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Chen Y, Fallon N, Kreilkamp BAK, Denby C, Bracewell M, Das K, Pegg E, Mohanraj R, Marson AG, Keller SS. Probabilistic mapping of thalamic nuclei and thalamocortical functional connectivity in idiopathic generalised epilepsy. Hum Brain Mapp 2021; 42:5648-5664. [PMID: 34432348 PMCID: PMC8559489 DOI: 10.1002/hbm.25644] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
It is well established that abnormal thalamocortical systems play an important role in the generation and maintenance of primary generalised seizures. However, it is currently unknown which thalamic nuclei and how nuclear‐specific thalamocortical functional connectivity are differentially impacted in patients with medically refractory and non‐refractory idiopathic generalised epilepsy (IGE). In the present study, we performed structural and resting‐state functional magnetic resonance imaging (MRI) in patients with refractory and non‐refractory IGE, segmented the thalamus into constituent nuclear regions using a probabilistic MRI segmentation method and determined thalamocortical functional connectivity using seed‐to‐voxel connectivity analyses. We report significant volume reduction of the left and right anterior thalamic nuclei only in patients with refractory IGE. Compared to healthy controls, patients with refractory and non‐refractory IGE had significant alterations of functional connectivity between the centromedian nucleus and cortex, but only patients with refractory IGE had altered cortical connectivity with the ventral lateral nuclear group. Patients with refractory IGE had significantly increased functional connectivity between the left and right ventral lateral posterior nuclei and cortical regions compared to patients with non‐refractory IGE. Cortical effects were predominantly located in the frontal lobe. Atrophy of the anterior thalamic nuclei and resting‐state functional hyperconnectivity between ventral lateral nuclei and cerebral cortex may be imaging markers of pharmacoresistance in patients with IGE. These structural and functional abnormalities fit well with the known importance of thalamocortical systems in the generation and maintenance of primary generalised seizures, and the increasing recognition of the importance of limbic pathways in IGE.
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Affiliation(s)
- Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | | | - Martyn Bracewell
- The Walton Centre NHS Foundation Trust, Liverpool, UK.,Schools of Medical Sciences and Psychology, Bangor University, Bangor, UK
| | - Kumar Das
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily Pegg
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Rajiv Mohanraj
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
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Lee DA, Ko J, Lee HJ, Kim HC, Park BS, Park S, Kim IH, Park JH, Lee YJ, Park KM. Alterations of the intrinsic amygdala-hippocampal network in juvenile myoclonic epilepsy. Brain Behav 2021; 11:e2274. [PMID: 34227259 PMCID: PMC8413739 DOI: 10.1002/brb3.2274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Several lines of evidence suggest that the amygdala-hippocampus is involved in the epileptogenic network of juvenile myoclonic epilepsy (JME). The aim of this study was to investigate the alterations in the individual nuclei of the amygdala and hippocampal subfields, and the intrinsic amygdala-hippocampal network of patients with JME compared to healthy controls. METHODS This retrospective study conducted at a single tertiary hospital involved 35 patients with newly diagnosed JME, and 34 healthy subjects. We calculated the individual structural volumes of 18 nuclei in the amygdala, and 38 hippocampal subfields using three-dimensional volumetric T1-weighted imaging and FreeSurfer program. We also performed an analysis of the intrinsic amygdala-hippocampal global and local network based on these volumes using a graph theory and Brain Analysis using Graph Theory (BRAPH) program. We investigated the differences in these volumes and network measures between patients with JME and healthy controls. RESULTS There were no significant volume differences in the nuclei of the amygdala and hippocampal subfields between patients with JME and healthy controls. However, we found significant differences in the global network between patients with JME and healthy controls. The mean clustering coefficient was significantly decreased in patients with JME compared to healthy controls (0.473 vs. 0.653, p = .047). In addition, specific regions in the hippocampal subfields showed significant differences in the local network between the two groups. The betweenness centrality of the right CA1-head, right hippocampus-amygdala-transition area, left hippocampal fissure, left fimbria, and left CA3-head, was increased in patients with JME compared to healthy controls. CONCLUSION The intrinsic amygdala-hippocampal global and local networks differed in patients with JME compared to healthy controls, which may be related to the pathogenesis of JME, and memory dysfunction in patients with JME.
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Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Junghae Ko
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hyung Chan Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sihyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Il Hwan Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jin Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Subcortical gray matter changes in pediatric patients with new-onset juvenile myoclonic epilepsy. Epilepsy Behav 2020; 104:106860. [PMID: 31935646 DOI: 10.1016/j.yebeh.2019.106860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/16/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to identify the relationship between subcortical gray matter (GM) volumes and juvenile myoclonic epilepsy (JME). METHODS We analyzed the brain magnetic resonance imaging (MRI) scans that were performed during the time of the diagnosis of epilepsy by using voxel-based morphometry (VBM) method. The volumetric three-dimensional sequence was used for structural investigation. The volumes of the thalamus, caudate nucleus, pallidum, and putamen were measured in both hemispheres of patients with JME, patients with generalized tonic-clonic seizures alone (GTCS) (as a disease control group) and healthy controls (HCs). All patients were drug-naïve, and treatment had been started after evaluating MRI results. RESULTS Fifteen patients with JME (9 females, mean age = 16.1 ± 3.2), 18 patients with GTCS (10 females, mean age = 15.5 ± 2.9), and 43 HCs (24 females, mean age = 15.9 ± 2.8) were included in the analysis. No significant difference was found for relative globus pallidus, caudate, and putamen volumes among the groups with JME, GTCS, and the HC group. The relative left and right thalamic volumes were significantly different between groups (Kruskal-Wallis rank test, p = 0.007, p = 0.001). In pairwise comparisons, both right and left relative thalamic volumes were lower in patients with JME than in HCs (right thalamus: means: 0.521 ± 0.066 vs. 0.597 ± 0.058, p < 0.001; left thalamus: means: 0.526 ± 0.088 vs. 0.605 ± 0.057, p < 0.001, Bonferroni post hoc corrections) and in patients with JME than in patients with GTCS (right thalamus: means: 0.521 ± 0.066 vs. 0.578 ± 0.066, p = 0.03; left thalamus: means: 0.526 ± 0.088 vs. 0.592 ± 0.068, p = 0.01, Bonferroni post hoc corrections), whereas there was no significant difference between the HCs and patients with GTCS (right thalamus: means: 0.597 ± 0.058 vs. 0.578 ± 0.066, p = 0.8; left thalamus: means: 0.605 ± 0.057 vs. 0.592 ± 0.068, p = 0.999, Bonferroni post hoc corrections). CONCLUSION This study allowed us to know that microstructural abnormalities exist from the disease onset, and the thalamus might play a critical role in the pathogenesis of JME.
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Gilsoul M, Grisar T, Delgado-Escueta AV, de Nijs L, Lakaye B. Subtle Brain Developmental Abnormalities in the Pathogenesis of Juvenile Myoclonic Epilepsy. Front Cell Neurosci 2019; 13:433. [PMID: 31611775 PMCID: PMC6776584 DOI: 10.3389/fncel.2019.00433] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/09/2019] [Indexed: 12/17/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME), a lifelong disorder that starts during adolescence, is the most common of genetic generalized epilepsy syndromes. JME is characterized by awakening myoclonic jerks and myoclonic-tonic-clonic (m-t-c) grand mal convulsions. Unfortunately, one third of JME patients have drug refractory m-t-c convulsions and these recur in 70-80% who attempt to stop antiepileptic drugs (AEDs). Behavioral studies documented impulsivity, but also impairment of executive functions relying on organization and feedback, which points to prefrontal lobe dysfunction. Quantitative voxel-based morphometry (VBM) revealed abnormalities of gray matter (GM) volumes in cortical (frontal and parietal) and subcortical structures (thalamus, putamen, and hippocampus). Proton magnetic resonance spectroscopy (MRS) found evidence of dysfunction of thalamic neurons. White matter (WM) integrity was disrupted in corpus callosum and frontal WM tracts. Magnetic resonance imaging (MRI) further unveiled anomalies in both GM and WM structures that were already present at the time of seizure onset. Aberrant growth trajectories of brain development occurred during the first 2 years of JME diagnosis. Because of genetic origin, disease causing variants were sought, first by positional cloning, and most recently, by next generation sequencing. To date, only six genes harboring pathogenic variants (GABRA1, GABRD, EFHC1, BRD2, CASR, and ICK) with Mendelian and complex inheritance and covering a limited proportion of the world population, are considered as major susceptibility alleles for JME. Evidence on the cellular role, developmental and cell-type expression profiles of these six diverse JME genes, point to their pathogenic variants driving the first steps of brain development when cell division, expansion, axial, and tangential migration of progenitor cells (including interneuron cortical progenitors) sculpture subtle alterations in brain networks and microcircuits during development. These alterations may explain "microdysgenesis" neuropathology, impulsivity, executive dysfunctions, EEG polyspike waves, and awakening m-t-c convulsions observed in JME patients.
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Affiliation(s)
- Maxime Gilsoul
- GIGA-Stem Cells, University of Liège, Liège, Belgium
- GIGA-Neurosciences, University of Liège, Liège, Belgium
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Thierry Grisar
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Antonio V. Delgado-Escueta
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Epilepsy Genetics/Genomics Lab, Neurology and Research Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Laurence de Nijs
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Bernard Lakaye
- GIGA-Stem Cells, University of Liège, Liège, Belgium
- GIGA-Neurosciences, University of Liège, Liège, Belgium
- GENESS International Consortium, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Kim JH. Grey and White Matter Alterations in Juvenile Myoclonic Epilepsy: A Comprehensive Review. J Epilepsy Res 2017; 7:77-88. [PMID: 29344465 PMCID: PMC5767493 DOI: 10.14581/jer.17013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/30/2017] [Indexed: 12/28/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME) has been classified as a syndrome of idiopathic generalized epilepsy and is characterized by a strong genetic basis, age-specific onset of seizures, specific types of seizures, generalized spike-wave discharges on electroencephalography, and a lack of focal abnormality on magnetic resonance imaging (MRI). Recently, a wide range of advanced neuroimaging techniques have been utilized to elucidate the neuroanatomical substrates and pathophysiological mechanisms underlying JME. Specifically, a number of quantitative MRI studies have reported focal or regional abnormalities of the subcortical and cortical grey matter, particularly the thalamus and frontal cortex, in JME patients. In addition, diffusion tensor imaging studies have pointed to disrupted microstructural integrity of the corpus callosum and multiple frontal white matter tracts as well as thalamofrontal dysconnectivity in JME patients. Converging evidence from neuroimaging studies strongly suggests that JME is a predominantly thalamofrontal network epilepsy, challenging the traditional concept of JME as a generalized epilepsy. There is also limited evidence indicating extrafrontal and extrathalamic involvement in JME. This systematic review outlines the main findings from currently available MRI studies focusing on grey and white matter alterations, and discusses their contributions to the etiology and pathophysiology of JME. The clinical utility, advantages, and drawbacks of each imaging modality are briefly described as well.
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Affiliation(s)
- Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kim JH, Kim JB, Suh SI, Kim DW. Subcortical grey matter changes in juvenile myoclonic epilepsy. NEUROIMAGE-CLINICAL 2017; 17:397-404. [PMID: 29159052 PMCID: PMC5683808 DOI: 10.1016/j.nicl.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022]
Abstract
Recent neuroimaging studies have provided converging evidence of structural and functional abnormalities of the thalamus in patients with juvenile myoclonic epilepsy (JME). There has also been limited evidence indicating involvement of the subcortical grey matter structures other than thalamus in JME, but with inconsistent findings across the studies. In the present study, we combined volumetric MRI and diffusion tensor imaging analyses to investigate macrostructural and microstructural alterations of the subcortical grey matter in 64 JME patients compared to 58 matched control subjects. Raw volume, fractional anisotropy (FA), and mean diffusivity (MD) of 6 subcortical grey matter structures (amygdala, hippocampus, caudate, pallidum, putamen, thalamus) were measured in both hemispheres. Between-group (controls versus patients) comparisons of normalized volume, FA, and MD, as well as within-group (patients) correlation analyses between structural changes and clinical variables were carried out. Compared to controls, JME patients exhibited significant volume reductions in left pallidum and bilateral putamen and thalamus. Duration of epilepsy negatively correlated with bilateral putamen volumes. Patients and controls did not differ in FA values of all structures. Compared to controls, JME patients showed significant MD increases in left pallidum and bilateral hippocampus, putamen, and thalamus. Significant positive correlations were found between duration of epilepsy and MD values of bilateral hippocampus and thalamus. We have provided evidence that macrostructural and microstructural abnormalities may not only be confined to the thalamus but also affect basal ganglia and hippocampus in JME. Our findings could further support the pathophysiological hypothesis of striato-thalamo-frontal network abnormality underlying JME, and may implicate disease progression. Reduced volumes of left pallidum and bilateral putamen and thalamus in JME patients Negative correlation between disease duration and putamen volumes Increased MD of left pallidum and bilateral hippocampus, putamen, and thalamus in JME patients Positive correlation between disease duration and MD of bilateral hippocampus and thalamus Structural changes may not only be confined to the thalamus but also affect basal ganglia and hippocampus in JME.
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Affiliation(s)
- Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Jung Bin Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
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Park KM, Lee BI, Shin KJ, Ha SY, Park J, Kim SE, Kim HC, Kim TH, Mun CW, Kim SE. Juvenile myoclonic epilepsy may be a disorder of cortex rather than thalamus: An effective connectivity analysis. J Clin Neurosci 2017; 35:127-132. [DOI: 10.1016/j.jocn.2016.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/30/2016] [Accepted: 09/28/2016] [Indexed: 01/19/2023]
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Anastasopoulou S, Kurth F, Luders E, Savic I. Generalized epilepsy syndromes and callosal thickness: Differential effects between patients with juvenile myoclonic epilepsy and those with generalized tonic-clonic seizures alone. Epilepsy Res 2016; 129:74-78. [PMID: 27923174 DOI: 10.1016/j.eplepsyres.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/14/2016] [Accepted: 11/17/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The definition of two well-studied genetic generalized epilepsy syndromes (GGE) - juvenile myoclonic epilepsy (JME) and epilepsy with generalized tonic-clonic seizures alone (GTCS) - suggests the absence of structural cerebral abnormalities. Nevertheless, there are various reports of such abnormalities (especially in JME), where effects mainly occur within thalamus and mesial prefrontal regions. This raises the question of whether JME is particularly linked to midline structure abnormalities, which may also involve the corpus callosum. METHOD We studied callosal morphology in a well-matched sample of 22 JME patients, 15 GTCS patients, and 42 controls (CTL) for all of whom we obtained T1-weighted data on a 3T MRI scanner. More specifically, we measured callosal thickness at 100 equidistant points across the callosal surface, and subsequently compared the three groups (JME, GTCS, and CTL) against each other. RESULTS Significant differences between JME patients and controls were observed within the callosal genu, anterior midbody, and isthmus, with thinner regions in JME patients. There were no significant differences between GTCS patients and controls, and also not between JME patients and GTCS patients. CONCLUSION The present outcomes point to callosal abnormalities in JME patients suggesting an impairment of interhemisperic communication between prefrontal, motor, parietal and temporal cortices. These findings further support the notion that structural aberrations are present and differentiated across GGE syndromes, with significant callosal deviations from normality in JME.
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Affiliation(s)
| | - Florian Kurth
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA, USA
| | - Eileen Luders
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA, USA
| | - Ivanka Savic
- Karolinska Institute and Karolinska Hospital and Neurology Clinic, Karolinska University Hospital Stockholm, Sweden.
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Abstract
Metabolic imaging enhances understanding of disease metabolisms and holds great potential as a measurement tool for evaluating disease prognosis and treatment effectiveness. Advancement of techniques, such as magnetic resonance spectroscopy, positron emission tomography, and mass spectrometry, allows for improved accuracy for quantification of metabolites and present unique possibilities for use in clinic. This article reviews and discusses literature reports of metabolic imaging in humans published since 2010 according to disease type, including cancer, degenerative disorders, psychiatric disorders, and others, as well as the current application of the various related techniques.
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Affiliation(s)
- Taylor L. Fuss
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114 USA
| | - Leo L. Cheng
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114 USA
- Corresponding Author: Leo L. Cheng, PhD, 149 13 Street, CNY-6, Charlestown, MA 02129, Ph.617-724-6593, Fax.617-726-5684,
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Proton magnetic resonance spectroscopy in juvenile myoclonic epilepsy: A systematic review and meta-analysis. Epilepsy Res 2016; 121:33-8. [DOI: 10.1016/j.eplepsyres.2016.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 12/07/2015] [Accepted: 01/24/2016] [Indexed: 12/30/2022]
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Kim SH, Lim SC, Kim W, Kwon OH, Jeon S, Lee JM, Shon YM. Extrafrontal structural changes in juvenile myoclonic epilepsy: A topographic analysis of combined structural and microstructural brain imaging. Seizure 2015. [DOI: 10.1016/j.seizure.2015.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Wang Y, Li D, Bao F, Ma S, Guo C, Jin C, Zhang M. Thalamic metabolic alterations with cognitive dysfunction in idiopathic trigeminal neuralgia: a multivoxel spectroscopy study. Neuroradiology 2014; 56:685-93. [PMID: 24820951 DOI: 10.1007/s00234-014-1376-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/01/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although abnormalities in metabolite compositions in the thalamus are well described in patients with idiopathic trigeminal neuralgia (ITN), differences in distinct thalamic subregions have not been measured with proton magnetic resonance spectroscopy ((1)H-MRS), and whether there are correlations between thalamic metabolites and cognitive function still remain unknown. METHODS Multivoxel MRS was recorded to investigate the metabolic alterations in the thalamic subregions of patients with ITN. The regions of interest were localized in the anterior thalamus (A-Th), intralaminar portion of the thalamus (IL-Th), posterior lateral thalamus (PL-Th), posterior medial thalamus (PM-Th), and medial and lateral pulvinar of the thalamus (PuM-Th and PuL-Th). The N-acetylaspartate to creatine (NAA/Cr) and choline to creatine (Cho/Cr) ratios were measured in the ITN and control groups. Scores of the visual analogue scale (VAS) and the Montreal Cognitive Assessment (MoCA) were analyzed to correlate with the neuroradiological findings. RESULTS The NAA/Cr ratio in the affected side of PM-Th and PL-Th in ITN patients was statistically lower than that in the corresponding regions of the thalamus in controls. The NAA/Cr ratio in the affected PM-Th was negatively associated with VAS and disease duration. Furthermore, decreases of NAA/Cr and Cho/Cr were detected in the affected side of IL-Th, and lower Cho/Cr was positively correlated with MoCA values in the ITN group. CONCLUSIONS Our result of low level of NAA/Cr in the affected PM-Th probably serves as a marker of the pain-rating index, and decreased Cho/Cr in IL-Th may be an indicator of cognitive disorder in patients with ITN.
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Affiliation(s)
- Yuan Wang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
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Saini J, Sinha S, Bagepally BS, Ramchandraiah CT, Thennarasu K, Prasad C, Taly AB, Satishchandra P. Subcortical structural abnormalities in juvenile myoclonic epilepsy (JME): MR volumetry and vertex based analysis. Seizure 2013; 22:230-5. [PMID: 23340274 DOI: 10.1016/j.seizure.2013.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 12/29/2012] [Accepted: 01/01/2013] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Imaging studies in juvenile myoclonic epilepsy (JME) have shown abnormalities of the thalamus and frontal cortex. The purpose of this study was to systematically investigate the morphological changes in the deep gray matter (GM) structures using techniques of voxel based morphometry (VBM), MR volumetry and shape analysis. METHODOLOGY The study included 40 patients with JME (M:F=21:19; age 22.8±5.3 years) and 19 matched controls (M:F=13:6; age 24.5±4.2 years). All subjects underwent MRI using standard protocol that included T1-3D TFE (Turbo Field Echo) images with 1mm thickness. VBM analysis and MR volumetry were performed. The volumes of deep subcortical GM structures were extracted and vertex-wise shape analysis was performed using FSL-FIRST (FSL-Integrated Registration and Segmentation Toolbox) software. RESULTS VBM analysis with a thalamic mask revealed focal thalamic alterations in the anteromedial aspect of the thalamus (p<0.05, false discovery rate (FDR) corrected) which remained significant after adjusting for age, gender and intracranial volume (ICV). Significant volume loss was noted in both the thalami. Vertex-wise shape analysis showed significant focal surface reductions in the thalami bilaterally in patients that were predominantly seen in the medial as well as lateral aspects of the thalamus (p<0.05, FDR corrected). The disease duration correlated with left hippocampus volume while age of onset correlated with right hippocampus volume. CONCLUSIONS This study confirms the presence of thalamic alterations in patients with JME. Shape analysis technique provided complementary information and disclosed the presence of focal atrophic changes in patients' thalami. The striatum and hippocampus did not show any significant alterations.
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Affiliation(s)
- J Saini
- Department of Neuroimaging and Interventional Radiology, NIMHANS, Bangalore, India
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