of the main psychoactive substances.

Methods: Adult patients with NT1 and controls completed questionnaires about tobacco, alcohol, and cannabis use patterns. Unadjusted bivariable then multivariate analyses (adjusted for sex, age, education, family status, and depression) were performed to compare SUPs between controls and patients, and to explore socio-demographic, psycho-behavioral, and clinical determinants of consumptions.

Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1.

Study Objectives: This multicenter comparative cross-sectional study aimed to describe educational and occupational pathways, quantify effort/reward imbalance at work, and identify factors associated with professional prognosis in patients with narcolepsy type 1.

Methods: Adult patients with narcolepsy type 1 and controls answered online questionnaires (Epworth Sleepiness Scale, Beck Depression Inventory II, Siegrist questionnaire, adult self-report, and a questionnaire on academic and professional trajectories) and were compared using sex- and age-adjusted logistic regressions. Clinical, demographic, and psycho-social factors associated with patients' professional prognosis, as assessed by a composite score based on occupational-related outcomes, were explored with a generalized linear model.

Long sleep time and excessive need for sleep: State of the art and perspectives.

The mechanisms underlying the individual need for sleep are unclear. Sleep duration is indeed influenced by multiple factors, such as genetic background, circadian and homeostatic processes, environmental factors, and sometimes transient disturbances such as infections. In some cases, the need for sleep dramatically and chronically increases, inducing a daily-life disability.

Spotlight on Sleep Stage Classification Based on EEG.

The recommendations for identifying sleep stages based on the interpretation of electrophysiological signals (electroencephalography [EEG], electro-oculography [EOG], and electromyography [EMG]), derived from the Rechtschaffen and Kales manual, were published in 2007 at the initiative of the American Academy of Sleep Medicine, and regularly updated over years. They offer an important tool to assess objective markers in different types of sleep/wake subjective complaints. With the aims and advantages of simplicity, reproducibility and standardization of practices in research and, most of all, in sleep medicine, they have overall changed little in the way they describe sleep.

Cortico-cortical and thalamo-cortical connectivity during non-REM and REM sleep: Insights from intracranial recordings in humans.

Objective: To study changes of thalamo-cortical and cortico-cortical connectivity during wakefulness, non-Rapid Eye Movement (non-REM) sleep, including N2 and N3 stages, and REM sleep, using stereoelectroencephalography (SEEG) recording in humans.

Methods: We studied SEEG recordings of ten patients during wakefulness, non-REM sleep and REM sleep, in seven brain regions of interest including the thalamus. We calculated directed and undirected functional connectivity using a measure of non-linear correlation coefficient h.

Focal seizures producing loss of wakefulness without ictal asystole: Does temporal lobe syncope exist?

Focal seizures are frequently associated with alteration of consciousness, mainly of awareness, rather than with complete loss of wakefulness. We aimed to explore whether episodes of complete loss of wakefulness (LOW) could be attributed to focal seizures alone, out of the context of ictal asystole or secondary generalization. From a database of adult patients with refractory, focal epilepsy, evaluated for presurgical work-up we searched for patients having the following criteria: (1) focal epilepsy, and (2) transient loss of consciousness, documented in video EEG or/and video SEEG, characterized by an alteration in the level of wakefulness ("syncope like", LOW), with eye closure, hypotonia and non-reactivity state.

Sleep and epilepsy: A snapshot of knowledge and future research lines.

Sleep and epilepsy have a reciprocal relationship, and have been recognized as bedfellows since antiquity. However, research on this topic has made a big step forward only in recent years. In this narrative review we summarize the most stimulating discoveries and insights reached by the "European school.

Safety and efficacy of subcutaneous night-time only apomorphine infusion to treat insomnia in patients with Parkinson's disease (APOMORPHEE): a multicentre, randomised, controlled, double-blind crossover study.

Background: Insomnia is a frequent complaint of patients with Parkinson's disease, and it negatively affects quality of life. Drugs that improve both sleep and parkinsonism would be of major benefit to patients with Parkinson's disease-related insomnia. We aimed to test the safety and efficacy of subcutaneous night-time only apomorphine infusion in patients with Parkinson's disease and insomnia.

The Ictal Signature of Thalamus and Basal Ganglia in Focal Epilepsy: A SEEG Study.

Objective: To determine the involvement of subcortical regions in human epilepsy by analyzing direct recordings from these regions during epileptic seizures using stereo-EEG (SEEG).

Methods: We studied the SEEG recordings of a large series of patients (74 patients, 157 seizures) with an electrode sampling the thalamus and in some cases also the basal ganglia (caudate nucleus, 22 patients; and putamen, 4 patients). We applied visual analysis and signal quantification methods (Epileptogenicity Index [EI]) to their ictal recordings and compared electrophysiologic with clinical data.

Quantitative analysis of hyperkinetic seizures and correlation with seizure onset zone.

Objective: Hyperkinetic epileptic seizures (HKS) are difficult to characterize and localize according to semiologic features. We propose a multicriteria scale to help visual analysis and report results of cerebral localization.

Methods: We assessed seizures from 37 patients with HKS, explored with stereoelectroencephalography during presurgical evaluation.

Hippocampal Interictal Spikes during Sleep Impact Long-Term Memory Consolidation.

Objective: Non-rapid eye movement (NREM) sleep is supposed to play a key role in long-term memory consolidation transferring information from hippocampus to neocortex. However, sleep also activates epileptic activities in medial temporal regions. This study investigated whether interictal hippocampal spikes during sleep would impair long-term memory consolidation.

Why do seizures impair consciousness and how can we reverse this?

Purpose Of Review: Consciousness disorders occurring during seizures are a major source of disability in people with epilepsy. The purpose of this review is to show recent developments in the assessment and understanding of consciousness disorders in epilepsy.

Recent Findings: The most frequent alterations in consciousness are alterations in the level of awareness.

The effect of medial pulvinar stimulation on temporal lobe seizures.

We investigated the effect of electrical stimulation of the medial pulvinar (PuM) in terms of its effect on temporal lobe seizures. Eight patients with drug-resistant temporal lobe epilepsy undergoing stereoelectroencephalographic exploration were included. All had at least one electrode exploring the PuM.

Interictal stereotactic-EEG functional connectivity in refractory focal epilepsies.

Drug-refractory focal epilepsies are network diseases associated with functional connectivity alterations both during ictal and interictal periods. A large majority of studies on the interictal/resting state have focused on functional MRI-based functional connectivity. Few studies have used electrophysiology, despite its high temporal capacities.

Brain regions and epileptogenicity influence epileptic interictal spike production and propagation during NREM sleep in comparison with wakefulness.

Objective: Non-rapid eye movement (NREM) sleep is known to be a brain state associated with an activation of interictal epileptic activity. The goal of this work was to quantify topographic changes occurring during NREM sleep in comparison with wakefulness.

Method: We studied intracerebral recordings of 20 patients who underwent stereo-electroencephalography (SEEG) during presurgical evaluation for pharmacoresistant focal epilepsy.

The different patterns of seizure-induced aphasia in temporal lobe epilepsies.

Objectives: Ictal language disturbances may occur in dominant hemisphere temporal lobe epilepsy (TLE), but little is known about the precise anatomoelectroclinical correlations. This study investigated the different facets of ictal aphasia in intracerebrally recorded TLE.

Methods: Video-stereoelectroencephalography (SEEG) recordings of 37 seizures in 17 right-handed patients with drug-resistant TLE were analyzed; SEEG electroclinical correlations between language disturbance and involvement of temporal lobe structures were assessed.

Brain connectivity changes during ictal aggression (a strangulation attempt).

Ictal aggressive behaviour is a rare manifestation of focal seizures. We report an episode of ictal aggression occurring during an intracerebrally recorded seizure (using stereoelectroencephalography) in a patient with drug-resistant temporal lobe epilepsy. Aggression occurred during the last part of the seizure and was coincident with marked EEG slowing of the frontal regions and persistent ictal activity in the medial temporal lobe.

How does vagal nerve stimulation (VNS) change EEG brain functional connectivity?

An effect of vagal nerve stimulation (VNS) on cortical synchronization has been postulated but remains to be verified. In this study we investigated the impact of VNS on functional connectivity (Fc) using direct intracerebral recordings (stereotactic EEG, SEEG). Five patients with epilepsy who underwent SEEG recordings during ongoing VNS therapy were investigated.

What is the concordance between the seizure onset zone and the irritative zone? A SEEG quantified study.

Objective: In focal epilepsies, the accurate delineation of the epileptogenic network is a fundamental step before surgery. For years, the relationship between the interictal epileptic spikes (defining the "irritative zone", IZ) and the sites of seizure initiation (SOZ) has been a matter of debate.

Methods: Our goal was to investigate from intracerebral recordings (stereoelectroencephalography, SEEG) the distribution of interictal epileptic spikes (based on a spike frequency index, SI) and the topography of the SOZ (based on the Epileptogenicity Index, EI) in patients having focal neocortical epilepsies.

Altered synchrony and loss of consciousness during frontal lobe seizures.

Objective: Loss of consciousness (LOC) in frontal lobe epilepsy (FLE) has been rarely specifically studied until now. In this study we evaluated the LOC in a population of patients with FLE and studied the relationship between changes in synchrony and degree of LOC.

Methods: 24 patients undergoing stereoelectroencephalography (SEEG) during pre-surgical evaluation of FLE were studied.