Martin Kurthen’s research while affiliated with Swiss Epilepsy Centre in Zurich and other places

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Publications (182)


Consciousness Performed
  • Chapter
  • Full-text available

December 2023

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17 Reads

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Martin Kurthen

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Anton Rey
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Consciousness Performed

July 2023

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10 Reads

What kind of relationship do we have with artificial beings (avatars, puppets, robots, etc.)? What does it mean to mirror ourselves in them, to perform them or to play trial identity games with them? Actor & Avatar addresses these questions from artistic and scholarly angles. Contributions on the making of »technical others« and philosophical reflections on artificial alterity are flanked by neuroscientific studies on different ways of perceiving living persons and artificial counterparts. The contributors have achieved a successful artistic-scientific collaboration with extensive visual material.



Characteristics of the antibody-defined groups. ASM, anti-seizure medication; CASPR2, contactin-associated protein-2; DDD, defined daily dose; GAD65, glutamic acid decarboxylase 65 kDa; LGI1, leucine-rich glioma inactivated protein 1; NMDAR, N-methyl-d-aspartate receptor. Lines and whiskers indicate medians and interquartile ranges
Seizure and anti-seizure medication (ASM) freedom over time. Kaplan-Meier-curves. Lines: censored cases. CASPR2, contactin-associated protein-2; GAD65, glutamic acid decarboxylase 65 kDa; LGI1, leucine-rich glioma inactivated protein 1; NMDAR, N-methyl-d-aspartate receptor
Courses of antibody titers in the cerebrospinal fluid (CSF, upper row, blue) and serum (lower row, red) during the first eight years after disease onset. The dots show all individual values, expressed as a percent of the individual’s highest titer. The blue dots in G and H are those of the patient with Ma2 antibodies. The lines are smoothed averages (see the Methods section)
Seizures associated with antibodies against cell surface antigens are acute symptomatic and not indicative of epilepsy: insights from long-term data

March 2021

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99 Reads

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32 Citations

Journal of Neurology

Background: Clinicians have questioned whether any disorder involving seizures and neural antibodies should be called "(auto)immune epilepsy." The concept of "acute symptomatic seizures" may be more applicable in cases with antibodies against neural cell surface antigens. We aimed at determining the probability of achieving seizure-freedom, the use of anti-seizure medication (ASM), and immunotherapy in patients with either constellation. As a potential pathophysiological correlate, we analyzed antibody titer courses. Methods: Retrospective cohort study of 39 patients with seizures and neural antibodies, follow-up ≥ 3 years. Results: Patients had surface antibodies against the N-methyl-D-aspartate receptor (NMDAR, n = 6), leucine-rich glioma inactivated protein 1 (LGI1, n = 11), contactin-associated protein-2 (CASPR2, n = 8), or antibodies against the intracellular antigens glutamic acid decarboxylase 65 kDa (GAD65, n = 13) or Ma2 (n = 1). Patients with surface antibodies reached first seizure-freedom (88% vs. 7%, P < 0.001) and terminal seizure-freedom (80% vs. 7%, P < 0.001) more frequently. The time to first and terminal seizure-freedom and the time to freedom from ASM were shorter in the surface antibody group (Kaplan-Meier curves: P < 0.0001 for first seizure-freedom; P < 0.0001 for terminal seizure-freedom; P = 0.0042 for terminal ASM-freedom). Maximum ASM defined daily doses were higher in the groups with intracellular antibodies. Seizure-freedom was achieved after additional immunotherapy, not always accompanied by increased ASM doses. Titers of surface antibodies but not intracellular antibodies decreased over time. Conclusion: Seizures with surface antibodies should mostly be considered acute symptomatic and transient and not indicative of epilepsy. This has consequences for ASM prescription and social restrictions. Antibody titers correlate with clinical courses.


Prächirurgische Diagnostik und operative Therapie bei Epilesien

September 2020

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7 Reads

Bei Vorliegen einer pharmakoresistenten fokalen Epilepsie ist die Indikation zur Durchführung einer prächirurgischen Diagnostik gegeben, welche über die Aussichten und Risiken einer kurativen epilepsiechirurgischen Behandlung Auskunft geben soll. Die Bestimmung des zu resezierenden („epileptogenen“) Areals erfolgt dadurch, dass die hirnlokalisierenden Informationen aus zerebraler Bildgebung, interiktalem und iktalem EEG und fokaler Anfallssemiologie (Anamnese und Video-EEG-Anfallsaufzeichnung) zur Deckung gebracht werden. Mögliche postoperative Defizite lassen sich durch neuropsychologische Untersuchungen (Testpsychologie, funktionelles MRI, kognitive Testung bei Elektrostimulation über intrakranielle Elektroden) abschätzen. Für epilepsiechirurgische Resektionen stehen standardisierte und auch individualisierte Operationsverfahren zur Verfügung. Das Komplikationsrisiko liegt im einstelligen Prozentbereich, die Chance auf Anfallsfreiheit je nach Befundkonstellation zwischen ca. 50 und 80 %. Falls ein kurativer Eingriff nicht möglich ist, können nichtresektive palliative Verfahren erwogen werden.



Age, sex, and prevalence. Distribution of age (in 5-year-intervals) and sex (red = female, blue = male) in the four major groups and the negatives. In the diagrams to the right, the bars indicate antibody prevalences, i.e., the proportions of positives related to all investigated patients (divided into subgroups defined by age and sex)
Disease durations, CSF/serum/CSF–serum pairs, IgG subclasses, and clinical ratings. a Latency (in months) between disease manifestation and antibody diagnostics in the antibody-positive cases with known disease onset. The lines indicate medians with quartiles. Antibody groups are given in ascending order of their median latencies. A1: linear x-axis, A2: logarithmic x-axis (note that “1” was added to all values to be able to include values of zero). b Ratio of cases with serum-only or CSF-only antibody positivity in the four major antibody groups plus onconeural and GABABR antibodies. The small groups with serum-only and CSF-only findings in the GAD65 group are cases with either very low CSF titers (N = 3) and negative serum or serum titers of just 1:500 and negative CSF samples (N = 2). In the onconeural group, there was one Ma2 case that was not fully appreciated in serum (blot positivity only) but clearly diagnosed in CSF (blot and tissue-based assay positive). c IgG subclasses in the four major antibody groups. d Clinical retrospective ratings (“Autoimmune disease of the CNS or PNS?”) in descending order of the positive ratings
Immunotherapy and outcome in the four major antibody groups (NMDAR-high, LGI1, CASPR2, and GAD65). a Mean number of immunotherapies per patient with standard deviations. b Proportions and extent of changes according to the modified Rankin scale (mRS). Blue boxes indicate improvements, grey boxes stability, and reddish boxes deterioration. Labeling of the x-axis: after the N values, the median follow-up is given (mo = months). c–f Clinical performance (mRS) at antibody diagnostics (“pre”) and at most recent follow-up (“post”). Lower values indicate better performance. Left-most bars: all patients with rating at antibody diagnostics; second bars: patients with “post” ratings available at the time-point “pre” (there are no relevant differences between the total groups and those with an outcome); third bars: outcome; right-most bars: proportions of number of immunotherapies used. Please note that information on “no. of therapies” was only available for 34 LGI1 patients
Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome

July 2020

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186 Reads

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49 Citations

Journal of Neurology

Objective To determine frequencies, interlaboratory reproducibility, clinical ratings, and prognostic implications of neural antibodies in a routine laboratory setting in patients with suspected neuropsychiatric autoimmune conditions.Methods Earliest available samples from 10,919 patients were tested for a broad panel of neural antibodies. Sera that reacted with leucine-rich glioma-inactivated protein 1 (LGI1), contactin-associated protein-2 (CASPR2), or the voltage-gated potassium channel (VGKC) complex were retested for LGI1 and CASPR2 antibodies by another laboratory. Physicians in charge of patients with positive antibody results retrospectively reported on clinical, treatment, and outcome parameters.ResultsPositive results were obtained for 576 patients (5.3%). Median disease duration was 6 months (interquartile range 0.6–46 months). In most patients, antibodies were detected both in CSF and serum. However, in 16 (28%) patients with N-methyl-d-aspartate receptor (NMDAR) antibodies, this diagnosis could be made only in cerebrospinal fluid (CSF). The two laboratories agreed largely on LGI1 and CASPR2 antibody diagnoses (κ = 0.95). The clinicians (413 responses, 71.7%) rated two-thirds of the antibody-positive patients as autoimmune. Antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), NMDAR (CSF or high serum titer), γ-aminobutyric acid-B receptor (GABABR), and LGI1 had ≥ 90% positive ratings, whereas antibodies against the glycine receptor, VGKC complex, or otherwise unspecified neuropil had ≤ 40% positive ratings. Of the patients with surface antibodies, 64% improved after ≥ 3 months, mostly with ≥ 1 immunotherapy intervention.Conclusions This novel approach starting from routine diagnostics in a dedicated laboratory provides reliable and useful results with therapeutic implications. Counseling should consider clinical presentation, demographic features, and antibody titers of the individual patient.



Epilepsien: Prächirurgische Diagnostik und operative Therapie

January 2017

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16 Reads

Bei Vorliegen einer pharmakoresistenten fokalen Epilepsie ist die Indikation zur Durchführung einer prächirurgischen Diagnostik gegeben, welche über die Aussichten und Risiken einer kurativen epilepsiechirurgischen Behandlung Auskunft geben soll. Die Bestimmung des zu resezierenden („epileptogenen“) Areals erfolgt dadurch, dass die hirnlokalisierenden Informationen aus zerebraler Bildgebung, interiktalem und iktalem EEG und fokaler Anfallssemiologie (Anamnese und Video-EEG-Anfallsaufzeichnung) zur Deckung gebracht werden. Mögliche postoperative Defizite lassen sich durch neuropsychologische Untersuchungen (Testpsychologie, funktionelles MRI, kognitive Testung bei Elektrostimulation über intrakranielle Elektroden) abschätzen. Für epilepsiechirurgische Resektionen stehen standardisierte und auch individualisierte Operationsverfahren zur Verfügung. Das Komplikationsrisiko liegt im einstelligen Prozentbereich, die Chance auf Anfallsfreiheit je nach Befundkonstellation zwischen ca. 50 und 80 %. Falls ein kurativer Eingriff nicht möglich ist, können nichtresektive palliative Verfahren erwogen werden.


Epilepsie und Fahreignung: die neue Richtlinie

October 2015

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11 Reads

Praxis

Zusammenfassung. Die fur die Schweiz gultige Richtlinie zur Fahreignung bei Epilepsie ist kurzlich uberarbeitet worden. Daraus ergeben sich bezuglich dieses fur die Epilepsiepatienten eminent wichtigen Krankheitsaspektes einige relevante Veranderungen. Diese entstehen uberwiegend mittelbar, durch Anwendung neuer Definitionen und Diagnosekriterien der Epilepsie, die es u.a. erlauben, in bestimmten Situationen schon nach einem einzigen Anfallsereignis die Diagnose einer Epilepsie zu stellen. Auch wurden fahreignungsrelevante Konzepte wie die «ausgeheilte Epilepsie» (resolved epilepsy) und die «drohende Epilepsie» neu eingefuhrt. Ferner ergeben sich leicht veranderte und differenziertere Empfehlungen zu Fahrkarenzen bei bestimmten Krankheitskonstellationen.


Citations (67)


... Clinical Assessment Scale in Autoimmune Encephalitis (CASE) scores were calculated during the acute encephalitis and at last follow-up [14]. CASE scores were used to classify outcome as excellent (0-4), moderate (5)(6)(7)(8)(9), and poor (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) [29]. The modified Rankin Scale was calculated at last follow-up, with mRS of 0-2 defined as a favorable outcome [1]. ...

Reference:

Seizures and status epilepticus in anti-NMDA receptor encephalitis
Seizures associated with antibodies against cell surface antigens are acute symptomatic and not indicative of epilepsy: insights from long-term data

Journal of Neurology

... The disease manifests variably, ranging from mild faciobrachial dystonic seizures to severe, treatment-refractory seizures. While immunotherapy often alleviates symptoms, patients frequently suffer from enduring cognitive impairments and seizures, resulting in long-term disability 6,7 . ...

Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome

Journal of Neurology

... These waves were P100 at 50-100 ms, N140 at 110-140 ms, and P200 at 160-200 ms (Buchsbaum, 1977). Later, the term mid-latency was used to describe potential components occurring between 50 and 200 ms and these components are P50, N100, and P200 (Nash N Boutros et al., 2006). It was suggested that latency reflects the complexity and efficiency of the synaptic pathway mediating the response and speed of information processing and that amplitude 00155-1. ...

Mid-latency auditory-evoked responses and sensory gating in focal epilepsy: A preliminary exploration
  • Citing Article
  • August 2006

The Journal of Neuropsychiatry and Clinical Neurosciences

... Studies on frontal lobe epilepsy serve as particularly valuable comparisons to interpret the results of this study. While outcomes in frontal lobe epilepsies have improved significantly in recent years, there remains a tendency to report less favorable results than in temporal lobe epilepsies [8,17,[38][39][40][41]. In a meta-analysis of 21 studies encompassing 1199 patients with frontal lobe epilepsies, Englot et al. reported a freedom from seizure rate of 45.1 %. ...

Surgery to Treat Focal Frontal Lobe Epilepsy in Adults
  • Citing Article
  • September 2002

Neurosurgery

... Patients with epileptic and non-epileptic seizures show impaired emotion regulation [44,45]. It has also been observed that patients with epileptic seizures with origin in frontal or mesial temporal lobe have deficits in social cognition [46,47]. From the above cited literature, researchers got motivation to examine which strategies patients with FLE use to control their cognitions and regulate emotions. ...

Mesial temporal and frontal lobe epilepsy impair advanced social cognition
  • Citing Conference Paper
  • January 2007

Epilepsia

... In contrast, there are not many studies on imagery of social experiences and interactions. Regarding the neural circuits of the 'social brain', the literature points to the medial prefrontal cortex, which represents stereotypes, prejudices and social characteristics of people (Proverbio et al. 2017;Ray et al. 2008;Shamay-Tsoory et al. 2009;Tsuchida and Fellows 2012;Proudfit 2015;Molenberghs et al. 2016;Nejati et al. 2021); the insula, which plays a key role in experiencing emotions and processing social cues (Calder et al. 2000;Pugnaghi et al. 2011;Knutson et al. 2013;Boucher et al. 2015;Li et al. 2020); the anterior cingulate cortex (ACC), which is involved in the regulation of emotional and social processes (Hornak et al. 2003;Hadland et al. 2003) and the temporal lobe, which plays an important role in encoding facial expressions, recognising familiar faces and voices, and regulating social behaviour (Toller et al. 2015;Redcay et al. 2016;Ong et al. 2021;Lee Masson and Isik 2021;Reisch et al. 2022;Su et al. 2022). ...

Right fronto-limbic atrophy is associated with reduced empathy in refractory unilateral mesial temporal lobe epilepsy
  • Citing Article
  • September 2015

Neuropsychologia

... Previous studies have shown that this is the case in people with epilepsy that originates in the temporal lobe of the brain (Ives-Deliperi/Jokeit 2019). For example, it was found that the amygdala is less active in response to a human face in the brain hemisphere where the epileptic seizures originate compared with the amygdala in the not affected brain hemisphere (Ives-Deliperi/Butler/Jokeit 2017, Labudda/Mertens/ Steinkroeger/Bien/Woermann 2014, Schacher et al. 2006;Toller et al., 2015). Therefore, a further aim of the fMRI study is to compare which brain regions are active while people with temporal lobe epilepsy (TLE) and people without epilepsy look at actor and avatar faces. ...

Right mesial temporal lobe epilepsy impairs empathy-related brain responses to dynamic fearful faces

Journal of Neurology

... In contrast to classical frameworks, the theory describes perception and cognition as the result of probing the environment with our actions and perceiving its effects. These effects then form the basis for new actions -action and perception are thus influencing each other bidirectionally (Engel et al., 2013;Kaspar et al., 2014;König et al., 2013). ...

Where’s the action? The pragmatic turn in cognitive science
  • Citing Article
  • April 2013

Trends in Cognitive Sciences

... How successful these attacks have been, should be discussed elsewhere. From my point of view, the sensorimotor theory (Hurley, 1998;Noe, 2005) has not convincingly responded to arguments raised by it critics (e.g., Hardcastle, 2001;Kurthen, 2001;Oberauer, 2001) who indicated that even a best explanation of mechanisms and phenomena of perception does not imply an explanation of perceptual experience, that is, "what it is like" to perceive a red color or a high-pitch tone. If we assume that simple robots do not have conscious experience, the fact that the proposed embodied and enacted mechanisms of perception can be modeled in robots already refutes the idea that these mechanisms can explain consciousness. ...

Consciousness as action: The eliminativist sirens are calling
  • Citing Article
  • October 2001

Behavioral and Brain Sciences

... When agents experience common external constraints or (physical or social regularities), under specific conditions they may develop similar mental models that will direct conscious deliberation towards a particular object in a particular class of situations. Different people that face similar environmental regularities will experience similar mental models that may be caused by different patterns of neuronal activity (Kurthen, 2001). Accordingly, similarities in habits of thought and mental models emerge when enduring similarities in external constraints or conventions exist. ...

The archeology of internalism
  • Citing Article
  • August 2001

Behavioral and Brain Sciences