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Introduction
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January 2012 - January 2014
July 2009 - present
April 2007 - June 2009
Publications
Publications (153)
Background
Intracranial EEG biomarkers are under investigation to help localize the seizure onset zone (SOZ) using ictal activity.
Existing methods
Biomarkers developed to date can be classified depending on whether they target abnormalities in signal power or the functional connectivity between signals, and they may be optimized depending on the...
Plain language summary The impact of treatment with either eslicarbazepine acetate or controlled-release carbamazepine on cholesterol levels in patients with newly diagnosed focal epilepsy
Patients with epilepsy have an increased risk of having cardiovascular and cerebrovascular diseases (e.g., myocardial infarction and stroke). Treatment with anti...
Purpose:
Urgent seizures are a medical emergency for which new therapies are still needed. This study evaluated the use of intravenous brivaracetam (IV-BRV) in an emergency setting in clinical practice.
Methods:
BRIV-IV was a retrospective, multicenter, observational study. It included patients ≥18 years old who were diagnosed with urgent seizur...
Purpose:
The pharmacokinetics of Brivaracetam (BRV) and its ability to penetrate the blood-brain barrier quickly make it a suitable drug for emergencies. In this study, our aim was to investigate the tolerability, safety, and acute efficacy of rapid intravenous (IV) loading of BRV during invasive and non-invasive video-EEG monitoring in patients w...
Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) has epilepsy as a cardinal feature. Here we report two new female patients and review six previously published patients, one male and five females, with features of CDD but who never developed epilepsy. In contrast with the classical and severe CDD phenotype, they presented with milde...
Objectives:
The insula is a brain area involved in the modulation of autonomic responses. Previous studies have focused mainly on its heart rate regulatory function, but its role in vascular control is not well defined. Ictal/postictal blood pressure (BP) fluctuations may have a role in the pathogenesis of sudden unexpected death in epilepsy. This...
Objective:
Coupled with stereo-electroencephalography (SEEG), radiofrequency thermocoagulation (RFTC) has emerged as a therapeutic alternative for patients with refractory focal epilepsy, with proven safe but highly variable results across studies. The authors aimed to describe the outcomes and safety of SEEG-RFTC, focusing on patients with MRI-ne...
The principles governing the formation of episodic memories from the continuous stream of sensory stimuli are not fully understood. Theoretical models of the hippocampus propose that the representational format of episodic memories comprise oscillations in the theta frequency band (2-8 Hz) that set the time boundaries in which discrete events are b...
Objective
Direct cortical stimulation (DCS) is standard for intracranial presurgical evaluation in drug-resistant epilepsy (DRE). Few studies have reported levels of concordance between spontaneous seizure generators and triggered seizures during DCS. The present work reports validity measures of DCS for detecting the seizure onset zone (SOZ) durin...
Epilepsy presurgical investigation may include focal intracortical single-pulse electrical stimulations with depth electrodes, which induce cortico-cortical evoked potentials at distant sites because of white matter connectivity. Cortico-cortical evoked potentials provide a unique window on functional brain networks because they contain sufficient...
Seizures recur in half of patients who undergo epilepsy surgery. Presurgical workup mainly focuses on seizures, but only partially helps predicting outcomes, even after invasive electroencephalography. We conceived a generalizable model to detect epileptogenic networks through connectivity changes and identified the crucial role of the transition f...
Introduction: The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reac...
Long-term video-EEG monitoring (LTVEEG-m) is the diagnostic test of certainty of epilepsy. The European Commission recommends one epilepsy unit with LTVEEG-m for every 3,000 patients with refractory epilepsy. In Spain, there was one center accredited every 10,600 patients with RE in 2019. There are different publications on LTVEEG-m about clinical...
Surgical planning is crucial to Stereoelectroencephalography (SEEG), a minimally invasive procedure that requires clinicians to operate with no direct view of the brain. Decisions making involves different clinical specialties and requires analysis of multiple multimodal datasets. We present a DepthMap tool designed to localize, measure, and visual...
The ability to deliberately overwrite ongoing automatic actions is a necessary feature of adaptive behavior. It has been proposed that the supplementary motor areas (SMAs) operate as a controller that orchestrates the switching between automatic and deliberate processes by inhibiting ongoing behaviors and so facilitating the execution of alternativ...
Background and purpose:
Magnetic resonance imaging (MRI) is essential in the diagnosis of pharmacoresistant epilepsy (PRE), because patients with lesions detected by MRI have a better prognosis after surgery. Focal cortical dysplasia (FCD) is one of the most frequent etiologies of PRE but can be difficult to identify by MRI. Voxel-based morphometr...
Wada test is an invasive procedure used in the preoperative evaluation for epilepsy surgery to determine language lateralization, post-operative risk of amnesia syndrome, and to assess the risk of memory deficits. It involves injection of amobarbital into internal carotid artery of the affected hemisphere followed by the healthy hemisphere to shut...
Objective
The link between brain function and cardiovascular dynamics is an important issue yet to be completely elucidated. The insula is a neocortical brain area that is thought to have a cardiac chronotropic regulatory function, but its role in cardiac contractility is unknown. We aim to analyze the heart rate and cardiac contractility variabili...
Significance
While behavioral evidence shows that volitionally controlled learning benefits human memory, little is known about the neural mechanisms underlying this effect. Insights from spatial navigation research in rodents point to the relevance of hippocampal theta oscillations. However, the mechanisms through which theta might support the ben...
Background and objective
: We present SYLVIUS, a software platform intended to facilitate and improve the complex workflow required to diagnose and surgically treat drug-resistant epilepsies. In complex epilepsies, additional invasive information from exploration with stereoencephalography (SEEG) with deep electrodes may be needed, for which the in...
Objective: We assessed the efficacy, safety, and tolerability of cannabidivarin (CBDV) as add-on therapy in adults with inadequately controlled focal seizures.
Materials and Methods: One hundred and sixty-two participants (CBDV n=81; placebo n=81) were enrolled. After a 4-week baseline, participants titrated from 400 to 800 mg CBDV twice daily (b.i...
Objective
Clinical care of rare and complex epilepsies is challenging, because evidence‐based treatment guidelines are scarce, the experience of many physicians is limited and interdisciplinary treatment of comorbidities is required. The pathomechanisms of rare epilepsies are, however, increasingly understood, which potentially fosters novel target...
Objective
Stereoelectroencephalography (SEEG) consists of the implantation of microelectrodes for the electrophysiological characterization of epileptogenic networks. To reduce a possible risk of intracranial bleeding by vessel rupture during the electrode implantation, the stereotactic trajectories must follow avascular corridors. The use of digit...
Objective:
To assess the efficacy, safety, and tolerability of eslicarbazepine acetate (ESL) monotherapy during long-term treatment.
Methods:
An open-label extension (OLE) study was conducted in adults completing a phase 3, randomized, double-blind, noninferiority trial, during which they had received monotherapy with either once-daily ESL or tw...
Aims . The COVID‐19 pandemic shook European healthcare systems, with unavoidable gaps in the management of patients with chronic diseases. We describe the impact of the pandemic on epilepsy care in three tertiary epilepsy centres from Spain and Italy, the most affected European countries.
Methods . The three epilepsy centres, members of the Europea...
Introduction: Although carbamazepine (CBZ) has strong enzyme-inducing properties, oxcarbazepine (OXC) and eslicarbazepine acetate (ESL) are thought to have a milder effect. These drugs are known to have effects on lipid metabolism and may cause hyponatremia and changes in blood cell counts and liver function tests.
Aim: To compare the long-term eff...
El presente Manual de Práctica Clínica en Epilepsia tiene por objeto ayudar al clínico y a los pacientes en la toma de decisiones en situaciones clínicas concretas, se fundamenta en las mejores evidencias científicas posibles y en la experiencia de los autores, sobre los aspectos diagnósticos, clasificatorios, terapéuticos, y pronósticos relacionad...
Purpose:
Among patients with epilepsy, sleep disturbances can worsen seizure control. This prospective open-label study determined the effect of the antiepileptic drug perampanel on sleep architecture in patients with refractory epilepsy.
Methods:
Adult patients with refractory epilepsy received add-on perampanel, starting at 2 mg/day at bedtime...
Theoretical models of episodic memory have proposed that retrieval depends on interactions between the hippocampus and neocortex, where hippocampal reinstatement of item-context associations drives neocortical reinstatement of item information. Here, we simultaneously recorded intracranial EEG from hippocampus and lateral temporal cortex (LTC) of e...
Purpose:
To assess the efficacy, safety and tolerability of eslicarbazepine acetate (ESL) in patients transitioning from carbamazepine or oxcarbazepine to ESL in clinical practice, by analysing data from the Euro-Esli study.
Methods:
Euro-Esli was a pooled analysis of 14 European clinical practice studies. Effectiveness assessments included resp...
The spatial mapping of localized events in brain activity critically depends on the correct identification of the pattern signatures associated with those events. For instance, in the context of epilepsy research, a number of different electrophysiological patterns have been associated with epileptogenic activity. Motivated by the need to define au...
Movement-related theta oscillations in rodent hippocampus coordinate ‘forward sweeps’ of location-specific neural activity that could be used to evaluate spatial trajectories online. This raises the possibility that increases in human hippocampal theta power accompany the evaluation of upcoming spatial choices. To test this hypothesis, we measured...
The spatial mapping of localized events in brain activity critically depends on the correct identification of the pattern signatures associated with those events. For instance, in the context of epilepsy research, a number of different electrophysiological patterns have been associated with epileptogenic activity. Motivated by the need to define au...
Purpose
SUDEP is the first cause of mortality related to epilepsy. However, in Spain there are no published cases or series from Epilepsy Monitoring Units that could expose the characteristics of SUDEP in our population.
Method
We reviewed all patients treated at our Spanish Epilepsy Reference Centre who died between 2010–2018. SUDEP cases were cl...
Introduction
Sudden unexpected death in epilepsy (SUDEP) is the most frequent cause of premature death in epileptic patients. Most SUDEP events occur at night and frequently go unnoticed; the exact pathophysiological mechanisms of this phenomenon therefore remain undetermined. Nevertheless, most cases of SUDEP are attributed to an infrequent yet ex...
Inferring the topology of a network using the knowledge of the signals of each of the interacting units is key to understanding real-world systems. One way to address this problem is using data-driven methods like cross-correlation or mutual information. However, these measures lack the ability to distinguish the direction of coupling. Here, we use...
While the benefits of self-directed learning on human memory are well-acknowledged, little is known on its underlying neurophysiological substrate. Here, we investigated the key signatures of volitional learning in the brain as assessed by representational similarity analysis applied to human intracranial EEG (iEEG) data. Epilepsy patients performe...
Several models have been proposed to explain brain regional and interregional communication, the majority of them using methods that tap the frequency domain, like spectral coherence. Considering brain interareal communication as binary interactions, we describe a novel method devised to predict dynamics and thus highlight abrupt changes marked by...
A major challenge in computational and systems neuroscience concerns the quantification of information processing at various scales of the brain’s anatomy. In particular, using human intracranial recordings, the question we ask in this paper is: How can we estimate the informational complexity of the brain given the complex temporal nature of its d...
Movement-related theta oscillations in rodent hippocampus coordinate forward sweeps of location-specific neural activity that could be used to evaluate spatial trajectories online. This raises the possibility that increases in human hippocampal theta power accompany the evaluation of upcoming spatial choices. To test this hypothesis, we measured hi...
Background:
Stereoelectroencephalography (SEEG) has been shown to be a valuable tool for the anatomoelectroclinical definition of the epileptogenic zone (EZ) in patients with medically refractory epilepsy considered for surgery (RES patients). In Spain, many of those patients are not offered this diagnostic procedure.
Objective:
To evaluate the...
In patients with pharmaco-resistant focal epilepsies investigated with intracranial electroencephalography (iEEG), direct electrical stimulations of a cortical region induce cortico-cortical evoked potentials (CCEP) in distant cerebral cortex, which properties can be used to infer large scale brain connectivity. In 2013, we proposed a new probabili...
Author summary
Understanding and predicting the generation of seizures in epileptic patients is fundamental to improving the quality of life of the more than 1% of the world population who suffer from this illness. Although seizure prediction has made important advances over the last decade, there is a lack of understanding of the common principles...
We report a patient presenting drug-resistant, non-dominant temporal lobe epilepsy with ictal spitting and prosopometamorphopsia, both extremely rare semiologies. Second-phase pre-surgical monitoring was performed using SEEG due to lesion-negative imaging and the rare semiology. The seizure onset zone was delimited to the right anterior hippocampus...
Numerical values underlying Fig 4.
Fig 4B results: percentage (over patients) of significant periods found in each comparison. Rows 2–4: Comparison 0, Comparison 1, Comparison 2. Columns 2–3: percentage (over patients), SEM. Fig 4C results: data that generate the mean connectivity plots for Comparisons 0 and 1. Top: mean connectivity values for Com...
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Numerical values underlying S1 Fig.
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Effect of the number of discretized states into the results of Fig 3.
Variance explained by state probability and state homogeneity (“state SD”) differences in the crossperiod regression per patient of Fig 3B. when using n = 8 (left), n = 10 (center) discretized states and the original discretization (n = 12) shown in Fig 3C. (left). In the 3 cases...
Numerical values underlying Fig 5.
Fig 5A results: mean eigenvector centrality values in the RZ and the nEZ. Rows 2–3: patient 1, patient 3. Columns 2–9: mean centrality in the RZ (control period), SD of the centrality in the RZ (control period), mean centrality in the RZ (preseizure period), SD of the centrality in the RZ (preseizure period), mean...
Numerical values underlying S6 Fig.
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Numerical values underlying S10 Fig.
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Effect of daily rhythms.
(A) Mean intracranial EEG signal energy (across channels and time windows of 120 s, bipolar montage) of patient 5 for more than 10 h preceding the seizure onset time in the control (blue) and preseizure period (red). The common time-dependent patterns of both traces reflect the potential effect of circadian rhythms into thi...
Postcritical functional connectivity decrease per patient.
Time-average mean functional connectivity computed for each patient in 3 periods of interest for 9.25 h preceding the seizure onset time: the precritical phase (1), the critical phase (2), and the postcritical phase (3). In patients 1, 5, and 8, the last interval of the critical phase was c...
Numerical values underlying Fig 2.
Fig 2A results: Data that generate the centrality entropy plots and justifies the statistics of Fig 2A. Rows 2–9: patients 1–8; Columns 2–11: mean entropy during the control period, SD of the entropy during the control period, mean entropy during the preseizure period, SD of the entropy during the preseizure perio...
Numerical values underlying Fig 3.
Fig 3A results: data that generate the centrality entropy plots of patient 3. Fig 3C results: data that generate the boxplots of Fig 3C left and the bars of Fig 3C right, and justifies the statistics shown for each panel. Top: rows 2–9: patients 1–8. Columns 2–13: pairs of R-squared coefficients for states 1–12 (i...
Numerical values underlying S2 Fig.
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Numerical values underlying S14 Fig.
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