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001 | Cerebrospinal Fluid Profile in Epilepsy Considering Exclusion Of DOI: 10.1111/epi.14612 ABSTRACT ADULT EPILEPTOLOGY etiology and seizure type. This is most important to prevent 27 AUGUST 2018 misinterpretation of postictal phenomena of CSF parame- ters. Nevertheless, one should note, that mild pleocytosis 001 | Cerebrospinal Fluid Profile in Epilepsy and/or intrathecal Ig is found only in a minor percentage of patients, indicating careful exclusion of alternative reasons Considering Exclusion of an Autoimmune Origin for alterations in CSF profile. M. Süße*, N. Saathoff†, M. Hannich*, C. Holbe*, A. Dressel‡, A. Flöel§, F. von Podewils* *University Medicine Greifswald, Neurology/Epileptology, Greifswald, Germany; †University Medicine Greifswald, Greifswald, Germany; 002 | Automated Free‐Water Imaging Analysis ‡ § Carl‐Thiem Klinikum Cottbus, Neurology, Cottbus, Germany; University in Patients with Epilepsy and Focal Cortical Medicine Greifswald, Neurology, Greifswald, Germany Dysplasia Purpose: Analyzing cerebrospinal fluid (CSF) is crucial in B.A.K. Kreilkamp*,†, O. Pasternak‡, K. Das†, U.C. Wieshmann†, † ,† ,† the diagnostic workup of epileptic seizures, in particular to S. Biswas , A.G. Marson* , S.S. Keller* *University of Liverpool, Liverpool, United Kingdom; †The Walton Centre investigate the occurrence of infectious diseases or autoim- ‡ mune epilepsy in cases of encephalitis. It is, therefore, essen- NHS Foundation Trust, Liverpool, United Kingdom; Harvard Medical School, Boston, ME, United States tial to characterize CSF changes caused by epileptic seizures to understand etiological associated pathogenic alterations in Purpose: Focal cortical dysplasia (FCD) may escape neuro- CSF profile. Existing systematic investigations differ in radiologist assessment [Martin et al. QIMS 2015;5(2):188– result and methodology; also the systematic exclusion of 203]. Quantitative lesion detection usually relies on T1w and autoimmune encephalitis is lacking in present studies. T2FLAIR imaging [Wagner et al. Brain 2011;134(10):2844– Method: A retrospective study with 247 patients newly 2854], while diffusion tensor imaging (DTI) approaches are diagnosed with an epileptic seizure was conducted. All rarely applied. We employed free‐water imaging analysis patients received CSF routine analysis including analysis [Pasternak et al. Magn Reson Med 2009;62:717–730] for of quantitative and/or qualitative intrathecal immunoglob- automatic detection of FCDs. Compared to conventional ulin (Ig) production. Neurological antibodies were DTI, free‐water imaging reduces partial‐volume effects. excluded in 162 paired serum and CSF samples. CSF Method: We studied 40 controls and 43 patients with results were evaluated for difference in seizure types (sim- treatment refractory focal epilepsy who were considered ′ ple partial seizure, complex partial seizure, generalized MRI‐negative′ following earlier MRI assessment. Repeat seizure, convulsive and non‐convulsive status epilepticus) neuroradiological evaluation of patients using our 3 Tesla and etiology [idiopathic (genetic), cryptogenic (non‐ epilepsy‐research dedicated protocol revealed six sites of lesional), symptomatic (structural metabolic), acute symp- FCD in four patients. Voxel‐based analysis of diffusion tomatic seizure]. maps was performed in CAT12. Gray matter (GM) seg- Results: Increased cell count in CSF (>4 Mpt/l) after an ments were computed from T1w images. GM diffusion epileptic seizure was observed in 4% (n = 10), increased maps were generated, brought to standard T1w space and ≥ lactate concentration ( 2.5 mmol/l) in 28% (n = 70), smoothed (6 mm). Automated individual t‐tests between ≥ increased total protein ( 500 mg/l) in 51% (n = 125), a controls and individual patients were conducted using GM ‐ disruption of the brain blood barrier in 29% (n = 71), and free‐water corrected mean diffusivity (MDt) and conven- intrathecal Ig synthesis in 5% of the patients (n = 11). No tional MD maps thresholded at p < 0.001 (voxel‐level significant differences were found between CSF parameters uncorrected), while using the ′AAL′ template as a mask. (cell count, lactate concentration, albumin quotient) and Region‐of‐interest (ROI) analyses allows landmark‐based different seizure types or seizure etiology. analysis of multiple averaged voxels within a ROI. Signifi- Conclusion: Elevated cell count, lactate concentration, and cant clusters from T1w feature maps [Wagner et al. Brain total protein as well as intrathecal Ig synthesis may be evi- 2011;134(10):2844–2854] were labeled as ROIs. dent following epileptic seizures independently of seizure | Epilepsia. 2018;59(S3):S3–S353. wileyonlinelibrary.com/journal/epi Wiley Periodicals, Inc. S3 © 2018 International League Against Epilepsy S4 | ABSTRACTS Results: In 5/6 FCD sites, MDt and MD was increased adults with GLUT1DS, increased functional connectivity compared to controls. MD voxel clusters showed lower T‐ was observed only within the motor resting state network. scores (four sites) and smaller cluster sizes relative to those No significant correlations were detected between seed‐ found in MDt maps (all sites). ROI analysis revealed that based functional connectivity and clinical variables. MDt values had less variance, were increased and outside Conclusion: FcMRI analyses show significant increase of 95% confidence intervals for all sites when compared to connectivity over the basal ganglia‐frontal cortex networks controls, as opposed to only 5/6 sites when using MD. in GLUT1DS patients compared to controls. This pattern is Conclusion: DTI values of FCDs are significantly altered observed in the children, while appears attenuated in adults. in patients. MDt may be more sensitive to dysplastic Our findings reinforce the notion that GLUT1DS is a non‐ changes relative to MD. Automated detection may facilitate evolutive encephalopathy. We speculate that the abnormal neuroradiological evaluation in previously ′MRI‐negative′ synchrony between (and within) basal ganglia with frontal patients. areas is the “intrinsic” substrate responsible of the appear- ance of movement disorder in GLUT1DS. 003 | Disrupted Basal Ganglia Networks in GLUT1 Deficiency Syndrome: Different 004 | Neuronal Antibodies in a Prospective, Connectivity Pattern at Different Stages of Life Multicenter Cohort of Patients with Focal Epilepsy A.E. Vaudano*, S. Olivotto†, A. Ruggieri‡, G. Gessaroli§, of Unknown Origin ¶ † †† † ‡ A. Parmeggiani , V. De Giorgis**, P. Veggiotti , S. Meletti M.A.A.M. de Bruijn*, R.D. Thijs , H.J.M. Majoie , *University of Parma, Department of Medicine and Surgery, Parma, Italy; R.P.W. Rouhl§, J.A.E. van Asseldonk¶, C. van Donselaar**, † ‡ University of Milan, V. Buzzi Hospital, Milan, Italy; University of F.S.S. Leijten††, P.W. Wirtz‡‡, A.E.M. Bastiaansen*, § Modena and Reggio Emilia, Modena, Italy; N.O.C.S.A.E. Hospital, AUSL M.W.J. Schreurs*, P.A.E. Sillevis Smitt*, M.J. Titulaer* ¶ Modena, Modena, Italy; Child Neurology and Psychiatry Unit, † *Erasmus University Medical Center, Rotterdam, Netherlands; SEIN, Policlinico S. Orsola‐Malpighi, Bologna, Italy; **C. Mondino, National Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands; Neurological Institute, Department of Child Neurology and Psychiatry, ‡ †† Kempenhaeghe Academic Center for Epileptology, Heeze, Netherlands; Pavia, Italy; University of Modena and Reggio Emilia, Department of §Maastricht University Medical Center, Maastricht, Netherlands; Biomedical, Metabolic and Neural Sciences, Modena, Italy ¶Elisabeth TweeSteden Hospital, Tilburg, Netherlands; **Maasstad Hospital, Rotterdam, Netherlands; ††University Medical Center Utrecht, ‡‡ Purpose: We aim to infer the resting‐state functional con- Utrecht, Netherlands; Haga Hospital, The Hague, Netherlands nectivity (fcMRI) of basal ganglia networks in children and adults with GLUT1‐DS, compared to healthy controls. Purpose: We aimed (1) to determine frequencies of anti- Method: Eighteen GLUT1DS patients (10 children and 8 body‐mediated encephalopathies in patients with focal epi- adults) and 36 healthy controls (19 children and 17 adults) lepsy of unknown origin and (2) to assess outcome in these were studied by means VideoEEG‐fMRI study during rest. patients. Functional connectivity measures (fcMRI) were assessed Method: In this Dutch multicenter prospective cohort using the following seeds (a) six bilateral regions of inter- study, we included adults ≥18 years with focal epilepsy of est (ROIs) in the striatum; (b) one bilateral seed in the pre- unknown origin, from December 2014‐December 2017. cuneus; (c) two bilateral ROIs in the primary visual cortex; Patients were recruited in general hospitals and in tertiary (d) two bilateral ROIs in the primary motor cortex. Within epilepsy referral centers. At enrollment, we gathered infor- and between groups comparison was performed as appro- mation on characteristics of patient and seizures, seizure priated. Finally, the connectivity measures were correlated frequency, and level of functioning (using the modified with main clinical variables. Rankin Scale (mRS)). Data about seizures frequency, treat- Results: Compared to controls, GLUT1DS showed ment, and mRS were obtained prospectively after one, four, increased functional connectivity between all the striatal eight and twelve months. At inclusion, serological analysis ROIs with the frontal cortex (supplementary motor area was done in all subjects, and additional CSF analysis, if and cingulate cortex) and other basal ganglia nuclei. Chil- available. To detect extracellular neuronal antibodies all dren with
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