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Article ; Online: Lithium toxicity: The SILENT threat.

Martínez-Martín, Álvaro / Sánchez-Larsen, Álvaro / Sánchez-Mora, Carolina / Sáez-Povedano, Rocío / Segura, Tomás

Revista de psiquiatria y salud mental

2021 Volume 14, Issue 4, Page(s) 233–234

MeSH term(s)	Bipolar Disorder/drug therapy ; Humans ; Lithium/adverse effects
Chemical Substances	Lithium (9FN79X2M3F)
Language	English
Publishing date	2021-11-19
Publishing country	Spain
Document type	Letter
ISSN	2173-5050
ISSN (online)	2173-5050
DOI	10.1016/j.rpsmen.2021.11.001
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Article ; Online: Seronegative limbic encephalitis.

Sánchez-Larsen, Álvaro / de Cabo, Carlos

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

2019 Volume 41, Issue 1, Page(s) 205–208

MeSH term(s)	Adult ; Autoantibodies/blood ; Electroencephalography/methods ; Female ; Humans ; Limbic Encephalitis/blood ; Limbic Encephalitis/diagnostic imaging ; Limbic Encephalitis/physiopathology ; Magnetic Resonance Imaging/methods
Chemical Substances	Autoantibodies
Language	English
Publishing date	2019-07-19
Publishing country	Italy
Document type	Case Reports ; Letter
ZDB-ID	2016546-8
ISSN	1590-3478 ; 1590-1874
ISSN (online)	1590-3478
ISSN	1590-1874
DOI	10.1007/s10072-019-04011-1
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Article ; Online: Insular Role in Blood Pressure and Systemic Vascular Resistance Regulation.

Sanchez-Larsen, Alvaro / Principe, Alessandro / Ley, Miguel / Vaquerizo, Beatriz / Langohr, Klaus / Rocamora, Rodrigo

Neuromodulation : journal of the International Neuromodulation Society

2023

Abstract: 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 ( ... ...

Abstract	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 study aims to characterize the insular influence on vascular regulation through direct high-frequency electrical stimulation (E-stim) of different insular regions during stereo-electroencephalographic studies. Materials and methods: An observational, prospective study was conducted, involving people with epilepsy who underwent E-stim of depth electrodes implanted in the insular cortex. Patients with anatomical or electrophysiological insular abnormalities, E-stim producing after discharges, or any elicited symptoms were excluded. Variations of BP and systemic vascular resistance (SVR) during the insular stimuli were analyzed, comparing them with those observed during E-stim of control contacts implanted in cortical noneloquent regions and sham stimulations. Results: Fourteen patients were included, five implanted in the right insula and nine in the left. We analyzed 14 stimulations in the right insula, 18 in the left insula, 18 in control electrodes, and 13 sham stimulations. Most right insular responses were hypertensive, whereas most left ones were hypotensive. E-stim of the right insula produced a significant BP and SVR increase, whereas the left insula induced a significant BP decrease without SVR changes. The most remarkable changes were elicited in both posterior insulas, although the magnitude of BP changes was generally low. Control and sham stimulations did not induce BP or SVR changes. Conclusion: Our findings on insular stimulation suggest an interhemispheric difference in its vascular regulatory function, with a vasopressor effect of the right insula and a vasodilator effect of the left one.
Language	English
Publishing date	2023-01-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1500372-3
ISSN	1525-1403 ; 1094-7159
ISSN (online)	1525-1403
ISSN	1094-7159
DOI	10.1016/j.neurom.2022.12.012
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Zs.A 5912: Show issues

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Article ; Online: Lithium toxicity: The SILENT threat.

Martínez-Martín, Álvaro / Sánchez-Larsen, Álvaro / Sánchez-Mora, Carolina / Sáez-Povedano, Rocío / Segura, Tomás

Revista de psiquiatria y salud mental

2020

Title translation	Intoxicación por litio: la amenaza SILENTiosa.
Language	Spanish
Publishing date	2020-07-24
Publishing country	Spain
Document type	Letter
ISSN	2173-5050
ISSN (online)	2173-5050
DOI	10.1016/j.rpsm.2020.06.006
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Article ; Online: Neurological Symptoms of COVID-19: The Zonulin Hypothesis.

Llorens, Sílvia / Nava, Eduardo / Muñoz-López, Mónica / Sánchez-Larsen, Álvaro / Segura, Tomás

Frontiers in immunology

2021 Volume 12, Page(s) 665300

Abstract: The irruption of SARS-CoV-2 during 2020 has been of pandemic proportions due to its rapid spread and virulence. COVID-19 patients experience respiratory, digestive and neurological symptoms. Distinctive symptom as anosmia, suggests a potential ... ...

Abstract	The irruption of SARS-CoV-2 during 2020 has been of pandemic proportions due to its rapid spread and virulence. COVID-19 patients experience respiratory, digestive and neurological symptoms. Distinctive symptom as anosmia, suggests a potential neurotropism of this virus. Amongst the several pathways of entry to the nervous system, we propose an alternative pathway from the infection of the gut, involving Toll-like receptor 4 (TLR4), zonulin, protease-activated receptor 2 (PAR2) and zonulin brain receptor. Possible use of zonulin antagonists could be investigated to attenuate neurological manifestations caused by SARS-CoV-19 infection.
MeSH term(s)	Blood-Brain Barrier/metabolism ; Blood-Brain Barrier/virology ; Brain/metabolism ; Brain/virology ; COVID-19/complications ; COVID-19/metabolism ; COVID-19/virology ; Complement System Proteins/metabolism ; Gastrointestinal Diseases/complications ; Gastrointestinal Diseases/metabolism ; Gastrointestinal Diseases/virology ; Haptoglobins/metabolism ; Humans ; Nervous System Diseases/complications ; Nervous System Diseases/metabolism ; Nervous System Diseases/virology ; Protein Precursors/metabolism ; SARS-CoV-2/metabolism ; SARS-CoV-2/pathogenicity ; Toll-Like Receptor 4/metabolism
Chemical Substances	Haptoglobins ; Protein Precursors ; TLR4 protein, human ; Toll-Like Receptor 4 ; zonulin ; Complement System Proteins (9007-36-7)
Language	English
Publishing date	2021-04-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2021.665300
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Article ; Online: “Encefalitis anti-NMDA-R post-COVID-19: descripción de un caso y propuesta de su mecanismo fisiopatológico”.

Sanchez-Larsen, Alvaro / Rojas-Bartolomé, Laura / Fernández-Valiente, María / Sopelana, David

Neurologia (Barcelona, Spain)

2022

Title translation	"Anti-NMDA-R encephalitis post-COVID-19: case report and proposed physiopathologic mechanism".
Language	Spanish
Publishing date	2022-09-16
Publishing country	Spain
Document type	Journal Article
ZDB-ID	1056021-x
ISSN	1578-1968 ; 0213-4853
ISSN (online)	1578-1968
ISSN	0213-4853
DOI	10.1016/j.nrl.2022.08.002
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Zs.A 3093: Show issues

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Article ; Online: Characterization of the Insular Role in Cardiac Function through Intracranial Electrical Stimulation of the Human Insula.

Sanchez-Larsen, Alvaro / Principe, Alessandro / Ley, Miguel / Navarro-Cuartero, Javier / Rocamora, Rodrigo

Annals of neurology

2021 Volume 89, Issue 6, Page(s) 1172–1180

Abstract: Objective: The link between brain function and cardiovascular dynamics is an important issue yet to be elucidated completely. The insula is a neocortical brain area that is thought to have a cardiac chronotropic regulatory function, but its role in ... ...

Abstract	Objective: The link between brain function and cardiovascular dynamics is an important issue yet to be elucidated completely. 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 aimed to analyze the variability in heart rate and cardiac contractility after functional activation of different insular regions through direct electrical stimulation (E-stim) in humans. Methods: This was an observational, prospective study, including patients admitted for stereo-electroencephalographic recording because of refractory epilepsy, in whom the insular cortex was implanted. Patients with anatomical or electrophysiological insular abnormalities and those in whom E-stim produced subjective symptoms were excluded. Variations in heart rate (HR), stroke volume (SV), and cardiac output (CO) were analyzed during insular E-stim and compared with control E-stim of non-eloquent brain regions and sham stimulations. Results: Ten patients were included, 5 implanted in the right insula (52 E-stim) and 5 in the left (37 E-stim). Demographic and clinical characteristics of both groups were similar. E-stim of both right and left insulas induced a significant decrease of the CO and HR, and an increase of the SV. E-stim of control electrodes and sham stimulations were not associated with variations in cardiac function. Blood pressure and respiratory rate remained unaltered. Interpretation: Our results suggest a direct chronotropic and inotropic cardiac depressor function of the right and left insulas. The evidence of an insular direct cardiac regulatory function might open a path in the prevention or treatment of heart failure, arrhythmias, and sudden unexpected death in epilepsy. ANN NEUROL 2021;89:1172-1180.
MeSH term(s)	Adult ; Autonomic Nervous System/physiology ; Cardiac Output/physiology ; Cerebral Cortex/physiology ; Electric Stimulation ; Electrocorticography ; Female ; Heart/physiology ; Heart Rate/physiology ; Humans ; Male ; Middle Aged ; Neural Pathways/physiology ; Prospective Studies ; Stroke Volume/physiology ; Young Adult
Language	English
Publishing date	2021-04-12
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80362-5
ISSN	1531-8249 ; 0364-5134
ISSN (online)	1531-8249
ISSN	0364-5134
DOI	10.1002/ana.26074
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Zs.A 1370: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 478: Show issues

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Article ; Online: SUDEP in Spain: An Epilepsy Monitoring Unit based case series.

Sanchez-Larsen, Alvaro / Fernandez-Perez, Isabel / Principe, Alessandro / Ley, Miguel / Rocamora, Rodrigo

Seizure

2019 Volume 69, Page(s) 258–264

Abstract: 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 ... ...

Abstract	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 classified as definite, probable, possible or near-SUDEP. Epilepsy type, demographics and case detection issues were described. Results: From 1250 evaluated patients, 102 died during the study period. Seven patients were diagnosed with SUDEP or near-SUDEP: two definite SUDEP, one definite SUDEP plus, two probable SUDEP and two near-SUDEP. Specific problems for detection and registration of SUDEP inherent to the Spanish healthcare system and the legal framework were defined. Only 43% of cases were known by the referral neurologist. SUDEP incidence was 1.3 per 1000 patient/year, comprising 0.56% of all deaths in our cohort. Two cases were female, the average age was 36 years (18-61). All patients had focal epilepsy and suffered from generalized tonic-clonic seizures. All witnessed cases occurred after a focal to bilateral tonic-clonic seizure. Four cases occurred during sleep and all non-witnessed cases were found in prone position. One case occurred during video-EEG monitoring. Conclusions: Our casuistic represents the first Epilepsy Monitoring Unit based case series of SUDEP conducted in Spain. The incidence in our population agrees with the reported in other countries. However, in our population, SUDEP is probably underdiagnosed due to administrative and legal issues.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain/physiopathology ; Child ; Child, Preschool ; Epilepsies, Partial/mortality ; Epilepsies, Partial/physiopathology ; Epilepsy, Tonic-Clonic/mortality ; Epilepsy, Tonic-Clonic/physiopathology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Spain/epidemiology ; Sudden Unexpected Death in Epilepsy/epidemiology ; Young Adult
Language	English
Publishing date	2019-05-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1137610-7
ISSN	1532-2688 ; 1059-1311
ISSN (online)	1532-2688
ISSN	1059-1311
DOI	10.1016/j.seizure.2019.05.014
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Zs.A 3573: Show issues

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Article ; Online: Observational retrospective analysis of vaccination against SARS-CoV-2 and seizures: VACCI-COVID registry.

Martinez-Fernandez, Isabel / Sanchez-Larsen, Alvaro / Gonzalez-Villar, Esther / Martínez-Martín, Álvaro / von Quednow, Enzo / Del Valle-Pérez, Jose Antonio / Andrés-López, Alberto / Restrepo-Carvajal, Laura Carolina / Cuenca-Juan, Fernando / Ballesta-García, Marina / Sopelana, David

Epilepsy & behavior : E&B

2022 Volume 134, Page(s) 108808

Abstract: Background: We aimed to assess the risk of developing new-onset seizures or seizure decompensations in people with epilepsy (PWE) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines.: Methods: A retrospective ... ...

Abstract	Background: We aimed to assess the risk of developing new-onset seizures or seizure decompensations in people with epilepsy (PWE) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Methods: A retrospective observational study in a tertiary hospital was conducted. Clinical records of all patients attended because of seizures or epilepsy at outpatient clinics, emergency department, or admitted to our hospital from January to December 2021 were reviewed, including patients older than 16 years who received some dose of coronavirus disease 2019 (COVID-19) vaccines. Results: A total of 418 vaccinated PWE were analyzed: 6.2% presented an increase in seizure frequency and 1% reported different seizure types during the next month after vaccination. However, 61.5% had another possible cause for this decompensation. Having monthly seizures (1-3/month) was the only associated risk factor (OR 4.9, p < 0.001) while being seizure free > 1 year had a protective role (OR 0.36, p = 0.019). Patients with epileptic encephalopathies or a history of COVID-19 infection were not at increased risk of seizure decompensation. Besides this, 15 patients presented new-onset seizures within the first month post-vaccination, mean time from vaccination 15 ± 8 days, 67% after the second dose. Again, 53.3% had another possible trigger for seizures. Eight debuted with status epilepticus or cluster of seizures. Conclusions: A small proportion of PWE (6.2%) had an increase in seizure frequency after COVID-19 vaccination and 15 patients had new-onset seizures during the first month after vaccination, though another reason for seizure exacerbation was identified in 61.5% and 53.3%, respectively. Severe acute respiratory syndrome COVID-19 vaccines appear to have little impact on the generation or decompensation of seizures.
MeSH term(s)	COVID-19 ; COVID-19 Vaccines ; Epilepsy ; Humans ; Registries ; Retrospective Studies ; SARS-CoV-2 ; Seizures ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-06-22
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2010587-3
ISSN	1525-5069 ; 1525-5050
ISSN (online)	1525-5069
ISSN	1525-5050
DOI	10.1016/j.yebeh.2022.108808
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Zs.A 5289: Show issues

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Article ; Online: Exceptional response to brivaracetam in a patient with refractory idiopathic generalized epilepsy and absence seizures.

Grande-Martín, Alberto / Sopelana-Garay, David / Pardal-Fernández, José Manuel / Sánchez-Honrubia, Rosa María / Sánchez-Larsen, Álvaro Abelardo

Epileptic disorders : international epilepsy journal with videotape

2017 Volume 20, Issue 1, Page(s) 60–64

Abstract: Brivaracetam is currently indicated as adjunctive therapy for patients with focal-onset seizures with or without secondary generalization. However, it has been suggested that it could provide broad-spectrum efficacy given its similarity to levetiracetam ... ...

Abstract	Brivaracetam is currently indicated as adjunctive therapy for patients with focal-onset seizures with or without secondary generalization. However, it has been suggested that it could provide broad-spectrum efficacy given its similarity to levetiracetam and based on the results from preclinical studies and others of patients with generalized epilepsy. We present the case of a woman with refractory idiopathic generalized epilepsy and absence seizures with dramatic response to brivaracetam. Our report supports a consideration of treatment with this new antiepileptic drug on a case-by-case basis in patients with refractory generalized epilepsy, while we await further studies on this topic.
MeSH term(s)	Anticonvulsants/administration & dosage ; Anticonvulsants/pharmacology ; Drug Resistant Epilepsy/drug therapy ; Epilepsy, Absence/drug therapy ; Epilepsy, Generalized/drug therapy ; Female ; Humans ; Middle Aged ; Pyrrolidinones/administration & dosage ; Pyrrolidinones/pharmacology
Chemical Substances	Anticonvulsants ; Pyrrolidinones ; brivaracetam (U863JGG2IA)
Language	English
Publishing date	2017-11-21
Publishing country	France
Document type	Case Reports ; Journal Article
ZDB-ID	2086797-9
ISSN	1950-6945 ; 1294-9361
ISSN (online)	1950-6945
ISSN	1294-9361
DOI	10.1684/epd.2017.0939
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