L’électroencéphalogramme (EEG) est un examen incontournable pour le diagnostic, la définition des structures cérébrales responsables de l’origine de crises et la classification des épilepsies. Cependant les enregistrements recueillis à la surface du scalp sont très perturbés par des artefacts et du bruit, ce qui complique considérablement l’interprétation clinique ou l’analyse automatique.Ce travail a pour objectif d’extraire des descripteurs des signaux d’EEG de surface qui peuvent conduire à la caractérisation de la dynamique spatio-temporelle des crises partielles du lobe temporal. Les estimateurs de relations inter-voies appliqués sont les méthodes linéaires paramétriques symétriques et non symétriques telles que l’inter-spectre (S), la cohérence (C), la Directed Transfert Function (DTF) ou la Partial Directed Coherence (PDC). Les relations sont estimées sur des EEG réels contenant une crise. La détection de fortes relations inter-voies est exploitée pour latéraliser puis caractériser la crise. Toutes les méthodes sont appliquées sur des signaux EEG bruts et prétraités. Une étape de prétraitement basée sur la séparation et classification de sources et le débruitage est mise en œuvre afin d’éliminer les artefacts et le bruit avec une perte minimale d’information en diminuant le risque de fausses détections de relations de connectivité inter-signaux. Les résultats obtenus sur 51 crises montrent que le prétraitement améliore la détection et le taux de bonnes latéralisations. Une méthode de couplage entre l’IS et les méthodes paramétriques directives (PDC et DTF) permet d’améliorer la caractérisation des crises / The electroencephalogram (EEG) is the essential clinical examination for the diagnosis, the definition of brain structures responsible of seizures and epilepsy classification. However, the signals collected on the surface of the scalp are very disturbed by artifacts and noise, which complicates the clinical interpretation or the automatic analysis. This work aims to extract descriptors of surface EEG signals that can lead to the spatio-temporal characterization of the temporal lobe seizures. The inter-channel relationship estimators applied are parametric linear methods, such as cross-spectrum (S), coherence (C), Directed Transfer Function (DTF) or Partial Directed Coherence (PDC). Relations are estimated on real EEG recordings containing a crisis. The detection of strong inter-channel relationships is exploited in order to lateralize and to characterize seizures. All methods are applied to raw and preprocessed EEG signals. A preprocessing step, based on the separation and classification of sources and denoising is implemented to remove artifacts and noise with a minimal loss of information by reducing the risk of false detections of inter-signal connectivity relationships. The results on 51 crises show that a signal preprocessing improves the detection and the rate of correct lateralization. A coupling method between S and directivity parametric methods (PDC and DTF) improves the characterization of crises

Im Subikulum der Ratte finden sich zwei unterschiedliche Typen von Pyramidalzellen, die sich auf Grund ihres intrinsischen Entladungsverhaltens unterscheiden. Die Funktion dieser beiden Zelltypen hinsichtlich der synaptischer Neurotransmission ist unklar. Bursterzellen und regulär feuernde Zellen zeigten nach tetanischer Reizung ein unterschiedliches Ausmaß der LTP. Neben der zellspezifischen Ausprägung der LTP fanden sich mehrere Hinweise auf eine zielspezifische Projektion der Efferenzen der vorgeschalteten Area CA1. Die durchgeführten Experimente legen den Schluss nahe, dass Axone von Pyramidalzellen der Area CA1 selektiv auf subikuläre Pyramidenzellen projizieren und so den hippokampalen Informationsfluss steuern und regulieren können. NMDA-Rezeptoren auf beiden Seiten des synaptischen Spaltes spielen hier eine besondere Rolle. Präsynaptische NMDAR der Untereinheit NR2B scheinen an der LTP in Bursterzellen beteiligt zu sein und über einen vermehrten Kalziumeinstrom in die Präsynapse eine langanhaltende Erhöhung der Transmitterausschüttung herbeizuführen. Ebenso zeigten sich abhängig von der Zielzelle Hinweise auf eine unterschiedliche Aktivierung der präsynaptischen Adenylylcyclase-cAMP Kaskade. In Pilokarpin-behandelten Tieren ließ sich nach hochfrequenter Reizung keine langanhaltende Potenzierung der synaptischen Antworten nachweisen. Stattdessen scheinen polysynaptisch latente Verbindungen mittels tetanischer Stimulation aktivierbar zu sein. In einigen Fällen waren diese polysynaptisch latenten Verbindungen per se, in anderen Fällen nach Blockade der GABAergen Neurotransmission aktiv. In Hirnschnittpräparaten von Patienten mit pharmakoresistenter Temporallappenepilepsie konnte im Subikulum spontane rhythmische Aktivität mit einer Frequenz von 0,75 bis 3 Hz aufgezeichnet werden. Diese Aktivität, bestehend aus EPSP/IPSP Sequenzen, wurde sowohl in sklerotischem als auch in nicht sklerotischem Gewebe gefunden. In beiden Gruppen korrelierte die in vitro Aktivität sehr gut mit dem präoperativen Auftreten elektroenzephalografisch detektierter interiktaler Aktivität. Die Blockade GABAerger oder glutamaterger Neurotransmission hob die inhibitorische bzw. exzitatorische Aktivität auf. Dies legt den Schluss nahe, dass sowohl Interneurone wie Pyramidalzellen an der spontanen rhythmischen Aktivität beteiligt sind. / The subiculum plays a key role in processing memory information from the hippocampus to different cortical and subcortical brain regions. Subicular pyramidal cells are classified as regular firing or bursting cells according to their responses to supra-threshold depolarizing current pulses. Synaptic terminals arising from CA1 pyramidal cells do not function as a single compartment but show a specialized synaptic plasticity onto subicular pyramidal cells depending on the discharge properties of the synaptic target. Tetanic stimulation of CA1 axons caused a significantly stronger long-term potentiation (LTP) in bursting cells than in regular firing cells. Postsynaptic bursting was not necessary for the enhanced synaptic potentiation in bursting cells. The LTP in bursting neurons was independent of postsynaptic calcium, induced by presynaptic NR2B-containing autoreceptors and mediated via a adenylyl cylcase-cAMP-dependent signaling cascade. In pilocarpine-treated animals subicular LTP was impaired. A long-lasting increase in synaptic transmission could not be observed after titanic stimulation neither in regular firing cells nor in bursting cells. In human brain slices resected from patients from with drug-resistant temporal lobe epilepsy the subiculum displayed spontaneous rhythmic activity. In sclerotic but also in non-sclerotic hippocampal tissue the subiculum showed cellular and synaptic changes which suffice to generate spontaneous rhythmic activity that is correlated with the occurrence and frequency of interictal discharges recorded in the electroencephalograms of the corresponding patients.

A epilepsia é um transtorno do funcionamento cerebral caracterizado por crises epilépticas recorrentes que acomete cerca de 1 a 2% da população mundial. A epilepsia do lobo temporal (ELT) é o subtipo mais prevalente. A refratariedade aos medicamentos é comum e cerca de 40 % destes pacientes apresentam transtornos psiquiátricos. Neste trabalho utilizamos o método de TacMan real time PCR para quantificar o mRNA de subtipos dos receptores de noradrenalina, dopamina, serotonina e substância P em hipocampos cirurgicamente removidos de pacientes com ELT para conhecer o papel destes na ELT com ou sem comorbidade psiquiátrica (depressão ou psicose). Nossa amostra foi de 48 pacientes com ELT sem (Epilepsia - 24) ou com comorbidade psicótica (Psicose - 10) ou depressiva (Depressão - 14) e 8 Controles (necrópsias). O receptor adrenérgico-α2A (AD2A) apresentou diferença entre os grupos (p = 0,0059) com significância para a variável Antiepiléptico (p = 0,0374) e pós-teste significante de maior expressão do mRNA de AD2A no grupo Epilepsia comparado com Controle e com Psicose. A ativação dos receptores α2A no hipocampo pelos antiepilépticos pode explicar nossos achados do grupo Epilepsia comparado ao Controle, corroborando a literatura acerca do AD2A na epilepsia e em relação aos antiepilépticos. O AD2C mostrou diferença entre os grupos (p = 0,0016), sem significância nas variáveis de controle e significante maior expressão do mRNA de AD2C no grupo Epilepsia comparado ao Controle e Psicose. O AD2C é encontrado em áreas que processam informações sensoriais e controlam atividades motoras e emocionais relacionadas, o que pode explicar nossos resultados. Parece ser importante na patologia relacionada à ELT e merece ser estudado. A não diferença entre Epilepsia e Depressão para AD2A e AD2C, parecem confirmar uma relação bi-direcional ou um mecanismo patogênico comum entre epilepsia e depressão, enquanto a menor expressão de AD2A e AD2C nos psicóticos parece indicar diferenças nos mecanismos adrenérgicos ligados a psicose e epilepsia. D2 mostrou diferença entre os grupos (p = 0,0125) com resultado significativo para a variável Subtipo de Diagnóstico Psiquiátrico (p = 0,0239), provavelmente devido a cronicidade da doença e a quantidade de episódios depressivos apresentados pelos sujeitos. Quanto maior a freqüência das crises (p = 0,0381) maior a expressão do D2 no grupo Epilepsia e no Depressão comparados ao Controle. Estes achados sugerem a participação deste receptor na depressão comórbida na ELT; corroboram que o monitoramento dopaminérgico límbico pode ser útil para desenvolver novos antidepressivos e propõem pesquisas futuras sobre D2 em epilépticos. A participação de 5-HT2A na ELT é indicada, pois, sua maior expressão no grupo Epilepsia em relação ao Controle foi significativa (p = 0,0273). Quanto maior a freqüência das crises epilépticas maior a expressão do 5-HT2A (p = 0, 0433). Não encontramos resultados significativos referentes aos receptores D4, 5-HT1A, 5-HT2C e NK1. Nossos resultados mostraram a possibilidade da aplicação do TacMan real time PCR no estudo de receptores de neurotransmissores, sugeriu a importância dos receptores estudados na ELT e comorbidades psiquiátricas, e que outras estruturas límbicas, como a amígdala, sejam focos de investigação. / Epilepsy is a mental functional disorder characterized by recurrent seizures that affect about 1 to 2% of world population. Temporal lobe epilepsy (TLE) is the most prevalent subtype. The refractory to medication is common and about 40% of these patients have psychiatric disorders. This study used the TacMan real time PCR method to quantify noradrenergic, dopaminergic, serotoninergic and substance P receptors subtypes mRNA expression in hippocampus surgically removed from patients with TLE to know their role in TLE with or without psychiatric commorbity (depression or psychosis). Our sample consisted of 48 TLE patients without (Epilepsy - 24) or with psychotic (Psychosis - 10) or depressive (Depression - 14) commorbity and 8 Controls (necropsies). The α2A adrenergic receptor (AD2A) showed difference between groups (p = 0.0059) with significance for Antiepileptic Medication variable (p = 0.0374) and post-hoc test significantly greater AD2A mRNA expression of Epilepsy group compared with Control and Psychosis. The activation of hippocampus α2A receptors by antiepileptic drugs can explain our findings of the Epilepsy group compared with Control, corroborating the literature about the AD2A in epilepsy and for antiepileptic drugs. The AD2C showed differences between groups (p = 0.0016) without significance in the variables of control and significantly greater AD2C mRNA expression of the Epilepsy group compared to Control and Psychosis. The AD2C is found in areas that process sensory information and control motor and emotional related activities, which may explain our results. It seems to be important in the pathology related to TLE and deserves to be studied. No differences between Epilepsy and Depression to AD2A and AD2C seem to confirm a bi-directional relation or a common pathogenic mechanism between epilepsy and depression, while the lowest AD2A and AD2C expression within psychotics seem suggests differences in adrenergic mechanisms linked to psychosis and epilepsy. D2 showed differences between groups (p = 0.0125) with significant results for the variable Subtype of Psychiatric Diagnosis (p = 0.0239), probably due to chronic disease and the number of depressive episodes presented by subjects. The higher the frequency of seizures (p = 0.0381) the higher was the D2 expression within Epilepsy group compared with Control and Depression compared to Control. These findings suggest the involvement of this receptor in TLE commorbid depression; corroborate that limbic dopaminergic monitoring may be useful in developing new antidepressants and propose future research on D2 in epileptics. The participation of 5-HT2A in TLE is indicated, therefore its significant higher expression in the Epilepsy group in relation to Control (p = 0.0273). The higher the frequency of seizures the higher was the 5-HT2A expression (p = 0.0433). We found no significant results for the D4, 5-HT1A, 5-HT2C and NK1 receptors. Our results showed the possibility of TacMan real time PCR method application in TLE neurotransmission receptors study, suggested the importance of the studied receptors in TLE and psychiatric commorbities and that other limbic structures, as the amygdala, should be investigation targets.

INTRODUÇÃO: Acometimento em diversos domínios cognitivos (funções executivas, linguagem, memória episódica e semântica) são complicações reconhecidas da epilepsia associada à esclerose mesial temporal (EMT). Também é reconhecido déficit de memória específico para material verbal e não verbal, segundo a lateralidade da lesão. Atividade epileptiforme (ictal e interictal) pode comprometer funções cognitivas. O impacto do envolvimento eletrográfico contralateral nas funções cognitivas em pacientes com EMT unilateral não foi estudado. METÓDOS: Avaliamos o impacto da atividade epileptiforme contralateral em funções cognitivas em 121 pacientes com EMT unilateral (69 EMT esquerda), destros, com QI>70, oito ou mais anos de escolaridade, sem comorbidades, e 39 controles pareados por sexo, idade e escolaridade. Todos os pacientes foram submetidos a monitorização por vídeo-EEG e avaliação neuropsicológica, que incluiu: memória verbal (Rey Auditory Verbal Learning Test, RAVLT), não verbal (Rey Visual Design Learning Test, RVDLT, figura complexa de Rey) funções executivas (Stroop, teste classificação cartões de Wisconsin, repetição de dígitos e fluência verbal - FAS), linguagem (teste nomeação de Boston), escalas de ansiedade e depressão e questionário de queixas de memória. Segundo os achados eletrográficos, classificamos os pacientes com EMT unilateral em direito e esquerdo concordantes (DC, EC), parcialmente concordantes (DPC, EPC) e discordantes (DD, ED), reagrupados, em seguida, por dois critérios: maior discordância (parcialmente concordantes + concordantes) e menor discordância (parcialmente concordantes + discordantes). RESULTADOS: Dados demográficos, características da doença e tratamento não diferiram entre grupos. EC e ED tiveram pior desempenho que controles em memória verbal tardia. Após sete dias, ED tiveram pior desempenho que controles e DC+DPC em evocação livre, em reconhecimento e erros de reconhecimento que os demais grupos. DD apresentaram mais erros no aprendizado no RVDLT que controles. DPC+DD apresentaram rendimento inferior a controles em recordação tardia e após 7 dias da figura complexa de Rey. Ambos os grupos EMT esquerda desempenharam abaixo dos controles em evocação tardia da figura complexa Rey. ED e DPC+DD apresentaram maior quantidade de queixas de memória que controles. Não se observou impacto da discordância sobre funções executivas. DD apresentaram tendência de pior desempenho que controles e DC+- DPC nos testes de linguagem. EPC+ED apresentaram maior pontuação que controles em escala de depressão. CONCLUSÃO: Envolvimento eletrográfico contralateral associa-se a comprometimento mais acentuado de memória verbal no grupo ED, e, menos intensamente, a alteração de memória não verbal para grupo DD+DPC. Observou-se maior quantidade de queixas de memória nos grupos ED e DD+DPC, e tendência de pior desempenho em linguagem no grupo DD. Estes achados contrariam o conceito de dominância hemisférica para memória verbal e não verbal. Propomos um modelo de predominância da memória verbal para o hemisfério dominante e, menos pronunciadamente, predominância de memória não verbal no hemisfério não dominante de linguagem. Especulamos que a cirurgia bem sucedida para epilepsia possa trazer melhora cognitiva nos casos com achados eletrográficos discordantes / INTRODUCTION: Mesial temporal sclerosis (MTS) associated epilepsy leads to cognitive changes in various cognitive domains, including episodic and semantic memory, executive functions, and language. A material-specific model for memory impairment has been proposed. Ictal and interictal epileptiform activity may negatively impact on cognitive functions. The impact of contralateral electrographic involvement on cognitive functions in unilateral MTS has not been studied. METHODS: We retrospectively studied the impact of contralateral interictal and ictal epileptiform activity on cognitive functions in 121 (69 left) right-handed unilateral MTS patients, with an IQ>70, eight or more education years, without comorbidities, and 39 age, gender and education-matched controls. All patients underwent video-EEG monitoring and neuropsychological testing, including verbal (Rey Auditory Verbal Learning Test, RAVLT) and nonverbal memory (Rey Visual Design Learning Test, RVDLT, and Complex-Rey-Osterrieth-Figure), executive functions (Stroop, Wisconsin Card Sorting Task, digit span and verbal fluency - FAS), language (Boston Naming Test) and self- report scales for anxiety, depression, and memory complaints. According to MTS side and EEG findings groups were classified as right or left concordant (RC,LC), partially concordant (RPC, LPC), discordant (RD, LD). Groups were regrouped by two criteria: major discordance (merging partially concordant and concordant groups) and minor discordance (merging partially concordant and discordant groups). RESULTS: Demographic, disease and treatment features did not differ among groups. On verbal memory, LD and LC performed worse than controls on delayed recall. On 7-day recall, LD scored significantly worse than controls and RC+RPC, recognized fewer words and had more recognition errors than all groups. On nonverbal memory, RD had more errors in RVDLT learning than controls, and showed a trend towards worse performance compared to RC+RPC in immediate and delayed recall. For the Complex- Rey-Osterrieth-Figure, RPC+RD performed significantly worse than controls on delayed and 7-day recall. Both left MTS groups attained lower scores than controls on the Complex-Rey-Osterrieth-Figure delayed recall. LD and RPC+RD had higher scores of memory complaints than controls. No impact of discordance was observed on executive functioning. On language tests, there was a trend towards worse performance for RD compared to controls and RC+-RPC. LPC+LD scored more than controls in depression scale. CONCLUSION: Contralateral EEG involvement was associated with impaired verbal memory for LD group, and, to a lesser extent, with impaired nonverbal memory for the RD+RPC group. These findings were associated with increased memory complaints for LD and RD+RPC groups. We also found a trend towards worse performance on language tests for RD. These findings suggest that verbal and nonverbal memory are not completely lateralized to the dominant and non- dominant hemispheres. We propose a model of language-dominant hemisphere predominance for verbal memory and a less pronounced non-language dominant hemisphere predominance for nonverbal memory. We speculate that memory impairment in patients with discordant EEG data may be partially reversed with successful epilepsy surgery and removal of the at-distance focus. This hypothesis should be tested with appropriately designed studies

Introdução: A epilepsia pode ser considerada uma desordem neurológica causada pela anormalidade da transmissão de impulsos nervosos, devido ao aumento da excitação nervosa e/ou diminuição da sua inibição. Dentre as síndromes epilépticas, destaca-se a Epilepsia do Lobo Temporal Mesial (ELTM) devido a sua alta prevalência e refratariedade ao tratamento medicamentoso. Com intuito de implementar novas possibilidades de tratamento torna-se necessário uma maior compreensão das bases moleculares da ELTM. Dentro desta perspectiva, destacam-se os microRNAs, que possuem papel regulatório nas células, inclusive as do Sistema Nervoso Central. Com base em dados da literatura e num experimento de microarray, realizado no laboratório de Biologia Molecular do Departamento de Cirurgia e Anatomia da Faculdade de Medicina de Ribeirão Preto, foram escolhidos 3 dos 10 microRNAs, cujos alvos preditos estão relacionados à epileptogênese e que se apresentam diferencialmente expressos em hipocampos de pacientes com ELTM. Objetivos: avaliar a expressão diferencial de três microRNAs de interesse em hipocampos de pacientes operados por ELTM refratária ao tratamento clínico a fim de correlacionar os resultados em relação aos controles das crises epilépticas após a cirurgia. Metodologia: Foram utilizadas 15 amostras de hipocampo de pacientes com ELTM classificados como Engel I (boa evolução - nenhuma ou poucas crises convulsivas após lobectomia temporal parcial) e 15 amostras de hipocampos de pacientes classificados como Engel III/IV (má evolução - sem melhora evidente após tratamento cirúrgico). Como controles, foram utilizadas 10 amostras de hipocampo de pacientes sem doenças neurológicas, obtidas de necropsias do Serviço de Patologia do Hospital das Clínicas de Ribeirão Preto (HCFMRP). Por meio de técnica de PCR quantitativo em tempo real (RT-qPCR) foram realizadas as avaliações das expressões diferenciais dos seguintes microRNAs: miR-184, miR-190a-5p e miR-493-3p. Resultados: Em relação aos controles, o miR-184 e o miR190a-5p apresentaram-se, respectivamente, com redução significativa (p = 0,001) e com tendência a baixa expressão (p = 0,24) nos hipocampos de pacientes com ELTM. No que se refere ao controle das crises, o miR-184 apresentou-se significativamente mais expresso nos hipocampos de pacientes com pior evolução (Engel III/IV vs Engel I, p = 0,003). A expressão do miR-493-3p não se correlacionou com o controle de crises com significância estatística. Conclusão: Dentro os microRNAs avaliados, a expressão do miR-184, que possui importante papel na regulação de componentes celulares relacionados a apoptose e morte celular, correlacionou-se inversamente com o controle das crises após cirurgia (mais expresso em pacientes com má evolução) tornando-se potencial biomarcador e com valor preditivo / Introduction: Epilepsy is a neurological disorder caused by nerve impulse transmission abnormalities, by increasing nerve excitation and/or decreasing nerve inhibition. Among the epileptic syndromes, one of the most important ones is Mesial Temporal Lobe Epilepsy (MTLE) due to its high prevalence and resistance to drug treatment. A greater understanding of the epilepsy molecular basis is necessary aiming to implement new treatments possibilities. Within this field of study, it is possible to highlight the microRNA molecules, which have a regulatory role in cell regulation including in the Central Nervous System (CNS). Based on literature data and in an microarray experiment, performed in the Anatomy and Surgery Departament Molecular Biology laboratory of the Ribeirao Preto Medical School, we have chosen three out of ten microRNAs, with predicted targets related to epileptogenesis and that presented themselves differencially expressed in patients hippocampus with MTLE. Objective: To evaluate three microRNAs of interest which were differentially expressed in the hippocampus of MTLE drug-resistant operated patients in order to correlate the results with the clinical evolution based on the seizures control after surgery. Methodology: Fifteen hippocampus samples from patients with MTLE classified as Engel I (good evolution - without seizures or few seizures after surgical resection) and 15 samples from patients classified as Engel III/IV (bad evolution - no evident improvement after surgery) were used in this study. In the control group, we used ten samples of hippocampus fragments from patients without neurological diseases, that were obtained from the Ribeirao Preto Clinical Hospital Pathology and Legal Medicine Service. The differential expression validation from microRNAs-184, -190a-5p and -493-3p were performed by quantitative real time PCR (RT-qPCR) technique. Results: Regarding the controls, miR-184 and miR- 190a-5p showed, respectively, a significant expression reduction (p=0,001) and a decreased expression tendency (p=0,24) in MTLE patients. If we consider seizure control, miR-184 presented itself significantly upregulated in bad evolution hippocampus patients (Engel III/IV vs Engel I, p=0,003). miR-493-3p did not show expression differences with statistical significance. Conclusions: After evaluating the expression of these microRNAs, it was possible to conclude that microRNA-184, which regulates cellular death and apoptosis related components, was the best molecule that could differentiate the patients regarding seizure control after surgery, and that fact makes this microRNA a potential biomarker with predictive value

L’épilepsie du lobe temporal (ELT) est une pathologie neurologique sévère dont le fort taux de pharmacorésistance nécessite de nouveaux traitements. Le modèle lithium-pilocarpine modélise les caractéristiques et le développement de l’ELT. L’administration du carisbamate au début de l’épileptogenèse empêche l’apparition de l’ELT dans une sous-population de rats et la remplace par une épilepsie de type absence (ETA). L’évaluation cognitive effectuée durant la phase chronique a permis de distinguer les deux sous-populations : le groupe épilepsie de type absence ne développe pas le déficit cognitif sévère observé dans le modèle lithium pilocarpine. La spectroscopie du 13C n’a pas révélé de différence métabolique majeure entre les deux sous populations traitées, qu’elles développent une ELT ou une ETA. Ce travail souligne que l’administration précoce de carisbamate peut transformer l’ELT en une épilepsie moins sévère et fortement améliorer les comorbidités cognitives qui accompagnent l’ELT. / Temporal lobe epilepsy (TLE) is a severe neurological disease with a high refractory rate, which requires new treatments. The lithium-pilocarpine model allows reproducing human TLE features and development. Carisbamate administration at epileptogenesis onset prevents TLE incidence in a rats’ subpopulation, which is substituted by absence-like epilepsy (ALE). Behavioral and cognitive assessment performed during chronic period allowed differentiating the two subpopulations: ALE group did not develop the severe cognitive impairment shown in the lithium-pilocarpine model. 13C spectroscopy did not show major metabolism difference between the two treated subpopulations, whatever they develop TLE or ALE. This work demonstrates that early carisbamate administration can induce a shift from TLE in a less severe epilepsy form, and can strikingly improve TLE-related cognitive comorbidities.

Avec l’avancée en âge, l’efficience de l’ensemble des fonctions cognitives, en particulier la mémoire épisodique, tend à diminuer. L’étude des effets Dm et old/new et des résultats de la méthode sLORETA a permis de caractériser sur un plan neurofonctionnel deux types de vieillissement non pathologique chez les seniors. D’une part, le vieillissement cognitif stable se traduit par des processus d’encodage identiques à ceux observés chez des sujets jeunes alors que les processus de récupération nécessitent un recrutement bilatéral des lobes temporaux médians, cette activation étant unilatérale chez les sujets jeunes. Ces résultats vont dans le sens du modèle HAROLD qui suggère une réduction de l’asymétrie hémisphérique avec l’âge. D’autre part, le vieillissement cognitif altéré proviendrait d’une altération des réseaux cérébraux dès la phase d’encodage. La baisse d'activité au niveau du cortex préfrontal gauche, siège des fonctions exécutives, suggèrerait une difficulté de mise en œuvre de stratégies d'encodage efficaces et aurait un impact direct sur l'activité observée au niveau du lobe temporal médian de façon bilatérale ce qui pourrait donc expliquer une difficulté de stockage de l'information. / With advancing age, the efficiency of all cognitive functions, especially episodic memory, tends to decrease. The study of Dm and old/new effects and of the results of the sLORETA method allowed to characterize, on a neurofunctionnal level, two types of non-pathological aging among seniors. On the one hand, stable cognitive aging results in encoding processes similar to those observed in young subjects while the retrieval processes require a bilateral recruitment of the medial temporal lobes, this activation being unilateral in young subjects. These results are in line with the HAROLD model, suggesting a reduction of hemispheric asymmetry with age. On the other hand, the altered cognitive aging might come from an alteration of brain networks at the early stage of the encoding phase. The decline of activity in the left prefrontal cortex, seat of executive functions, would suggest a difficult implementation of effective encoding strategies and have a direct impact on the activity observed in the medial temporal lobe bilaterally which could therefore explain information storage difficulties.

L’épilepsie du lobe temporal (ELT) est la forme d’épilepsie partielle la plus fréquente chez l’adulte. Elle se caractérise par une période de latence pendant laquelle l’ELT se met en place. Cette période est appelée épileptogenèse. L’épileptogenèse reste une période inaccessible chez l’Homme. Cependant, les modèles animaux présentent l’avantage de pouvoir l’étudier, dans le but de prévenir l’ELT. Ainsi, mon travail de thèse a consisté à mettre en évidence des marqueurs prédictifs de l’épileptogenèse, sur le plan cognitif et électrophysiologique in vivo, à partir du modèle pilocarpine. Les résultats ont montré que dès le stade précoce de l’épileptogenèse, des déficits de mémoire spatiale corrélaient avec une diminution de la puissance des oscillations thêta chez les animaux pilocarpine, sans modification jusqu’au stade chronique. Au même stade, une diminution de la puissance et de la fréquence des oscillations thêta lors du comportement d’exploration a été observée. L’activité interictale, activité paroxystique présente chez les patients entre leurs crises et caractéristique du stade épileptogène dans les modèles animaux, ne corrèle pas directement avec les déficits cognitifs mais diminue la puissance des oscillations thêta dans l’onde après la pointe au cours de l’épileptogenèse mais plus au stade chronique, ce qui suggère une importante modification du réseau avant le stade chronique. On a également décrit deux types d’activité interictale dont les propriétés (amplitude, nombre) et la dynamique au cours du temps sont modifiées juste avant la première crise spontanée, ce qui pourrait constituer, comme les déficits spatiaux et l’altération du rythme thêta, un marqueur prédictif de l’épileptogenèse. De plus, une augmentation du couplage entre l’hippocampe et le CE est observée au cours de l’épileptogenèse mais plus au stade chronique, alors qu’une modification du flux de l’information entre ces deux structures au stade épileptogène précoce persiste jusqu’au stade chronique, indépendamment de la présence ou non d’activité interictale. Ces résultats mettent en évidence la construction d’un réseau épileptogène, un changement majeur du réseau avant la première crise spontanée, et des marqueurs qui pourraient être prédictifs de l’épileptogenèse. L’ELT, les oscillations et les fonctions cognitives faisant intervenir des propriétés de réseau, tels les processus de synchronisation, l’enregistrement de 15 structures au sein du lobe temporal a montré, à partir du modèle pilocarpine, un réseau doté de caractéristiques plus « small-world » (SW) qui tendrait à se synchroniser plus localement, avec une perte des connexions longue distance. Ces résultats pourraient expliquer les altérations de réseau observées précédemment au cours de l’épileptogenèse. L’analyse SW et de cohérence, à l’échelle de ce réseau de structures, lors de différents états (comportementaux, processus cognitifs), mettent en évidence des changements de la dynamique lors de ces états, en conditions normales et pathologiques. Toutes ces modifications de réseau doivent être sûrement recrutées dans la mise en place d’un cerveau épileptique et des altérations cognitives associées. / Temporal lobe epilepsy (TLE) is the most common form of partial epilepsy in adults. TLE is characterized by a latent period during which TLE takes place. This period is called epileptogenesis. In TLE patients, epileptogenesis is unexplored. However, the use of animal models, like pilocarpine model, allows the study of epileptogenic processes, in order to try to prevent TLE. Thus, my PhD work tries to yield some predictive markers of epileptogenesis, in the pilocarpine model. We studied cognitive and electrophysiological in vivo alterations in this model. We showed that there are early and persistent spatial deficits that correlate with a decrease of the power of theta oscillations, i.e. during the early stage of epileptogenesis and the chronic stage. At the same time, there is also a decrease of power and frequency of theta rhythm during exploratory behaviors. Interictal-like activity (ILA) is a pathological activity present during epileptogenesis in experimental models. ILA does not correlate with cognitive deficits, but decreases theta power after the spike, i.e. in its wave, during epileptogenesis but not during the chronic stage anymore. This suggests an important network alteration before the chronic stage. Indeed, we described two types of ILA, whose properties (number, amplitude) and dynamics evolved during epileptogenesis with a major switch just before the first spontaneous seizure. All together, these results may constitute, with spatial deficits and theta rhythm alterations, predictive markers of epileptogenesis. Moreover, we showed an increase in the coupling, ILA-dependent, between the hippocampus and the entorhinal cortex, during epileptogenesis but not during the chronic stage, whereas a reversal of the information flow between these two structures occurs at the early stage of epileptogenesis and persists without any modification till the chronic stage. These results suggest the build-up of an epileptogenic network, a major switch of network properties just before the first spontaneous seizure, and some markers that could be predictive of epileptogenesis. TLE, oscillations and cognition involved processes at the network level, in particular synchronization processes. These processes could be possible via oscillations, which allow information transfer between structures of the network, in order to provide behavioral and cognitive processing. Recordings performed in 15 different structures of the temporal lobe showed, in pilocarpine animals, a network with more “small-world” (SW) features, with a higher local clustering and a loss of long-range connections. These results could explain cognitive and oscillatory alterations observed previously during epileptogenesis. SW and coherence analysis, at the network level, between signals during different brain-states (behaviors and cognitive processes) showed changes in dynamics occurring during these states, in normal and epileptogenic conditions. All these modifications in network activities may be involved in the construction of an epileptic brain and in associated cognitive deficits.

Jusqu'à récemment, les patients souffrant d'épilepsie réfractaire aux traitements médicamenteux étaient destinés à un avenir incertain. Le recours à la chirurgie comme traitement alternatif offre l'espoir de mener un jour une vie normale. Pour déterminer si un patient peut bénéficier d’une intervention chirurgicale, une évaluation complète est cruciale. Les méthodes d’évaluation préchirurgicale ont connu des progrès importants au cours des dernières décennies avec le perfectionnement des techniques d’imagerie cérébrale. Parmi ces techniques, la spectroscopie proche infrarouge (SPIR), aussi connue sous le nom d’imagerie optique, présente de nombreux avantages (coût, mobilité du participant, résolution spatiale et temporelle, etc.). L’objectif principal de cette étude est de développer un protocole d'évaluation préchirurgicale de la mémoire. Une tâche de mémoire verbale incluant l’encodage, le rappel immédiat et le rappel différé de listes de mots a été administrée à dix adultes sains lors d’un enregistrement en imagerie optique. Les résultats obtenus suggèrent l’activation bilatérale des aires préfrontales antérieures et dorsolatérales ainsi que des aires temporales antérieures et moyennes. Les aires préfrontales et temporales antérieures semblent modulées par les différents processus mnésiques et la position du rappel dans le temps. La première fois qu’une liste est rappelée, l’activité hémodynamique est plus élevée que lors des rappels subséquents, et ce, davantage dans l’hémisphère gauche que dans l’hémisphère droit. Cette étude constitue la première étape dans le processus de validation du protocole à des fins cliniques auprès de patients épileptiques. / Until recently, patients with epilepsy refractory to drug treatments were intended to an uncertain future. Surgery as an alternative treatment offers hope to, one day, lead a normal life. In order to determine if a patient may benefit from a surgical intervention, a complete evaluation is essential. With the advancements in brain imagery techniques over the last few decades, preoperative evaluation methods have seen important progress. Among these techniques, near infrared spectroscopy (NIRS), also known as optical imaging, presents numerous advantages (cost, participant mobility, spatial and temporal resolution, etc.). The purpose of this study is to develop a preoperative evaluation protocol for memory assessment. During a NIRS recording, a verbal memory task including encoding, immediate and delayed free-recall of a list of words was administered to ten healthy adults. The results obtained revealed bilateral activation of anterior and dorsolateral prefrontal areas as well as anterior and median temporal areas. Prefrontal and anterior temporal areas seemed to be regulated by different memory processes and the recall location in time. The first time that a list is recalled, increased hemodynamic activity is observed in comparison to subsequent recalls, with a greater activity in the left hemisphere than in the right hemisphere. This study constitutes the first step in the validation process of the protocol for clinical needs among epileptic patients.

In der vorliegenden Arbeit wurde durch die Kombination zweier nichtinvasiver MR-Methoden in vivo untersucht, ob sich die funktionelle Sprachlateralisierung in einer strukturellen Asymmetrie der weißen Substanz widerspiegelt. Dafür wurden die Ergebnisse einer Patientengruppe mit Temporallappenepilepsie mit den Ergebnissen einer gesunden Kontrollgruppe verglichen. Es konnte gezeigt werden, dass mittels BOLD MRT eine Sprachlateralisierung in der grauen Substanz nachgewiesen werden kann, die mit einem strukturellen Korrelat in der weißen Substanz der sprachdominanten Hemisphäre einhergeht. Dieses Korrelat konnte als Asymmetrie der Mikrostruktur der weißen Substanz in DTI-Messungen belegt werden. Darüber hinaus konnte bewiesen werden, dass Patienten mit einer Temporallappenepilepsie im Vergleich zu gesunden Probanden eine atypische Lateralisierung der Sprachaktivierung im Broca-Areal aufweisen, die von einer gleichsinnig atypischen strukturelle Asymmetrie der weißen Substanz im Broca-Areal begleitet wird. Die These, dass eine funktionelle Sprachlateralisierung mit einer mikrostrukturellen Veränderung der weißen Substanz assoziiert ist, wird durch die vorliegende Arbeit sowohl für die gesunden Kontrollprobanden als auch für die Patienten mit einer fokalen Epilepsie bestätigt. Die Ergebnisse der vorliegenden Arbeit zeigen, dass DTI-Messungen eine sinnvolle Ergänzung zu BOLD MRT-Messungen in der Bestimmung der sprachrelevanten Areale darstellen können. Sprachlateralisierung könnte mit ihrer Hilfe in Zukunft exakt und nichtinvasiv bestimmt werden. Es stellte sich jedoch auch heraus, dass das in der vorliegenden Arbeit angewendete Verfahren in der Praxis sehr aufwendig ist, ohne eine entschieden höhere Aussagekraft über die Sprachlateralisierung zu erbringen. In dieser Form wird die nichtinvasive Bildgebung den Wada-Test als Goldstandard für den klinischen Alltag noch nicht ersetzen können.