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Nica A. Drug-resistant juvenile myoclonic epilepsy: A literature review. Rev Neurol (Paris) 2024; 180:271-289. [PMID: 38461125 DOI: 10.1016/j.neurol.2024.02.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/11/2024]
Abstract
The ILAE's Task Force on Nosology and Definitions revised in 2022 its definition of juvenile myoclonic epilepsy (JME), the most common idiopathic generalized epilepsy disorder, but this definition may well change again in the future. Although good drug response could almost be a diagnostic criterion for JME, drug resistance (DR) is observed in up to a third of patients. It is important to distinguish this from pseudoresistance, which is often linked to psychosocial problems or psychiatric comorbidities. After summarizing these aspects and the various definitions applied to JME, the present review lists the risk factors for DR-JME that have been identified in numerous studies and meta-analyses. The factors most often cited are absence seizures, young age at onset, and catamenial seizures. By contrast, photosensitivity seems to favor good treatment response, at least in female patients. Current hypotheses on DR mechanisms in JME are based on studies of either simple (e.g., cortical excitability) or more complex (e.g., anatomical and functional connectivity) neurophysiological markers, bearing in mind that JME is regarded as a neural network disease. This research has revealed correlations between the intensity of some markers and DR, and above all shed light on the role of these markers in associated neurocognitive and neuropsychiatric disorders in both patients and their siblings. Studies of neurotransmission have mainly pointed to impaired GABAergic inhibition. Genetic studies have generally been inconclusive. Increasing restrictions have been placed on the use of valproate, the standard antiseizure medication for this syndrome, owing to its teratogenic and developmental risks. Levetiracetam and lamotrigine are prescribed as alternatives, as is vagal nerve stimulation, and there are several other promising antiseizure drugs and neuromodulation methods. The development of better alternative treatments is continuing to take place alongside advances in our knowledge of JME, as we still have much to learn and understand.
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Affiliation(s)
- A Nica
- Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Clinical Investigation Center 1414, Rennes University Hospital, Rennes, France; Signal and Image Processing Laboratory (LTSI), INSERM, Rennes University, Rennes, France.
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2
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Jiang S, Wang Y, Pei H, Li H, Chen J, Yao Y, Li Q, Yao D, Luo C. Brain activation and connection across resting and motor-task states in patients with generalized tonic-clonic seizures. CNS Neurosci Ther 2024; 30:e14672. [PMID: 38644561 PMCID: PMC11033329 DOI: 10.1111/cns.14672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 04/23/2024] Open
Abstract
AIMS Motor abnormalities have been identified as one common symptom in patients with generalized tonic-clonic seizures (GTCS) inspiring us to explore the disease in a motor execution condition, which might provide novel insight into the pathomechanism. METHODS Resting-state and motor-task fMRI data were collected from 50 patients with GTCS, including 18 patients newly diagnosed without antiepileptic drugs (ND_GTCS) and 32 patients receiving antiepileptic drugs (AEDs_GTCS). Motor activation and its association with head motion and cerebral gradients were assessed. Whole-brain network connectivity across resting and motor states was further calculated and compared between groups. RESULTS All patients showed over-activation in the postcentral gyrus and the ND_GTCS showed decreased activation in putamen. Specifically, activation maps of ND_GTCS showed an abnormal correlation with head motion and cerebral gradient. Moreover, we detected altered functional network connectivity in patients within states and across resting and motor states by using repeated-measures analysis of variance. Patients did not show abnormal connectivity in the resting state, while distributed abnormal connectivity in the motor-task state. Decreased across-state network connectivity was also found in all patients. CONCLUSION Convergent findings suggested the over-response of activation and connection of the brain to motor execution in GTCS, providing new clues to uncover motor susceptibility underlying the disease.
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Affiliation(s)
- Sisi Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduP. R. China
- Research Unit of NeuroInformationChinese Academy of Medical SciencesChengduP. R. China
- High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceCenter for Information in MedicineUniversity of Electronic Science and Technology of ChinaChengduP. R. China
| | - Yuehan Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduP. R. China
| | - Haonan Pei
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduP. R. China
| | - Hechun Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduP. R. China
| | - Junxia Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduP. R. China
| | - Yutong Yao
- Department of NeurosurgeySichuan Provincial People's Hospital, University of Electronic Science and Technology of ChinaChengduP. R. China
| | - Qifu Li
- Department of NeurologyHainan Medical UniversityHainanP. R. China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduP. R. China
- Research Unit of NeuroInformationChinese Academy of Medical SciencesChengduP. R. China
- High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceCenter for Information in MedicineUniversity of Electronic Science and Technology of ChinaChengduP. R. China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, School of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduP. R. China
- Research Unit of NeuroInformationChinese Academy of Medical SciencesChengduP. R. China
- High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan ProvinceCenter for Information in MedicineUniversity of Electronic Science and Technology of ChinaChengduP. R. China
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3
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Xiao F, Caciagli L, Wandschneider B, Sone D, Young AL, Vos SB, Winston GP, Zhang Y, Liu W, An D, Kanber B, Zhou D, Sander JW, Thom M, Duncan JS, Alexander DC, Galovic M, Koepp MJ. Identification of different MRI atrophy progression trajectories in epilepsy by subtype and stage inference. Brain 2023; 146:4702-4716. [PMID: 37807084 PMCID: PMC10629797 DOI: 10.1093/brain/awad284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/30/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Artificial intelligence (AI)-based tools are widely employed, but their use for diagnosis and prognosis of neurological disorders is still evolving. Here we analyse a cross-sectional multicentre structural MRI dataset of 696 people with epilepsy and 118 control subjects. We use an innovative machine-learning algorithm, Subtype and Stage Inference, to develop a novel data-driven disease taxonomy, whereby epilepsy subtypes correspond to distinct patterns of spatiotemporal progression of brain atrophy.In a discovery cohort of 814 individuals, we identify two subtypes common to focal and idiopathic generalized epilepsies, characterized by progression of grey matter atrophy driven by the cortex or the basal ganglia. A third subtype, only detected in focal epilepsies, was characterized by hippocampal atrophy. We corroborate external validity via an independent cohort of 254 people and confirm that the basal ganglia subtype is associated with the most severe epilepsy.Our findings suggest fundamental processes underlying the progression of epilepsy-related brain atrophy. We deliver a novel MRI- and AI-guided epilepsy taxonomy, which could be used for individualized prognostics and targeted therapeutics.
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Affiliation(s)
- Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
| | - Daichi Sone
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
| | - Alexandra L Young
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sjoerd B Vos
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- Centre for Microscopy, Characterisation, and Analysis, University of Western Australia, Perth, WA 6009, Australia
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, K7L 3N6, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, K7L 3N6, Canada
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wenyu Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Dongmei An
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Baris Kanber
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
- Stichting Epilepsie Instellingen Nederland – (SEIN), Heemstede, 2103SW, The Netherlands
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Departments of Computer Science, Medical Physics, and Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, CH-8091, Switzerland
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UCL-Epilepsy Society MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, SL9 0RJ, UK
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Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Byars A, Fastenau P, Austin J, Hermann B. The Impact of Sociodemographic Disadvantage on Cognitive Outcomes in Children With Newly Diagnosed Seizures and Their Unaffected Siblings Over 36 Months. Pediatr Neurol 2023; 148:178-188. [PMID: 37742443 DOI: 10.1016/j.pediatrneurol.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Accumulating evidence indicates that children with newly diagnosed epilepsy have comorbidities including cognitive challenges. Research investigating comorbidities has focused on clinical epilepsy characteristics and neurobiological/genetic correlates. The role that sociodemographic disadvantage (SD) may play has received less attention. We investigated the role of SD in cognitive status in youth with newly diagnosed epilepsy over a follow-up of 36 months to determine the degree, extent, and duration of the role of disadvantage. METHODS A total of 289 children (six to 16 years) within six weeks of their first seizure along with 167 siblings underwent comprehensive neuropsychological assessments (intelligence, language, memory, executive function, processing speed, and academic achievement) at baseline, 18 months later, and at 36 months from baseline. Baseline demographic information (race, caregivers education, household income, and parental marital status), clinical epilepsy characteristics (e.g., age of onset), and magnetic resonance imaging (MRI) and electroencephalographic (EEG) information was collected. RESULTS An SD index was computed for each family and categorized into four groups by level of disadvantage. In children and siblings, the least disadvantaged group exhibited the highest Full-Scale IQ, neuropsychological factor scores, and academic performances, whereas the most disadvantaged showed the polar opposite with the worst performances across all tests. Findings remained stable and significant over 36 months. Linear regression analyses indicated that disadvantage was a more constant and stable predictor of cognitive and academic performance over time compared with clinical epilepsy characteristics and MRI/EEG abnormalities. CONCLUSIONS This study indicates the strong association between SD and cognitive/academic performance in children with newly diagnosed epilepsy and their siblings is significant and predictive of three-year cognitive outcomes.
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Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Philip Fastenau
- Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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5
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Oyegbile-Chidi T, Harvey D, Jones J, Byars A, Austin J, Hermann B, Dunn D. Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months. Epilepsia 2023; 64:2172-2185. [PMID: 37264778 PMCID: PMC10526637 DOI: 10.1111/epi.17672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study was undertaken to determine the short-term and longer term impact of sociodemographic disadvantage on the emotional-behavioral status of youths with new onset epilepsy and their unaffected siblings at the time of diagnosis and the subsequent 3 years. METHODS Three hundred twelve youths with newly diagnosed epilepsies and 223 unaffected siblings, aged 6-16 years, were independently assessed regarding their emotional and behavioral status by their parents and teachers at baseline, and at 18 at 36 months later; youths with seizures also completed self-report measures of depression, anxiety, and hostility at those three time points. A sociodemographic disadvantage score was computed for each family (children with newly diagnosed seizures and their siblings), and families were separated into four categories from most disadvantaged to least disadvantaged. RESULTS In both children and siblings, the least disadvantaged group exhibited the lowest level of neurobehavioral problems, whereas the most disadvantaged group showed a higher level of neurobehavioral problems across all the same behavior metrics. Findings remained stable and significant across all informants (parent, teacher, child) and across all time periods (throughout the 3-year period). Furthermore, both corrected and uncorrected linear regression analyses indicated that disadvantage was a more constant and stable predictor of behavioral and emotional problems over time compared to clinical seizure characteristics and abnormalities in magnetic resonance imaging and electroencephalographic testing. SIGNIFICANCE Sociodemographic disadvantage bears a strong relationship to youths with emotional and behavioral problems both at the time of diagnosis as well as prospectively. The relationship is robust and reflected in reports from multiple informants (parent, teacher, child self-report), evident in siblings as well, and possibly more explanatory than traditional clinical seizure variables. Future studies will be needed to determine whether this disadvantage factor is modifiable with early intervention.
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Affiliation(s)
| | - Danielle Harvey
- Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anna Byars
- Department of Neurology, Cincinnati, Cincinnati Children's Hospital, University of Cincinnati, Ohio, USA
| | - Joan Austin
- Department of Environments for Health, Indiana University, Indianapolis, Indiana, USA
| | - Bruce Hermann
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Dunn
- Department of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana, USA
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6
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Jeppesen JM, Sandvei CM, Beier CP, Gesche J. Neuropsychological profile and drug treatment response in Idiopathic Generalized Epilepsy. Seizure 2023; 109:12-17. [PMID: 37178660 DOI: 10.1016/j.seizure.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The endophenotype of Idiopathic Generalized Epilepsies (IGE) comprises distinct neuropsychological deficits compared to normal controls. It is unknown if the severity of features of the endophenotype correlates with resistance to anti-seizure medication. Therefore, we here studied the association of neuropsychological profiles with treatment response. METHODS We evaluated 106 Danish patients aged ≥18 and diagnosed with IGE using a neuropsychological test battery comprising tests for executive dysfunction, visual attention, episodic memory, and verbal comprehension. Tests were complemented by the Purdue Pegboard test. Patients with suspected ongoing psychogenic non-epileptic seizures were excluded. RESULTS At testing, 72 patients were seizure free, and 34 patients had recent seizures despite anti-seizure medication. As compared to age corrected Danish normative values, IGE patients showed significant impairments in semantic fluency and performed significantly worse in the Purdue Pegboard test. The vocabulary subtest of the WAIS-IV suggested lower verbal comprehension in IGE patients. We found no signs of memory impairment. Comparisons between results of the test battery, drug resistance, and the different IGE subsyndromes revealed consistent null-associations in various predefined and exploratory univariate and multivariate analyses. CONCLUSION We here found and confirmed the distinct neuropsychological profile comprising impaired executive functions, reduced psychomotor speed, and normal memory previously described in juvenile myoclonic epilepsy. This profile was, however, not restricted to juvenile myoclonic epilepsy but equally affected all IGE patients. The neuropsychological deficits were not significantly associated with drug treatment outcome.
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Affiliation(s)
| | | | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN - Open Patient Data Explorative Network, Odense, Denmark.
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Szabo CA, Salinas FS. Neuroimaging in the Epileptic Baboon. Front Vet Sci 2022; 9:908801. [PMID: 35909685 PMCID: PMC9330034 DOI: 10.3389/fvets.2022.908801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Characterization of baboon model of genetic generalized epilepsy (GGE) is driven both electroclinically and by successful adoption of neuroimaging platforms, such as magnetic resonance imaging (MRI) and positron emission tomography (PET). Based upon its phylogenetic proximity and similar brain anatomy to humans, the epileptic baboon provides an excellent translational model. Its relatively large brain size compared to smaller nonhuman primates or rodents, a gyrencephalic structure compared to lissencephalic organization of rodent brains, and the availability of a large pedigreed colony allows exploration of neuroimaging markers of diseases. Similar to human idiopathic generalized epilepsy (IGE), structural imaging in the baboon is usually normal in individual subjects, but gray matter volume/concentration (GMV/GMC) changes are reported by statistical parametric mapping (SPM) analyses. Functional neuroimaging has been effective for mapping the photoepileptic responses, the epileptic network, altered functional connectivity of physiological networks, and the effects of anti-seizure therapies. This review will provide insights into our current understanding the baboon model of GGE through functional and structural imaging.
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Affiliation(s)
- C. Akos Szabo
- Department of Neurology, University of Texas Health San Antonio, San Antonio, TX, United States
- *Correspondence: C. Akos Szabo
| | - Felipe S. Salinas
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX, United States
- Department of Radiology, University of Texas Health San Antonio, San Antonio, TX, United States
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8
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Kim KY, Moon JU, Lee JY, Eom TH, Kim YH, Lee IG. Distributed source localization of epileptiform discharges in juvenile myoclonic epilepsy: Standardized low-resolution brain electromagnetic tomography (sLORETA) Study. Medicine (Baltimore) 2022; 101:e29625. [PMID: 35777062 PMCID: PMC9239631 DOI: 10.1097/md.0000000000029625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Juvenile myoclonic epilepsy (JME) is a common generalized epilepsy syndrome considered the prototype of idiopathic generalized epilepsy. To date, generalized and focal seizures have been the fundamental concepts for classifying seizure types. In several studies, focal features of JME have been reported predominantly in the frontal lobe. However, results in previous studies are inconsistent. Therefore, we investigated the origin of epileptiform discharges in JME. We performed electroencephalography source localization using a distributed model with standardized low-resolution brain electromagnetic tomography. In 20 patients with JME, standardized low-resolution brain electromagnetic tomography images corresponding to the midpoint of the ascending phase and the negative peak of epileptiform discharges were obtained from a total of 362 electroencephalography epochs (181 epochs at each timepoint). At the ascending phase, the maximal current source density was located in the frontal lobe (58.6%), followed by the parietal (26.5%) and occipital lobes (8.8%). At the negative peak, the maximal current source density was located in the frontal lobe (69.1%), followed by the parietal (11.6%) and occipital lobes (9.4%). In the ascending phase, 41.4% of discharges were located outside the frontal lobe, and 30.9% were in the negative peak. Frontal predominance of epileptiform discharges was observed; however, source localization extending to various cortical regions also was identified. This widespread pattern was more prominent in the ascending phase (P = .038). The study results showed that JME includes widespread cortical regions over the frontal lobe. The current concept of generalized epilepsy and pathophysiology in JME needs further validation.
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Affiliation(s)
- Kwang Yeon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja-Un Moon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Hoon Eom
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Goo Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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9
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Stier C, Loose M, Kotikalapudi R, Elshahabi A, Li Hegner Y, Marquetand J, Braun C, Lerche H, Focke NK. Combined electrophysiological and morphological phenotypes in patients with genetic generalized epilepsy and their healthy siblings. Epilepsia 2022; 63:1643-1657. [PMID: 35416282 DOI: 10.1111/epi.17258] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Genetic generalized epilepsy is characterized by aberrant neuronal dynamics and subtle structural alterations. We evaluated whether a combination of magnetic and electrical neuronal signals and cortical thickness would provide complementary information about network pathology in GGE. We also investigated if these imaging phenotypes were present in healthy siblings of the patients to test for genetic influence. METHODS In this cross-sectional study, we analyzed five minutes of resting-state data acquired using electroencephalography (EEG) and magnetoencephalography (MEG) in patients, their siblings, and controls, matched for age and sex. We computed source-reconstructed power and connectivity in six frequency bands (1-40 Hz) and cortical thickness (derived from magnetic resonance imaging (MRI)). Group differences were assessed using permutation analysis of linear models for each modality separately and jointly for all modalities using a non-parametric combination. RESULTS Patients with GGE (n = 23) had higher power than controls (n = 35) in all frequencies, with a more posterior focus in MEG than EEG. Connectivity was also increased, particularly in frontotemporal and central regions in theta (strongest in EEG) and low beta frequencies (strongest in MEG), which was eminent in the joint EEG/MEG analysis. EEG showed weaker connectivity differences in higher frequencies, possibly related to drug effects. The inclusion of cortical thickness reinforced group differences in connectivity and power. Siblings (n = 18) had functional and structural patterns intermediate between those of patients and controls. SIGNIFICANCE EEG detected increased connectivity and power in GGE similar to MEG, but with different spectral sensitivity, highlighting the importance of theta and beta oscillations. Cortical thickness reductions in GGE corresponded to functional imaging patterns. Our multimodal approach extends the understanding of the resting-state in GGE and points to genetic underpinnings of the imaging markers studied, providing new insights into the causes and consequences of epilepsy.
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Affiliation(s)
- Christina Stier
- Clinic of Neurology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Markus Loose
- Clinic of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Raviteja Kotikalapudi
- Clinic of Neurology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - Adham Elshahabi
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Yiwen Li Hegner
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Justus Marquetand
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christoph Braun
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,MEG-Center, University of Tübingen, Tübingen, Germany.,CIMeC, Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Niels K Focke
- Clinic of Neurology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Rodriguez-Cruces R, Royer J, Larivière S, Bassett DS, Caciagli L, Bernhardt BC. Multimodal connectome biomarkers of cognitive and affective dysfunction in the common epilepsies. Netw Neurosci 2022; 6:320-338. [PMID: 35733426 PMCID: PMC9208009 DOI: 10.1162/netn_a_00237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/02/2022] [Indexed: 11/05/2022] Open
Abstract
Epilepsy is one of the most common chronic neurological conditions, traditionally defined as a disorder of recurrent seizures. Cognitive and affective dysfunction are increasingly recognized as core disease dimensions and can affect patient well-being, sometimes more than the seizures themselves. Connectome-based approaches hold immense promise for revealing mechanisms that contribute to dysfunction and to identify biomarkers. Our review discusses emerging multimodal neuroimaging and connectomics studies that highlight network substrates of cognitive/affective dysfunction in the common epilepsies. We first discuss work in drug-resistant epilepsy syndromes, that is, temporal lobe epilepsy, related to mesiotemporal sclerosis (TLE), and extratemporal epilepsy (ETE), related to malformations of cortical development. While these are traditionally conceptualized as ‘focal’ epilepsies, many patients present with broad structural and functional anomalies. Moreover, the extent of distributed changes contributes to difficulties in multiple cognitive domains as well as affective-behavioral challenges. We also review work in idiopathic generalized epilepsy (IGE), a subset of generalized epilepsy syndromes that involve subcortico-cortical circuits. Overall, neuroimaging and network neuroscience studies point to both shared and syndrome-specific connectome signatures of dysfunction across TLE, ETE, and IGE. Lastly, we point to current gaps in the literature and formulate recommendations for future research. Epilepsy is increasingly recognized as a network disorder characterized by recurrent seizures as well as broad-ranging cognitive difficulties and affective dysfunction. Our manuscript reviews recent literature highlighting brain network substrates of cognitive and affective dysfunction in common epilepsy syndromes, namely temporal lobe epilepsy secondary to mesiotemporal sclerosis, extratemporal epilepsy secondary to malformations of cortical development, and idiopathic generalized epilepsy syndromes arising from subcortico-cortical pathophysiology. We discuss prior work that has indicated both shared and distinct brain network signatures of cognitive and affective dysfunction across the epilepsy spectrum, improves our knowledge of structure-function links and interindividual heterogeneity, and ultimately aids screening and monitoring of therapeutic strategies.
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Affiliation(s)
- Raul Rodriguez-Cruces
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jessica Royer
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sara Larivière
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Dani S. Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom
| | - Boris C. Bernhardt
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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11
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Genetic generalized epilepsies in adults - challenging assumptions and dogmas. Nat Rev Neurol 2022; 18:71-83. [PMID: 34837042 DOI: 10.1038/s41582-021-00583-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/16/2023]
Abstract
Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15-20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizures alone. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Nevertheless, long-term follow-up studies have shown that with advancing age, many patients can discontinue their anti-seizure medication without seizure relapses. Several outcome predictors have been identified, but prognosis across the syndromes is more homogeneous than previously assumed. Overall, overlap in pathophysiology, seizure types, treatment responses and outcomes support the idea that GGEs are not separate nosological entities but represent a neurobiological continuum.
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12
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Hermann BP, Struck AF, Busch RM, Reyes A, Kaestner E, McDonald CR. Neurobehavioural comorbidities of epilepsy: towards a network-based precision taxonomy. Nat Rev Neurol 2021; 17:731-746. [PMID: 34552218 PMCID: PMC8900353 DOI: 10.1038/s41582-021-00555-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this 'lesion model' has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.
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Affiliation(s)
- Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,
| | - Aaron F. Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Robyn M. Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anny Reyes
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Erik Kaestner
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R. McDonald
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
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13
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Gray Matter Changes in Juvenile Myoclonic Epilepsy. A Voxel-Wise Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111136. [PMID: 34833354 PMCID: PMC8620511 DOI: 10.3390/medicina57111136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022]
Abstract
Background and Objectives. Juvenile myoclonic epilepsy (JME) is an idiopathic generalized epileptic syndrome, with a genetic basis clinically identified by myoclonic jerks of the upper limbs upon awaking, generalized tonic-clonic seizures and less frequent absences. Although the brain magnetic resonance imaging (MRI) is by definition normal, computer-based Voxel-Based morphometry studies have shown a number of volumetric changes in patients with juvenile myoclonic epilepsy. Thus, the aim of the present Voxel-Wise Meta-Analysis was to determine the most consistent regional differences of gray matter volume between JME patients and healthy controls. Materials and Methods. The initial search returned 31 studies. After excluding reviews and studies without control groups or without detailed peak coordinates, 12 studies were finally included in the present meta-analysis. The total number of JME patients was 325, and that of healthy controls was 357. Results. Our study showed a statistically significant increase of the gray matter in the left median cingulate/paracingulate gyri, the right superior frontal gyrus, the left precentral gyrus, the right supplementary motor area and left supplementary motor area. It also showed a decrease in the gray matter volume in the left thalamus, and in the left insula. Conclusions. Our findings could be related to the functional deficits and changes described by previous studies in juvenile myoclonic epilepsy. In this way, the volumetric changes found in the present study could be related to the impaired frontal lobe functions, the emotional dysfunction and impaired pain empathy, and to the disrupted functional connectivity of supplementary motor areas described in JME. It additionally shows changes in the volume of the left thalamus, supporting the theory of thalamocortical pathways being involved in the pathogenesis of juvenile myoclonic epilepsy.
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Wang J, Chen J, Yang X, Liu L, Wu C, Lu L, Li L, Wu Y. Common Brain Substrates Underlying Auditory Speech Priming and Perceived Spatial Separation. Front Neurosci 2021; 15:664985. [PMID: 34220425 PMCID: PMC8247760 DOI: 10.3389/fnins.2021.664985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Under a “cocktail party” environment, listeners can utilize prior knowledge of the content and voice of the target speech [i.e., auditory speech priming (ASP)] and perceived spatial separation to improve recognition of the target speech among masking speech. Previous studies suggest that these two unmasking cues are not processed independently. However, it is unclear whether the unmasking effects of these two cues are supported by common neural bases. In the current study, we aimed to first confirm that ASP and perceived spatial separation contribute to the improvement of speech recognition interactively in a multitalker condition and further investigate whether there exist intersectant brain substrates underlying both unmasking effects, by introducing these two unmasking cues in a unified paradigm and using functional magnetic resonance imaging. The results showed that neural activations by the unmasking effects of ASP and perceived separation partly overlapped in brain areas: the left pars triangularis (TriIFG) and orbitalis of the inferior frontal gyrus, left inferior parietal lobule, left supramarginal gyrus, and bilateral putamen, all of which are involved in the sensorimotor integration and the speech production. The activations of the left TriIFG were correlated with behavioral improvements caused by ASP and perceived separation. Meanwhile, ASP and perceived separation also enhanced the functional connectivity between the left IFG and brain areas related to the suppression of distractive speech signals: the anterior cingulate cortex and the left middle frontal gyrus, respectively. Therefore, these findings suggest that the motor representation of speech is important for both the unmasking effects of ASP and perceived separation and highlight the critical role of the left IFG in these unmasking effects in “cocktail party” environments.
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Affiliation(s)
- Junxian Wang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Jing Chen
- Department of Machine Intelligence, Peking University, Beijing, China.,Speech and Hearing Research Center, Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, China
| | - Xiaodong Yang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Lei Liu
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Chao Wu
- School of Nursing, Peking University, Beijing, China
| | - Lingxi Lu
- Center for the Cognitive Science of Language, Beijing Language and Culture University, Beijing, China
| | - Liang Li
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.,Speech and Hearing Research Center, Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Yanhong Wu
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.,Speech and Hearing Research Center, Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, China
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15
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Stier C, Elshahabi A, Li Hegner Y, Kotikalapudi R, Marquetand J, Braun C, Lerche H, Focke NK. Heritability of Magnetoencephalography Phenotypes Among Patients With Genetic Generalized Epilepsy and Their Siblings. Neurology 2021; 97:e166-e177. [PMID: 34045271 PMCID: PMC8279565 DOI: 10.1212/wnl.0000000000012144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/07/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To assess whether neuronal signals in patients with genetic generalized epilepsy (GGE) are heritable, we examined magnetoencephalography resting-state recordings in patients and their healthy siblings. Methods In a prospective, cross-sectional design, we investigated source-reconstructed power and functional connectivity in patients, siblings, and controls. We analyzed 5 minutes of cleaned and awake data without epileptiform discharges in 6 frequency bands (1–40 Hz). We further calculated intraclass correlations to estimate heritability for the imaging patterns within families. Results Compared with controls (n = 45), patients with GGE (n = 25) showed widespread increased functional connectivity (θ to γ frequency bands) and power (δ to γ frequency bands) across the spectrum. Siblings (n = 18) fell between the levels of patients and controls. Heritability of the imaging metrics was observed in regions where patients strongly differed from controls, mainly in β frequencies, but also for δ and θ power. Network connectivity in GGE was heritable in frontal, central, and inferior parietal brain areas and power in central, temporo-parietal, and subcortical structures. Presence of generalized spike-wave activity during recordings and medication were associated with the network patterns, whereas other clinical factors such as age at onset, disease duration, or seizure control were not. Conclusion Metrics of brain oscillations are well suited to characterize GGE and likely relate to genetic factors rather than the active disease or treatment. High power and connectivity levels co-segregated in patients with GGE and healthy siblings, predominantly in the β band, representing an endophenotype of GGE.
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Affiliation(s)
- Christina Stier
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy
| | - Adham Elshahabi
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy
| | - Yiwen Li Hegner
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy
| | - Raviteja Kotikalapudi
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy
| | - Justus Marquetand
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy
| | - Christoph Braun
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy
| | - Holger Lerche
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy
| | - Niels K Focke
- From the Clinic of Clinical Neurophysiology (C.S., R.K., N.K.F.), University Medical Center Göttingen; Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research (C.S., A.E., Y.L.H., R.K., J.M., H.L., N.K.F., C.B.), and MEG Center (C.B.), University of Tübingen, Germany; Department of Neurology (A.E.), University Hospital Zurich; Institute of Psychology (R.K.), University of Bern, Switzerland; and CIMeC (C.B.), Center for Mind/Brain Sciences, University of Trento, Italy.
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16
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Alterations of functional connectivity density in a Chinese family with a mild phenotype associated with a novel inherited variant of SCN8A. Epilepsy Behav 2020; 112:107379. [PMID: 32920374 DOI: 10.1016/j.yebeh.2020.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/26/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Only a few heritable SCN8A variants have been described in patients with a mild phenotype of epilepsy. Here, we describe a Chinese family with a novel inherited SCN8A variant and investigate changes in spontaneous cerebral activity during the resting-state in magnetic resonance imaging (MRI)-negative patients with epilepsy and their unaffected siblings. METHODS A gene panel targeting 535 epilepsy genes was performed on the proband and his parents. The identified variant was confirmed in other affected members by Sanger sequencing. Resting-state functional MRI (fMRI) data were gathered from the family (4 affected individuals and 3 unaffected siblings) and 72 healthy controls (HCs). Functional connectivity density (FCD) was used to assess whether distant or local functional network changes occurred in patients with epilepsy. RESULTS A heterozygous missense variant (c.4568C>A; p.A1523D) in SCN8A was identified in the Chinese family, with a total of 7 members who presented with a mild phenotype (childhood seizures and normal cognition). All patients remained seizure-free, and one patient remained seizure-free without medication. Increased FCD values in the thalamocortical network and basal ganglia network were observed in both patients with epilepsy and their unaffected siblings compared with the HCs. Direct comparison between SCN8A variant patients and unaffected siblings showed that more serious and distributed abnormal changes occurred in the mesial frontal regions of patients with epilepsy. CONCLUSIONS We identified a novel SCN8A variant with a mild familial epilepsy phenotype. A similar pattern of FCD alterations in patients and their unaffected siblings might represent an endophenotype of benign epilepsy associated with the SCN8A inherited variant, and more extensive alterations in mesial frontal regions may help us to further understand the pathogenesis of SCN8A-related mild epilepsy.
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17
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Larivière S, Rodríguez-Cruces R, Royer J, Caligiuri ME, Gambardella A, Concha L, Keller SS, Cendes F, Yasuda C, Bonilha L, Gleichgerrcht E, Focke NK, Domin M, von Podewills F, Langner S, Rummel C, Wiest R, Martin P, Kotikalapudi R, O'Brien TJ, Sinclair B, Vivash L, Desmond PM, Alhusaini S, Doherty CP, Cavalleri GL, Delanty N, Kälviäinen R, Jackson GD, Kowalczyk M, Mascalchi M, Semmelroch M, Thomas RH, Soltanian-Zadeh H, Davoodi-Bojd E, Zhang J, Lenge M, Guerrini R, Bartolini E, Hamandi K, Foley S, Weber B, Depondt C, Absil J, Carr SJA, Abela E, Richardson MP, Devinsky O, Severino M, Striano P, Tortora D, Hatton SN, Vos SB, Duncan JS, Whelan CD, Thompson PM, Sisodiya SM, Bernasconi A, Labate A, McDonald CR, Bernasconi N, Bernhardt BC. Network-based atrophy modeling in the common epilepsies: A worldwide ENIGMA study. SCIENCE ADVANCES 2020; 6:6/47/eabc6457. [PMID: 33208365 PMCID: PMC7673818 DOI: 10.1126/sciadv.abc6457] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/05/2020] [Indexed: 06/10/2023]
Abstract
Epilepsy is increasingly conceptualized as a network disorder. In this cross-sectional mega-analysis, we integrated neuroimaging and connectome analysis to identify network associations with atrophy patterns in 1021 adults with epilepsy compared to 1564 healthy controls from 19 international sites. In temporal lobe epilepsy, areas of atrophy colocalized with highly interconnected cortical hub regions, whereas idiopathic generalized epilepsy showed preferential subcortical hub involvement. These morphological abnormalities were anchored to the connectivity profiles of distinct disease epicenters, pointing to temporo-limbic cortices in temporal lobe epilepsy and fronto-central cortices in idiopathic generalized epilepsy. Negative effects of age on atrophy further revealed a strong influence of connectome architecture in temporal lobe, but not idiopathic generalized, epilepsy. Our findings were reproduced across individual sites and single patients and were robust across different analytical methods. Through worldwide collaboration in ENIGMA-Epilepsy, we provided deeper insights into the macroscale features that shape the pathophysiology of common epilepsies.
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Affiliation(s)
- Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Raúl Rodríguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | | | - Antonio Gambardella
- Neuroscience Research Center, University Magna Græcia, Catanzaro, CZ, Italy
- Institute of Neurology, University Magna Græcia, Catanzaro, CZ, Italy
| | - Luis Concha
- Institute of Neurobiology, Universidad Nacional Autónoma de México, Querétaro, México
| | - Simon S Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Fernando Cendes
- Department of Neurology, University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
| | - Clarissa Yasuda
- Department of Neurology, University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Niels K Focke
- Department of Clinical Neurophysiology, University of Medicine Göttingen, Göttingen, Germany
| | - Martin Domin
- Institute of Diagnostic Radiology and Neuroradiology, Functional Imaging Unit, University Medicine Greifswald, Greifswald, Germany
| | - Felix von Podewills
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Soenke Langner
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Raviteja Kotikalapudi
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Sinclair
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M Desmond
- Departments of Medicine and Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Saud Alhusaini
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Colin P Doherty
- Department of Neurology, St. James' Hospital, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Gianpiero L Cavalleri
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Norman Delanty
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Reetta Kälviäinen
- Epilepsy Center, Neuro Center, Kuopio University Hospital, European Reference Network for Rare and Complex Epilepsies EpiCARE, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Magdalena Kowalczyk
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Mario Mascalchi
- Neuroradiology Research Program, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | - Mira Semmelroch
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hamid Soltanian-Zadeh
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
- Departments of Research Administration and Radiology, Henry Ford Health System, Detroit, MI, USA
| | | | - Junsong Zhang
- Cognitive Science Department, Xiamen University, Xiamen, China
| | - Matteo Lenge
- Child Neurology Unit and Laboratories, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children's Hospital A. Meyer-University of Florence, Italy
| | - Renzo Guerrini
- Child Neurology Unit and Laboratories, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Italy
| | - Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre (CUBRIC), College of Biomedical Sciences, Cardiff University, Cardiff, UK
- Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Sonya Foley
- Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah J A Carr
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eugenio Abela
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Orrin Devinsky
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | | | - Sean N Hatton
- Department of Neurosciences, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Christopher D Whelan
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Angelo Labate
- Neuroscience Research Center, University Magna Græcia, Catanzaro, CZ, Italy
- Institute of Neurology, University Magna Græcia, Catanzaro, CZ, Italy
| | - Carrie R McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada.
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Gesche J, Hjalgrim H, Rubboli G, Beier CP. The clinical spectrum of familial and sporadic idiopathic generalized epilepsy. Epilepsy Res 2020; 165:106374. [DOI: 10.1016/j.eplepsyres.2020.106374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022]
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Ciumas C, Montavont A, Ilski F, Laurent A, Saignavongs M, Lachaux JP, de Bellescize J, Panagiotakaki E, Ostrowsky-Coste K, Herbillon V, Ibarrola D, Hermier M, Arzimanoglou A, Ryvlin P. Neural correlates of verbal working memory in children with epilepsy with centro-temporal spikes. NEUROIMAGE-CLINICAL 2020; 28:102392. [PMID: 32927234 PMCID: PMC7495114 DOI: 10.1016/j.nicl.2020.102392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous functional magnetic resonance imaging (fMRI) studies have identified brain systems underlying different components of working memory (WM) in healthy subjects. The aim of this study was to compare the functional integrity of these neural networks in children with self-limited childhood epilepsy with centro-temporal spikes (ECTS) as compared to healthy controls, using a verbal working memory task (WMT). METHODS Functional MRI of WM in seventeen 6-to-13 year-old children, diagnosed with ECTS, and 17 sex- and age-matched healthy controls were conducted at 3 T. To estimate BOLD responses during the maintenance of low, medium, and high WMT loads, we used a Sternberg verbal WMT. Neuropsychological testing prior to scanning and behavioral data during scanning were also acquired. RESULTS Behavioral performances during WMT, in particular accuracy and response time, were poorer in children with ECTS than in controls. Increased WM load was associated with increased BOLD signal in all subjects, with significant clusters detected in frontal and parietal regions, predominantly in the left hemisphere. However, under the high load condition, patients showed reduced activation in the frontal, temporal and parietal regions as compared to controls. In brain regions where WM-triggered BOLD activation differed between groups, this activation correlated with neuropsychological performances in healthy controls but not in patients with ECTS, further suggesting WM network dysfunction in the latter. CONCLUSION Children with ECTS differ from healthy controls in how they control WM processes during tasks with increasing difficulty level, notably for high WM load where patients demonstrate both reduced BOLD activation and behavioral performances.
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Affiliation(s)
- Carolina Ciumas
- Translational and Integrative Group in Epilepsy Research (TIGER), INSERM U1028, CNRS UMR5292, Centre de Recherche en Neuroscience de Lyon, Université Lyon1, Lyon, France; Institute of Epilepsies (IDEE), Lyon, France; Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.
| | - Alexandra Montavont
- University Hospitals of Lyon (HCL), Department of Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, Member of the ERN EpiCARE, Lyon, France
| | - Faustine Ilski
- University Hospitals of Lyon (HCL), Department of Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, Member of the ERN EpiCARE, Lyon, France
| | - Agathe Laurent
- Department of Neurosurgery, Sainte-Anne Hospital, 75014 Paris, France
| | - Mani Saignavongs
- Translational and Integrative Group in Epilepsy Research (TIGER), INSERM U1028, CNRS UMR5292, Centre de Recherche en Neuroscience de Lyon, Université Lyon1, Lyon, France
| | - Jean-Philippe Lachaux
- Brain Dynamics and Cognition team (DYCOG), INSERM U1028, CNRS UMR5292, Centre de Recherche en Neuroscience de Lyon, Lyon, France
| | - Julitta de Bellescize
- University Hospitals of Lyon (HCL), Department of Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, Member of the ERN EpiCARE, Lyon, France
| | - Eleni Panagiotakaki
- University Hospitals of Lyon (HCL), Department of Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, Member of the ERN EpiCARE, Lyon, France
| | - Karine Ostrowsky-Coste
- University Hospitals of Lyon (HCL), Department of Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, Member of the ERN EpiCARE, Lyon, France
| | - Vania Herbillon
- University Hospitals of Lyon (HCL), Department of Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, Member of the ERN EpiCARE, Lyon, France; Department of Neurosurgery, Sainte-Anne Hospital, 75014 Paris, France
| | | | - Marc Hermier
- University Hospitals of Lyon (HCL), Department of Diagnostic and Functional Neuroradiology, Hôpital Neurologique & Neurochirurgical P. Wertheimer, Bron, France
| | - Alexis Arzimanoglou
- University Hospitals of Lyon (HCL), Department of Clinical Epileptology, Sleep Disorders and Functional Neurology in Children, Member of the ERN EpiCARE, Lyon, France; Department of Neurosurgery, Sainte-Anne Hospital, 75014 Paris, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
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Gesche J, Hjalgrim H, Rubboli G, Beier CP. Patterns and prognostic markers for treatment response in generalized epilepsies. Neurology 2020; 95:e2519-e2528. [DOI: 10.1212/wnl.0000000000010644] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/01/2020] [Indexed: 01/04/2023] Open
Abstract
ObjectiveTo determine the pattern of treatment response in patients with idiopathic generalized epilepsy (IGE) and whether routinely assessed clinical and neurophysiological parameters allow predicting response to lamotrigine, levetiracetam, or valproic acid.MethodsIn 328 adult patients with IGE, demographic data, imaging, EEG data, current and prior antiepileptic treatment, treatment outcome, and side effects were analyzed from the patients' medical files and patient interviews.ResultsSeizure freedom with acceptable side effects at the first attempt was achieved in 61 (18.6%) patients. One hundred four (31.7%) patients tried ≥3 antiepileptic drugs before achieving seizure control at the last follow-up. Lamotrigine, levetiracetam, and valproic acid showed differential response rates (39.8% vs 47.5% vs 71.1%) that were most pronounced in patients with juvenile myoclonic epilepsy. The risk of having side effects was higher with valproic acid (23.7%) than with lamotrigine (10.4%) or levetiracetam (20.4%) treatment, contributing to the low retention rate of valproic acid (53.7%). Treatment resistance was associated with established risk factors. Multivariate analyses aiming at identifying clinical indicators for response to specific drugs did not reveal putative biomarkers when corrected for drug resistance.ConclusionDespite a high rate of seizure control, the chance of achieving seizure control and acceptable side effects at first attempt was low due to an inverse association of effectiveness and side effects of the 3 most commonly used drugs. Routinely assessed clinical parameters were not indicative for response to specific drugs.Classification of evidenceThis study provides Class II evidence that for patients with IGE, various clinical factors do not predict a response to specific antiepileptic drugs.
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Caciagli L, Wandschneider B, Centeno M, Vollmar C, Vos SB, Trimmel K, Long L, Xiao F, Lowe AJ, Sidhu MK, Thompson PJ, Winston GP, Duncan JS, Koepp MJ. Motor hyperactivation during cognitive tasks: An endophenotype of juvenile myoclonic epilepsy. Epilepsia 2020; 61:1438-1452. [PMID: 32584424 PMCID: PMC7681252 DOI: 10.1111/epi.16575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Juvenile myoclonic epilepsy (JME) is the most common genetic generalized epilepsy syndrome. Myoclonus may relate to motor system hyperexcitability and can be provoked by cognitive activities. To aid genetic mapping in complex neuropsychiatric disorders, recent research has utilized imaging intermediate phenotypes (endophenotypes). Here, we aimed to (a) characterize activation profiles of the motor system during different cognitive tasks in patients with JME and their unaffected siblings, and (b) validate those as endophenotypes of JME. METHODS This prospective cross-sectional investigation included 32 patients with JME, 12 unaffected siblings, and 26 controls, comparable for age, sex, handedness, language laterality, neuropsychological performance, and anxiety and depression scores. We investigated patterns of motor system activation during episodic memory encoding and verb generation functional magnetic resonance imaging (fMRI) tasks. RESULTS During both tasks, patients and unaffected siblings showed increased activation of motor system areas compared to controls. Effects were more prominent during memory encoding, which entailed hand motion via joystick responses. Subgroup analyses identified stronger activation of the motor cortex in JME patients with ongoing seizures compared to seizure-free patients. Receiver-operating characteristic curves, based on measures of motor activation, accurately discriminated both patients with JME and their siblings from healthy controls (area under the curve: 0.75 and 0.77, for JME and a combined patient-sibling group against controls, respectively; P < .005). SIGNIFICANCE Motor system hyperactivation represents a cognitive, domain-independent endophenotype of JME. We propose measures of motor system activation as quantitative traits for future genetic imaging studies in this syndrome.
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Affiliation(s)
- Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Britta Wandschneider
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Maria Centeno
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Epilepsy UnitHospital Clínic de BarcelonaBarcelonaSpain
| | - Christian Vollmar
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Sjoerd B. Vos
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Centre for Medical Image ComputingUniversity College LondonLondonUK
- Neuroradiological Academic UnitUCL Queen Square Institute of NeurologyLondonUK
| | - Karin Trimmel
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Lili Long
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyXiangya Hospital of Central South UniversityChangshaChina
| | - Fenglai Xiao
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduChina
| | - Alexander J. Lowe
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
| | - Meneka K. Sidhu
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Pamela J. Thompson
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
- Department of NeurologyQueen's UniversityKingstonONCanada
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
| | - Matthias J. Koepp
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyChalfont St PeterBuckinghamshireUK
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Routley B, Shaw A, Muthukumaraswamy SD, Singh KD, Hamandi K. Juvenile myoclonic epilepsy shows increased posterior theta, and reduced sensorimotor beta resting connectivity. Epilepsy Res 2020; 163:106324. [PMID: 32335503 PMCID: PMC7684644 DOI: 10.1016/j.eplepsyres.2020.106324] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022]
Abstract
We investigated whole brain source space connectivity in JME using across standard MEG frequency bands. Connectivity was increased in posterior theta and alpha bands in JME, and decreased in sensorimotor beta band. Our findings highlight altered interactions between posterior networks of arousal and attention and the motor system in JME.
Background Widespread structural and functional brain network changes have been shown in Juvenile Myoclonic Epilepsy (JME) despite normal clinical neuroimaging. We sought to better define these changes using magnetoencephalography (MEG) and source space connectivity analysis for optimal neurophysiological and anatomical localisation. Methods We consecutively recruited 26 patients with JME who underwent resting state MEG recording, along with 26 age-and-sex matched controls. Whole brain connectivity was determined through correlation of Automated Anatomical Labelling (AAL) atlas source space MEG timeseries in conventional frequency bands of interest delta (1−4 Hz), theta (4−8 Hz), alpha (8−13 Hz), beta (13−30 Hz) and gamma (40−60 Hz). We used a Linearly Constrained Minimum Variance (LCMV) beamformer to extract voxel wise time series of ‘virtual sensors’ for the desired frequency bands, followed by connectivity analysis using correlation between frequency- and node-specific power fluctuations, for the voxel maxima in each AAL atlas label, correcting for noise, potentially spurious connections and multiple comparisons. Results We found increased connectivity in the theta band in posterior brain regions, surviving statistical correction for multiple comparisons (corrected p < 0.05), and decreased connectivity in the beta band in sensorimotor cortex, between right pre- and post- central gyrus (p < 0.05) in JME compared to controls. Conclusions Altered resting-state MEG connectivity in JME comprised increased connectivity in posterior theta – the frequency band associated with long range connections affecting attention and arousal - and decreased beta-band sensorimotor connectivity. These findings likely relate to altered regulation of the sensorimotor network and seizure prone states in JME.
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Affiliation(s)
- Bethany Routley
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom
| | - Alexander Shaw
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom
| | - Suresh D Muthukumaraswamy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Krish D Singh
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging, School of Psychology, Cardiff University, United Kingdom; The Wales Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, United Kingdom.
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Ratcliffe C, Wandschneider B, Baxendale S, Thompson P, Koepp MJ, Caciagli L. Cognitive Function in Genetic Generalized Epilepsies: Insights From Neuropsychology and Neuroimaging. Front Neurol 2020; 11:144. [PMID: 32210904 PMCID: PMC7076110 DOI: 10.3389/fneur.2020.00144] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/10/2020] [Indexed: 12/17/2022] Open
Abstract
Genetic generalized epilepsies (GGE), previously called idiopathic generalized epilepsies, constitute about 20% of all epilepsies, and include childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone (CAE, JAE, JME, and GGE-GTCS, respectively). GGE are characterized by high heritability, likely underlain by polygenetic mechanisms, which may relate to atypical neurodevelopmental trajectories. Age of onset ranges from pre-school years, for CAE, to early adulthood for GGE-GTCS. Traditionally, GGE have been considered benign, a belief contrary to evidence from neuropsychology studies conducted over the last two decades. In JME, deficits in executive and social functioning are common findings and relate to impaired frontal lobe function. Studies using neuropsychological measures and cognitive imaging paradigms provide evidence for hyperconnectivity between prefrontal and motor cortices, aberrant fronto-thalamo-cortical connectivity, and reduced fronto-cortical and subcortical gray matter volumes, which are associated with altered cognitive performance. Recent research has also identified associations between abnormal hippocampal morphometry and fronto-temporal activation during episodic memory. Longitudinal studies on individuals with newly diagnosed JME have observed cortical dysmaturation, which is paralleled by delayed cognitive development compared to the patients' peers. Comorbidities and cognitive deficits observed in other GGE subtypes, such as visuo-spatial and language deficits in both CAE and JAE, have also been correlated with atypical neurodevelopment. Although it remains unclear whether cognitive impairment profiles differ amongst GGE subtypes, effects may become more pronounced with disease duration, particularly in absence epilepsies. Finally, there is substantial evidence that patients with JME and their unaffected siblings share patterns of cognitive deficits, which is indicative of an underlying genetic etiology (endophenotype), independent of seizures and anti-epileptic medication.
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Affiliation(s)
- Corey Ratcliffe
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Pamela Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, United Kingdom
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
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Tan L, Chen Y, Wu W, Liu C, Fu Y, He J, Zhang M, Wang G, Wang K, Long H, Xiao W, Xiao B, Long L. Impaired Cognitive Abilities in Siblings of Patients with Temporal Lobe Epilepsy. Neuropsychiatr Dis Treat 2020; 16:3071-3079. [PMID: 33363375 PMCID: PMC7752648 DOI: 10.2147/ndt.s258074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Patients with temporal lobe epilepsy (TLE) are at high risk of cognitive impairment. In addition to persistent seizures and antiepileptic drugs (AEDs), genetic factors also play an important role in the progression of cognitive deficits in TLE patients. Defining a cognitive endophenotype for TLE can provide information on the risk of cognitive impairment in patients. This study investigated the cognitive endophenotype of TLE by comparing neuropsychological function between patients with TLE, their unaffected siblings, and healthy control subjects. PATIENTS AND METHODS A total of 46 patients with TLE, 26 siblings, and 33 control subjects were recruited. Cognitive function (ie, general cognition, short- and long-term memory, attention, visuospatial and executive functions, and working memory) was assessed with a battery of neuropsychological tests. Differences between groups were evaluated by analysis of covariance, with age and years of education as covariates. The Kruskal-Wallis test was used to evaluate data that did not satisfy the homogeneity of variance assumption. Pairwise comparisons were adjusted by Bonferroni correction, with a significance threshold of P<0.05. RESULTS Patients with TLE showed deficits in the information test (P<0.001), arithmetic test (P=0.003), digit symbol substitution test (P=0.001), block design test (BDT; P=0.005), and backward digit span test (P=0.001) and took a longer time to complete the Hayling test Part A (P=0.011) compared to controls. Left TLE patients tended to have worse executive function test scores than right TLE patients. The siblings of TLE patients showed deficits in the BDT (P=0.006, Bonferroni-corrected) relative to controls. CONCLUSION Patients with TLE exhibit cognitive impairment. Executive function is worse in patients with left TLE than in those with right TLE. Siblings show impaired visuospatial function relative to controls. Thus, cognitive deficits in TLE patients have a genetic component and are independent of seizures or AED use.
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Affiliation(s)
- Langzi Tan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yayu Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Wenyue Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Chaorong Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yujiao Fu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jialinzi He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Min Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ge Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Kangrun Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Wenbiao Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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25
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Almane DN, Jones JE, McMillan T, Stafstrom CE, Hsu DA, Seidenberg M, Hermann BP, Oyegbile TO. The Timing, Nature, and Range of Neurobehavioral Comorbidities in Juvenile Myoclonic Epilepsy. Pediatr Neurol 2019; 101:47-52. [PMID: 31122836 PMCID: PMC6752993 DOI: 10.1016/j.pediatrneurol.2019.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accumulating evidence suggests that considerable cognitive and psychiatric comorbidity is associated with juvenile myoclonic epilepsy, for which the etiology remains controversial. Our goal was to comprehensively characterize the status of multiple neurobehavioral comorbidities in youth with new- or recent-onset juvenile myoclonic epilepsy, before effects of chronic seizures and medications. METHODS A total of 111 children aged eight to 18 years (41 new- or recent-onset juvenile myoclonic epilepsy and 70 first-degree cousin controls) underwent neuropsychological assessment (attention, executive, verbal, perceptual, speed), structured review of need for supportive academic services, parent reports of behavior and executive function (Child Behavior Checklist and Behavior Rating Inventory of Executive Function), and formal structured psychiatric interview and diagnosis (Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version). RESULTS Children with juvenile myoclonic epilepsy performed worse than controls across all tested cognitive domains (F(1,105) = 3.85, P < 0.01), utilized more academic services (47% versus 19%, P = 0.002), had more parent-reported behavioral problems and dysexecutive function with lower competence (P < 0.001), and had a higher prevalence of current Axis I diagnoses (attention-deficit/hyperactivity disorder, depression, and anxiety; 54% versus 23%, P = 0.001). Academic and psychiatric problems occurred antecedent to epilepsy onset compared with comparable timeline in controls. CONCLUSION Comprehensive assessment of cognitive, academic, behavioral, and psychiatric comorbidities in youth with new- or recent-onset juvenile myoclonic epilepsy reveals a pattern of significantly increased neurobehavioral comorbidities across a broad spectrum of areas. These early evident comorbidities are of clear clinical importance with worrisome implications for future cognitive, behavioral, and social function. It is important for health care providers to avoid delays in intervention by assessing potential comorbidities early in the course of the disorder to optimize their patients' social, academic and behavioral progress.
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Affiliation(s)
- Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Taylor McMillan
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore Maryland
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | | | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
| | - Temitayo O Oyegbile
- Department of Pediatrics and Neurology, Georgetown University, Washington District of Columbia.
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Oyegbile TO. The role of task-based neural activation research in understanding cognitive deficits in pediatric epilepsy. Epilepsy Behav 2019; 99:106332. [PMID: 31399340 DOI: 10.1016/j.yebeh.2019.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 11/29/2022]
Abstract
Children with epilepsy can experience significant cognitive dysfunction that can lead to academic underachievement. Traditionally believed to be primarily due to the effects of factors such as the chronicity of epilepsy, medication effects, or the location of the primary epileptogenic lesion;, recent evidence has indicated that disruption of cognition-specific distributed neural networks may play a significant role as well. Specifically, over the last decade, researchers have begun to characterize the mechanisms underlying disrupted cognitive substrates by evaluating neural network abnormalities observed during specific cognitive tasks, using task-based functional magnetic resonance imaging (fMRI). This targeted review assesses the current literature investigating the relationship between neural network abnormalities and cognitive deficits in pediatric epilepsy. The findings indicate that there are indeed neural network abnormalities associated with deficits in executive function, language, processing speed, and memory. Overall, cognitive dysfunction in pediatric epilepsy is associated with a decrease in neural network activation/deactivation as well as increased recruitment of brain regions not typically related to the specific cognitive task under investigation. The research to date has focused primarily on children with focal epilepsy syndromes with small sample sizes and differing research protocols. More extensive research in children with a wider representation of epilepsy syndromes (including generalized epilepsy syndromes) is necessary to fully understand these relationships and begin to identify underlying cognitive phenotypes that may account for the variability observed across children with epilepsy. Furthermore, more uniformity in fMRI protocols and neuropsychological tasks would be ideal to advance this literature.
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Affiliation(s)
- Temitayo O Oyegbile
- Georgetown University Medical Center, Washington, D.C., United States of America.
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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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Wandschneider B, Hong SJ, Bernhardt BC, Fadaie F, Vollmar C, Koepp MJ, Bernasconi N, Bernasconi A. Developmental MRI markers cosegregate juvenile patients with myoclonic epilepsy and their healthy siblings. Neurology 2019; 93:e1272-e1280. [PMID: 31467252 PMCID: PMC7011863 DOI: 10.1212/wnl.0000000000008173] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 06/07/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE MRI studies of genetic generalized epilepsies have mainly described group-level changes between patients and healthy controls. To determine the endophenotypic potential of structural MRI in juvenile myoclonic epilepsy (JME), we examined MRI-based cortical morphologic markers in patients and their healthy siblings. METHODS In this prospective, cross-sectional study, we obtained 3T MRI in patients with JME, siblings, and controls. We mapped sulco-gyral complexity and surface area, morphologic markers of brain development, and cortical thickness. Furthermore, we calculated mean geodesic distance, a surrogate marker of cortico-cortical connectivity. RESULTS Compared to controls, patients and siblings showed increased folding complexity and surface area in prefrontal and cingulate cortices. In these regions, they also displayed abnormally increased geodesic distance, suggesting network isolation and decreased efficiency, with strongest effects for limbic, fronto-parietal, and dorsal-attention networks. In areas of findings overlap, we observed strong patient-sibling correlations. Conversely, neocortical thinning was present in patients only and related to disease duration. Patients showed subtle impairment in mental flexibility, a frontal lobe function test, as well as deficits in naming and design learning. Siblings' performance fell between patients and controls. CONCLUSION MRI markers of brain development and connectivity are likely heritable and may thus serve as endophenotypes. The topography of morphologic anomalies and their abnormal structural network integration likely explains cognitive impairments in patients with JME and their siblings. By contrast, cortical atrophy likely represents a marker of disease.
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Affiliation(s)
- Britta Wandschneider
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Seok-Jun Hong
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Boris C Bernhardt
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Fatemeh Fadaie
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Christian Vollmar
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Matthias J Koepp
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada.
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (B.W., S.-J.H., B.C.B., F.F., N.B., A.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal; Department of Clinical and Experimental Epilepsy (B.W., C.V., M.J.K.), UCL Institute of Neurology, London, UK; Epilepsy Center, Department of Neurology (C.V.), Klinikum Großhadern, University of Munich, Germany; and Multimodal Imaging and Connectome Analysis Lab (B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada.
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Caciagli L, Wandschneider B, Xiao F, Vollmar C, Centeno M, Vos SB, Trimmel K, Sidhu MK, Thompson PJ, Winston GP, Duncan JS, Koepp MJ. Abnormal hippocampal structure and function in juvenile myoclonic epilepsy and unaffected siblings. Brain 2019; 142:2670-2687. [PMID: 31365054 PMCID: PMC6776114 DOI: 10.1093/brain/awz215] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 04/09/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023] Open
Abstract
Juvenile myoclonic epilepsy is the most common genetic generalized epilepsy syndrome, characterized by a complex polygenetic aetiology. Structural and functional MRI studies demonstrated mesial or lateral frontal cortical derangements and impaired fronto-cortico-subcortical connectivity in patients and their unaffected siblings. The presence of hippocampal abnormalities and associated memory deficits is controversial, and functional MRI studies in juvenile myoclonic epilepsy have not tested hippocampal activation. In this observational study, we implemented multi-modal MRI and neuropsychological data to investigate hippocampal structure and function in 37 patients with juvenile myoclonic epilepsy, 16 unaffected siblings and 20 healthy controls, comparable for age, gender, handedness and hemispheric dominance as assessed with language laterality indices. Automated hippocampal volumetry was complemented by validated qualitative and quantitative morphological criteria to detect hippocampal malrotation, assumed to represent a neurodevelopmental marker. Neuropsychological measures of verbal and visuo-spatial learning and an event-related verbal and visual memory functional MRI paradigm addressed mesiotemporal function. We detected a reduction of mean left hippocampal volume in patients and their siblings compared with controls (P < 0.01). Unilateral or bilateral hippocampal malrotation was identified in 51% of patients and 50% of siblings, against 15% of controls (P < 0.05). For bilateral hippocampi, quantitative markers of verticalization had significantly larger values in patients and siblings compared with controls (P < 0.05). In the patient subgroup, there was no relationship between structural measures and age at disease onset or degree of seizure control. No overt impairment of verbal and visual memory was identified with neuropsychological tests. Functional mapping highlighted atypical patterns of hippocampal activation, pointing to abnormal recruitment during verbal encoding in patients and their siblings [P < 0.05, familywise error (FWE)-corrected]. Subgroup analyses indicated distinct profiles of hypoactivation along the hippocampal long axis in juvenile myoclonic epilepsy patients with and without malrotation; patients with malrotation also exhibited reduced frontal recruitment for verbal memory, and more pronounced left posterior hippocampal involvement for visual memory. Linear models across the entire study cohort indicated significant associations between morphological markers of hippocampal positioning and hippocampal activation for verbal items (all P < 0.05, FWE-corrected). We demonstrate abnormalities of hippocampal volume, shape and positioning in patients with juvenile myoclonic epilepsy and their siblings, which are associated with reorganization of function and imply an underlying neurodevelopmental mechanism with expression during the prenatal stage. Co-segregation of abnormal hippocampal morphology in patients and their siblings is suggestive of a genetic imaging phenotype, independent of disease activity, and can be construed as a novel endophenotype of juvenile myoclonic epilepsy.
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Affiliation(s)
- Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Christian Vollmar
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Neurology, Ludwig-Maximilians-Universität, Marchioninistrasse 15, Munich, Germany
| | - Maria Centeno
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
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30
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Wang Z, Larivière S, Xu Q, Vos de Wael R, Hong SJ, Wang Z, Xu Y, Zhu B, Bernasconi N, Bernasconi A, Zhang B, Zhang Z, Bernhardt BC. Community-informed connectomics of the thalamocortical system in generalized epilepsy. Neurology 2019; 93:e1112-e1122. [PMID: 31405905 DOI: 10.1212/wnl.0000000000008096] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To study the intrinsic organization of the thalamocortical circuitry in patients with generalized epilepsy with tonic-clonic seizures (GTCS) via resting-state fMRI (rs-fMRI) connectome analysis and to evaluate its relation to drug response. METHODS In a prospectively followed-up sample of 41 patients and 27 healthy controls, we obtained rs-fMRI and structural MRI. After 1 year of follow-up, 27 patients were classified as seizure-free and 14 as drug-resistant. We examined connectivity within and between resting-state communities in cortical and thalamic subregions. In addition to comparing patients to controls, we examined associations with seizure control. We assessed reproducibility in an independent cohort of 21 patients. RESULTS Compared to controls, patients showed a more constrained network embedding of the thalamus, while frontocentral neocortical regions expressed increased functional diversity. Findings remained significant after regressing out thalamic volume and cortical thickness, suggesting independence from structural alterations. We observed more marked network imbalances in drug-resistant compared to seizure-free patients. Findings were similar in the reproducibility dataset. CONCLUSIONS Our findings suggest a pathoconnectomic mechanism of generalized epilepsy centered on diverging changes in cortical and thalamic connectivity. More restricted thalamic connectivity could reflect the tendency to engage in recursive thalamocortical loops, which may contribute to hyperexcitability. Conversely, increased connectional diversity of frontocentral networks may relay abnormal activity to an extended bilateral territory. Network imbalances were observed shortly after diagnosis and related to future drug response, suggesting clinical utility.
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Affiliation(s)
- Zhengge Wang
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Sara Larivière
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Qiang Xu
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Reinder Vos de Wael
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Seok-Jun Hong
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Zhongyuan Wang
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Yun Xu
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Bin Zhu
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Neda Bernasconi
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Andrea Bernasconi
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Bing Zhang
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Zhiqiang Zhang
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China
| | - Boris C Bernhardt
- From the Departments of Radiology (Z.W., B.Z., B.Z.) and Neurology (Z.W., Y.X.), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, China; Multimodal Imaging and Connectome Analysis Laboratory (Z.W., S.L., R.V.d.W., S.-J.H., B.C.B.) and Neuroimaging of Epilepsy Laboratory (S.-J.H., N.B., A.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada; and Department of Medical Imaging (Q.X., Z.Z.), Jinling Hospital, Nanjing University School of Medicine, China.
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31
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Tavakol S, Royer J, Lowe AJ, Bonilha L, Tracy JI, Jackson GD, Duncan JS, Bernasconi A, Bernasconi N, Bernhardt BC. Neuroimaging and connectomics of drug-resistant epilepsy at multiple scales: From focal lesions to macroscale networks. Epilepsia 2019; 60:593-604. [PMID: 30889276 PMCID: PMC6447443 DOI: 10.1111/epi.14688] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 01/03/2023]
Abstract
Epilepsy is among the most common chronic neurologic disorders, with 30%-40% of patients having seizures despite antiepileptic drug treatment. The advent of brain imaging and network analyses has greatly improved the understanding of this condition. In particular, developments in magnetic resonance imaging (MRI) have provided measures for the noninvasive characterization and detection of lesions causing epilepsy. MRI techniques can probe structural and functional connectivity, and network analyses have shaped our understanding of whole-brain anomalies associated with focal epilepsies. This review considers the progress made by neuroimaging and connectomics in the study of drug-resistant epilepsies due to focal substrates, particularly temporal lobe epilepsy related to mesiotemporal sclerosis and extratemporal lobe epilepsies associated with malformations of cortical development. In these disorders, there is evidence of widespread disturbances of structural and functional connectivity that may contribute to the clinical and cognitive prognosis of individual patients. It is hoped that studying the interplay between macroscale network anomalies and lesional profiles will improve our understanding of focal epilepsies and assist treatment choices.
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Affiliation(s)
- Shahin Tavakol
- Multimodal Imaging and Connectome Analysis Lab, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Lab, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Alexander J Lowe
- Multimodal Imaging and Connectome Analysis Lab, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph I Tracy
- Cognitive Neuroscience and Brain Mapping Laboratory, Thomas Jefferson University Hospitals/Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Lab, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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Tangwiriyasakul C, Perani S, Abela E, Carmichael DW, Richardson MP. Sensorimotor network hypersynchrony as an endophenotype in families with genetic generalized epilepsy: A resting-state functional magnetic resonance imaging study. Epilepsia 2019; 60:e14-e19. [PMID: 30730052 PMCID: PMC6446943 DOI: 10.1111/epi.14663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/24/2018] [Accepted: 01/15/2019] [Indexed: 12/30/2022]
Abstract
Recent evidence suggests that three specific brain networks show state-dependent levels of synchronization before, during, and after episodes of generalized spike-wave discharges (GSW) in patients with genetic generalized epilepsy (GGE). Here, we investigate whether synchronization in these networks differs between patients with GGE (n = 13), their unaffected first-degree relatives (n = 17), and healthy controls (n = 18). All subjects underwent two 10-minute simultaneous electroencephalographic-functional magnetic resonance imaging (fMRI) recordings without GSW. Whole-brain data were divided into 90 regions, and blood oxygen level-dependent (BOLD) phase synchrony in a 0.04-0.07-Hz band was estimated between all pairs of regions. Three networks were defined: (1) the network with highest synchrony during GSW events, (2) a sensorimotor network, and (3) an occipital network. Average synchrony (mean node degree) was inferred across each network over time. Notably, synchrony was significantly higher in the sensorimotor network in patients and in unaffected relatives, compared to controls. There was a trend toward higher synchrony in the GSW network in patients and in unaffected relatives. There was no difference between groups for the occipital network. Our findings provide evidence that elevated fMRI BOLD synchrony in a sensorimotor network is a state-independent endophenotype of GGE, present in patients in the absence of GSW, and present in unaffected relatives.
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Affiliation(s)
- Chayanin Tangwiriyasakul
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Suejen Perani
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
- UCL Great Ormond Street Institute of Child Health, University College LondonLondonUK
| | - Eugenio Abela
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - David W. Carmichael
- UCL Great Ormond Street Institute of Child Health, University College LondonLondonUK
- School of Imaging and BioengineeringFaculty of Life Sciences and MedicineKing's College LondonLondonUK
| | - Mark P. Richardson
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
- Centre for EpilepsyKing's College HospitalLondonUK
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Almane DN, Zhao Q, Rathouz PJ, Hanson M, Jackson DC, Hsu DA, Stafstrom CE, Jones JE, Seidenberg M, Koehn M, Hermann BP. Contribution of Family Relatedness to Neurobehavioral Comorbidities in Idiopathic Childhood Epilepsies. J Int Neuropsychol Soc 2018; 24:653-661. [PMID: 29745359 PMCID: PMC6988642 DOI: 10.1017/s1355617718000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Rates of cognitive, academic and behavioral comorbidities are elevated in children with epilepsy. The contribution of environmental and genetic influences to comorbidity risk is not fully understood. This study investigated children with epilepsy, their unaffected siblings, and controls to determine the presence and extent of risk associated with family relatedness across a range of epilepsy comorbidities. METHODS Participants were 346 children (8-18 years), n=180 with recent-onset epilepsy, their unaffected siblings (n=67), and healthy first-degree cousin controls (n=99). Assessments included: (1) Child Behavior Checklist/6-18 (CBCL), (2) Behavior Rating Inventory of Executive Function (BRIEF), (3) history of education and academic services, and (4) lifetime attention deficit hyperactivity disorder (ADHD) diagnosis. Analyses consisted of linear mixed effect models for continuous variables, and logistic mixed models for binary variables. RESULTS Differences were detected between the three groups of children across all measures (p<.001). For ADHD, academic problems, and executive dysfunction, children with epilepsy exhibited significantly more problems than unaffected siblings and controls; siblings and controls did not differ statistically significantly from each other. For social competence, children with epilepsy and their unaffected siblings displayed more abnormality compared with controls, with no statistically significant difference between children with epilepsy and unaffected siblings. For behavioral problems, children with epilepsy had more abnormality than siblings and controls, but unaffected siblings also exhibited more abnormalities than controls. CONCLUSIONS The contribution of epilepsy and family relatedness varies across specific neurobehavioral comorbidities. Family relatedness was not significantly associated with rates of ADHD, academic problems and executive dysfunction, but was associated with competence and behavioral problems. (JINS, 2018, 24, 653-661).
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Affiliation(s)
- Dace N Almane
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Qianqian Zhao
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Paul J Rathouz
- 2Department of Biostatistics and Medical Informatics,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Melissa Hanson
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Daren C Jackson
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - David A Hsu
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Carl E Stafstrom
- 3Department of Neurology,Johns Hopkins University School of Medicine,Baltimore,Maryland
| | - Jana E Jones
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
| | - Michael Seidenberg
- 4Department of Psychology,Rosalind Franklin University of Medicine and Science,North Chicago,Illinois
| | - Monica Koehn
- 5Marshfield Clinic Neurosciences,Marshfield Clinic,Marshfield,Wisconsin
| | - Bruce P Hermann
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison,Wisconsin
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Cação G, Parra J, Mannan S, Sisodiya SM, Sander JW. Juvenile myoclonic epilepsy refractory to treatment in a tertiary referral center. Epilepsy Behav 2018; 82:81-86. [PMID: 29602081 DOI: 10.1016/j.yebeh.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Juvenile myoclonic epilepsy (JME) is an epileptic syndrome often regarded as one in which seizures are relatively easy to control. Individuals with JME, however, often require lifelong therapy to remain seizure-free, and a few have refractory epilepsy. We ascertained a population with JME and characterized a subgroup with refractory epilepsy. MATERIAL AND METHODS We audited and reviewed clinical records of individuals diagnosed with JME identified via a sample of 6600 individuals in a clinical database from a specialized epilepsy clinic at a tertiary referral center. RESULTS We identified 240 people with a diagnosis of JME (146 females), with a mean age at seizure onset of 14.2years (SD: 4.5), and a mean age at diagnosis of 15.6years (SD: 4.9). Clinical phenotypes seen were classic JME phenotype (88%), childhood absence epilepsy evolving into JME (6%), JME with adolescent absences (4%), and JME with astatic seizures (2%). More than a quarter (28%) had a family history of epilepsy. The most commonly used antiepileptic drug (AED) was sodium valproate in 78% of individuals, followed by levetiracetam (64%) and lamotrigine (55%). In the previous year, 47.5% were seizure-free. Using the International League against Epilepsy (ILAE) definitions and considering National Institute for Health and Care Excellence (NICE)-recommended AEDs for this syndrome, 121 individuals (50.4%) were identified as having refractory epilepsy. DISCUSSION Juvenile myoclonic epilepsy is often regarded as a benign epileptic syndrome, but in this setting, half of the individuals with JME have refractory epilepsy with only about a quarter of those seizure-free in the previous year. Despite some advances in the understanding of this syndrome, there is still much to do before we can offer all the best outcomes.
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Affiliation(s)
- Gonçalo Cação
- Neurology Department, Centro Hospitalar do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Joana Parra
- Neurology Department, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
| | - Shahidul Mannan
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Sanjay M Sisodiya
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 8ES, UK
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 8ES, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103SW Heemstede, Netherlands
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Abstract
This article reviews the major paradigm shifts that have occurred in the area of the application of clinical and experimental neuropsychology to epilepsy and epilepsy surgery since the founding of the International Neuropsychological Society. The five paradigm shifts discussed include: 1) The neurobiology of cognitive disorders in epilepsy - expanding the landscape of syndrome-specific neuropsychological impairment; 2) pathways to comorbidities: bidirectional relationships and their clinical implications; 3) discovering quality of life: The concept, its quantification and applicability; 4) outcomes of epilepsy surgery: challenging conventional wisdom; and 5) Iatrogenic effects of treatment: cognitive and behavioral effects of antiepilepsy drugs. For each area we characterize the status of knowledge, the key developments that have occurred, and how they have altered our understanding of the epilepsies and their management. We conclude with a brief overview of where we believe the field will be headed in the next decade which includes changes in assessment paradigms, moving from characterization of comorbidities to interventions; increasing development of new measures, terminology and classification; increasing interest in neurodegenerative proteins; transitioning from clinical seizure features to modifiable risk factors; and neurobehavioral phenotypes. Overall, enormous progress has been made over the lifespan of the INS with promise of ongoing improvements in understanding of the cognitive and behavioral complications of the epilepsies and their treatment. (JINS, 2017, 23, 791-805).
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Affiliation(s)
- Bruce Hermann
- 1Department of Neurology,University of Wisconsin School of Medicine and Public Health,Madison Wisconsin
| | - David W Loring
- 2Departments of Neurology and Pediatrics,Emory University School of Medicine,Atlanta Georgia
| | - Sarah Wilson
- 3Department of Psychology,Melbourne University,Melbourne,Australia
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Control groups in paediatric epilepsy research: do first-degree cousins show familial effects? Epileptic Disord 2017; 19:49-58. [PMID: 28351825 DOI: 10.1684/epd.2017.0898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To determine whether first-degree cousins of children with idiopathic focal and genetic generalized epilepsies show any association across measures of cognition, behaviour, and brain structure. The presence/absence of associations addresses the question of whether and to what extent first-degree cousins may serve as unbiased controls in research addressing the cognitive, psychiatric, and neuroimaging features of paediatric epilepsies. Participants were children (aged 8-18) with epilepsy who had at least one first-degree cousin control enrolled in the study (n=37) and all enrolled cousin controls (n=100). Participants underwent neuropsychological assessment and brain imaging (cortical, subcortical, and cerebellar volumes), and parents completed the Child Behaviour Checklist (CBCL). Data (based on 42 outcome measures) from cousin controls were regressed on the corresponding epilepsy cognitive, behavioural, and imaging measures in a linear mixed model and case/control correlations were examined. Of the 42 uncorrected correlations involving cognitive, behavioural, and neuroimaging measures, only two were significant (p<0.05). The median correlation was 0.06. A test for whether the distribution of p values deviated from the null distribution under no association was not significant (p>0.25). Similar results held for the cognition/behaviour and brain imaging measures separately. Given the lack of association between cases and first-degree cousin performances on measures of cognition, behaviour, and neuroimaging, the results suggest a non-significant genetic influence on control group performance. First-degree cousins appear to be unbiased controls for cognitive, behavioural, and neuroimaging research in paediatric epilepsy.
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37
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Wolf P. Reflex epileptic mechanisms in humans: Lessons about natural ictogenesis. Epilepsy Behav 2017; 71:118-123. [PMID: 25958226 DOI: 10.1016/j.yebeh.2015.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/17/2022]
Abstract
The definition of reflex epileptic seizures is that specific seizure types can be triggered by certain sensory or cognitive stimuli. Simple triggers are sensory (most often visual, more rarely tactile or proprioceptive; simple audiogenic triggers in humans are practically nonexistent) and act within seconds, whereas complex triggers like praxis, reading and talking, and music are mostly cognitive and work within minutes. The constant relation between a qualitatively, often even quantitatively, well-defined stimulus and a specific epileptic response provides unique possibilities to investigate seizure generation in natural human epilepsies. For several reflex epileptic mechanisms (REMs), this has been done. Reflex epileptic mechanisms have been reported less often in focal lesional epilepsies than in idiopathic "generalized" epilepsies (IGEs) which are primarily genetically determined. The key syndrome of IGE is juvenile myoclonic epilepsy (JME), where more than half of the patients present reflex epileptic traits (photosensitivity, eye closure sensitivity, praxis induction, and language-induced orofacial reflex myocloni). Findings with multimodal investigations of cerebral function concur to indicate that ictogenic mechanisms in IGEs largely (ab)use preexisting functional anatomic networks (CNS subsystems) normally serving highly complex physiological functions (e.g., deliberate complex actions and linguistic communication) which supports the concept of system epilepsy. Whereas REMs in IGEs, thus, are primarily function-related, in focal epilepsies, they are primarily localization-related. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
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Affiliation(s)
- Peter Wolf
- Danish Epilepsy Centre Filadelfia, Kolonivej 2, DK-4293 Dianalund, Denmark; Department of Clinical Medicine, Neurological Service, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Baykan B, Wolf P. Juvenile myoclonic epilepsy as a spectrum disorder: A focused review. Seizure 2017; 49:36-41. [PMID: 28544889 DOI: 10.1016/j.seizure.2017.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 01/11/2023] Open
Abstract
In consequence of newer research juvenile myoclonic epilepsy (JME) is no longer seen as a homogeneous disease. The causes of the existing variance are only partially known yet. We discuss to what extent the phenotypical spectrum of this polygenetically determined disorder expresses genetically defined endophenotypes, or is due to mere quantitative differences in the expression of the core phenotype. Of the three common seizure types of JME, myoclonic, generalized tonic-clonic and absences, absences also occur independently and are strong candidates for an endophenotype. Focal features may in some patients be seen in clinical seizures or the EEG but rarely in both. They have no morphological correlates. In a system epilepsy, local manifestations are possible, and some are due to reflex mechanisms. Of the four reflex epileptic traits common in JME, photosensitivity and praxis induction appear related to basic mechanisms of the core syndrome, whereas language-induced orofacial reflex myocloni and eye closure sensitivity are also seen in other clinical contexts and therefore seem to represent endophenotypes. Cognitive abnormalities indicating slight frontal lobe dysfunction seem to be ubiquitous in JME and are also seen in unaffected siblings of patients. Cluster B personality disorder is found in 1/3 of patients, representing a more severe expression of the underlying pathology. Treatment response and prognosis seem to be affected by an interplay of the described factors producing the severest end of the JME spectrum. The spectrum appears to be due to an interaction of stronger or weaker expression of the core phenotype with various endophenotypes.
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Affiliation(s)
- Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Turkey.
| | - Peter Wolf
- Danish Epilepsy Centre, Kolonivej 1, 4293 Dianalund, Denmark; Programa de Pós-Graduação em Ciências Médicas, Universidad Federal de Santa Catarina, Florianópolis, SC, Brazil.
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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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Alhusaini S, Whelan CD, Sisodiya SM, Thompson PM. Quantitative magnetic resonance imaging traits as endophenotypes for genetic mapping in epilepsy. NEUROIMAGE-CLINICAL 2016; 12:526-534. [PMID: 27672556 PMCID: PMC5030372 DOI: 10.1016/j.nicl.2016.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/21/2016] [Accepted: 09/05/2016] [Indexed: 12/18/2022]
Abstract
Over the last decade, the field of imaging genomics has combined high-throughput genotype data with quantitative magnetic resonance imaging (QMRI) measures to identify genes associated with brain structure, cognition, and several brain-related disorders. Despite its successful application in different psychiatric and neurological disorders, the field has yet to be advanced in epilepsy. In this article we examine the relevance of imaging genomics for future genetic studies in epilepsy from three perspectives. First, we discuss prior genome-wide genetic mapping efforts in epilepsy, considering the possibility that some studies may have been constrained by inherent theoretical and methodological limitations of the genome-wide association study (GWAS) method. Second, we offer a brief overview of the imaging genomics paradigm, from its original inception, to its role in the discovery of important risk genes in a number of brain-related disorders, and its successful application in large-scale multinational research networks. Third, we provide a comprehensive review of past studies that have explored the eligibility of brain QMRI traits as endophenotypes for epilepsy. While the breadth of studies exploring QMRI-derived endophenotypes in epilepsy remains narrow, robust syndrome-specific neuroanatomical QMRI traits have the potential to serve as accessible and relevant intermediate phenotypes for future genetic mapping efforts in epilepsy. QMRI traits have the potential to serve as robust intermediate phenotypes for brain-related disorders. Hippocampal volume is the most promising neuroimaging endophenotype for MTLE + HS. Imaging genomics holds great promise in advancing epilepsy genetic research. Studies are encouraged to explore the validity of QMRI traits as endophenotypes for epilepsy.
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Affiliation(s)
- Saud Alhusaini
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Christopher D Whelan
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
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Carvalho KCD, Uchida CGP, Guaranha MSB, Guilhoto LMF, Wolf P, Yacubian EMT. Cognitive performance in juvenile myoclonic epilepsy patients with specific endophenotypes. Seizure 2016; 40:33-41. [DOI: 10.1016/j.seizure.2016.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/03/2016] [Accepted: 06/05/2016] [Indexed: 11/15/2022] Open
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Altered Local Spontaneous Brain Activity in Juvenile Myoclonic Epilepsy: A Preliminary Resting-State fMRI Study. Neural Plast 2015; 2016:3547203. [PMID: 26823984 PMCID: PMC4707362 DOI: 10.1155/2016/3547203] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/10/2015] [Accepted: 10/26/2015] [Indexed: 12/05/2022] Open
Abstract
Purpose. The purpose of this study was to evaluate the regional synchronization of brain in patients with juvenile myoclonic epilepsy (JME). Methods. Resting-state fMRI data were acquired from twenty-one patients with JME and twenty-two healthy subjects. Regional homogeneity (ReHo) was used to analyze the spontaneous activity in whole brain. Two-sample t-test was performed to detect the ReHo difference between two groups. Correlations between the ReHo values and features of seizures were calculated further. Key Findings. Compared with healthy controls, patients showed significantly increased ReHo in bilateral thalami and motor-related cortex regions and a substantial reduction of ReHo in cerebellum and occipitoparietal lobe. In addition, greater ReHo value in the left paracentral lobule was linked to the older age of onset in patients. Significance. These findings implicated the abnormality of thalamomotor cortical network in JME which were associated with the genesis and propagation of epileptiform activity. Moreover, our study supported that the local brain spontaneous activity is a potential tool to investigate the epileptic activity and provided important insights into understanding the pathophysiological mechanisms of JME.
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Hamandi K, Routley BC, Koelewijn L, Singh KD. Non-invasive brain mapping in epilepsy: Applications from magnetoencephalography. J Neurosci Methods 2015; 260:283-91. [PMID: 26642968 DOI: 10.1016/j.jneumeth.2015.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Non-invasive in vivo neurophysiological recordings with EEG/MEG are key to the diagnosis, classification, and further understanding of epilepsy. Historically the emphasis of these recordings has been the localisation of the putative sources of epileptic discharges. More recent developments see new techniques studying oscillatory dynamics, connectivity and network properties. NEW METHOD New analysis strategies for whole head MEG include the development of spatial filters or beamformers for source localisation, time-frequency analysis for cortical dynamics and graph theory applications for connectivity. RESULTS The idea of epilepsy as a network disorder is not new, and new applications of structural and functional brain imaging show differences in cortical and subcortical networks in patients with epilepsy compared to controls. Concepts of 'focal' and 'generalised' are challenged by evidence of focal onsets in generalised epileptic discharges, and widespread network changes in focal epilepsy. Spectral analyses can show differences in induced cortical response profiles, particularly in photosensitive epilepsy. COMPARISON WITH EXISTING METHOD This review focuses on the application of MEG in the study of epilepsy, starting with a brief historical perspective, followed by novel applications of source localisation, time-frequency and connectivity analyses. CONCLUSION Novel MEG analyses approaches show altered cortical dynamics and widespread network alterations in focal and generalised epilepsies, and identification of regional network abnormalities may have a role in epilepsy surgery evaluation.
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Affiliation(s)
- Khalid Hamandi
- The Alan Richens Welsh Epilepsy Centre, University Hospital of Wales, Cardiff CF5 6LR, United Kingdom.
| | - Bethany C Routley
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff CF10 3AT, United Kingdom
| | - Loes Koelewijn
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff CF10 3AT, United Kingdom
| | - Krish D Singh
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff CF10 3AT, United Kingdom
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Koepp MJ, Caciagli L, Pressler RM, Lehnertz K, Beniczky S. Reflex seizures, traits, and epilepsies: from physiology to pathology. Lancet Neurol 2015; 15:92-105. [PMID: 26627365 DOI: 10.1016/s1474-4422(15)00219-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
Abstract
Epileptic seizures are generally unpredictable and arise spontaneously. Patients often report non-specific triggers such as stress or sleep deprivation, but only rarely do seizures occur as a reflex event, in which they are objectively and consistently modulated, precipitated, or inhibited by external sensory stimuli or specific cognitive processes. The seizures triggered by such stimuli and processes in susceptible individuals can have different latencies. Once seizure-suppressing mechanisms fail and a critical mass (the so-called tipping point) of cortical activation is reached, reflex seizures stereotypically manifest with common motor features independent of the physiological network involved. The complexity of stimuli increases from simple sensory to complex cognitive-emotional with increasing age of onset. The topography of physiological networks involved follows the posterior-to-anterior trajectory of brain development, reflecting age-related changes in brain excitability. Reflex seizures and traits probably represent the extremes of a continuum, and understanding of their underlying mechanisms might help to elucidate the transition of normal physiological function to paroxysmal epileptic activity.
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Affiliation(s)
- Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK.
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Institute of Neurology, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, UK
| | - Ronit M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital, London, UK; Clinical Neuroscience, UCL Institute of Child Health, London, UK
| | - Klaus Lehnertz
- Department of Epileptology, University Hospital of Bonn, Bonn, Germany
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University, Aarhus, Denmark
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Meletti S, Vaudano AE. Comment on "Reflex epileptic mechanisms in humans: Lessons about natural ictogenesis" by Peter Wolf. Epilepsy Behav 2015; 52:275-6. [PMID: 26420227 DOI: 10.1016/j.yebeh.2015.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, N.O.C.S.A.E. Hospital-AUSL, Modena, Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, N.O.C.S.A.E. Hospital-AUSL, Modena, Italy.
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Magnetoencephalography Reveals a Widespread Increase in Network Connectivity in Idiopathic/Genetic Generalized Epilepsy. PLoS One 2015; 10:e0138119. [PMID: 26368933 PMCID: PMC4569354 DOI: 10.1371/journal.pone.0138119] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/26/2015] [Indexed: 12/25/2022] Open
Abstract
Idiopathic/genetic generalized epilepsy (IGE/GGE) is characterized by seizures, which start and rapidly engage widely distributed networks, and result in symptoms such as absences, generalized myoclonic and primary generalized tonic-clonic seizures. Although routine magnetic resonance imaging is apparently normal, many studies have reported structural alterations in IGE/GGE patients using diffusion tensor imaging and voxel-based morphometry. Changes have also been reported in functional networks during generalized spike wave discharges. However, network function in the resting-state without epileptiforme discharges has been less well studied. We hypothesize that resting-state networks are more representative of the underlying pathophysiology and abnormal network synchrony. We studied functional network connectivity derived from whole-brain magnetoencephalography recordings in thirteen IGE/GGE and nineteen healthy controls. Using graph theoretical network analysis, we found a widespread increase in connectivity in patients compared to controls. These changes were most pronounced in the motor network, the mesio-frontal and temporal cortex. We did not, however, find any significant difference between the normalized clustering coefficients, indicating preserved gross network architecture. Our findings suggest that increased resting state connectivity could be an important factor for seizure spread and/or generation in IGE/GGE, and could serve as a biomarker for the disease.
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Watanabe T, Kuroda M, Kuwabara H, Aoki Y, Iwashiro N, Tatsunobu N, Takao H, Nippashi Y, Kawakubo Y, Kunimatsu A, Kasai K, Yamasue H. Clinical and neural effects of six-week administration of oxytocin on core symptoms of autism. Brain 2015; 138:3400-12. [PMID: 26336909 DOI: 10.1093/brain/awv249] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 07/13/2015] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorder is a prevalent neurodevelopmental disorder with no established pharmacological treatment for its core symptoms. Although previous literature has shown that single-dose administration of oxytocin temporally mitigates autistic social behaviours in experimental settings, it remains in dispute whether such potentially beneficial responses in laboratories can result in clinically positive effects in daily life situations, which are measurable only in long-term observations of individuals with the developmental disorder undergoing continual oxytocin administration. Here, to address this issue, we performed an exploratory, randomized, double-blind, placebo-controlled, crossover trial including 20 high-functional adult males with autism spectrum disorder. Data obtained from 18 participants who completed the trial showed that 6-week intranasal administration of oxytocin significantly reduced autism core symptoms specific to social reciprocity, which was clinically evaluated by Autism Diagnostic Observation Scale (P = 0.034, PFDR < 0.05, Cohen's d = 0.78). Critically, the improvement of this clinical score was accompanied by oxytocin-induced enhancement of task-independent resting-state functional connectivity between anterior cingulate cortex and dorso-medial prefrontal cortex (rho = -0.60, P = 0.011), which was measured by functional magnetic resonance imaging. Moreover, using the same social-judgement task as used in our previous single-dose oxytocin trial, we confirmed that the current continual administration also significantly mitigated behavioural and neural responses during the task, both of which were originally impaired in autistic individuals (judgement tendency: P = 0.019, d = 0.62; eye-gaze effect: P = 0.03, d = 0.56; anterior cingulate activity: P = 0.00069, d = 0.97; dorso-medial prefrontal activity: P = 0.0014, d = 0.92; all, PFDR < 0.05). Furthermore, despite its longer administration, these effect sizes of the 6-week intervention were not larger than those seen in our previous single-dose intervention. These findings not only provide the evidence for clinically beneficial effects of continual oxytocin administration on the core social symptoms of autism spectrum disorder with suggesting its underlying biological mechanisms, but also highlight the necessity to seek optimal regimens of continual oxytocin treatment in future studies.
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Affiliation(s)
- Takamitsu Watanabe
- 1 Department of Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan 2 Department of Physiology, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan 3 Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London, WC1N 3AR, UK
| | - Miho Kuroda
- 4 Department of Child Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hitoshi Kuwabara
- 4 Department of Child Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuta Aoki
- 1 Department of Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Norichika Iwashiro
- 1 Department of Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Natsubori Tatsunobu
- 1 Department of Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hidemasa Takao
- 5 Department of Radiology, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasumasa Nippashi
- 5 Department of Radiology, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuki Kawakubo
- 4 Department of Child Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akira Kunimatsu
- 5 Department of Radiology, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kiyoto Kasai
- 1 Department of Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hidenori Yamasue
- 1 Department of Neuropsychiatry, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan 6 Japan Science and Technology Agency, CREST, 5 Sambancho, Chiyoda-ku, Tokyo 102-0075, Japan
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Wolf P, Yacubian EMT, Avanzini G, Sander T, Schmitz B, Wandschneider B, Koepp M. Juvenile myoclonic epilepsy: A system disorder of the brain. Epilepsy Res 2015; 114:2-12. [DOI: 10.1016/j.eplepsyres.2015.04.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/14/2015] [Indexed: 12/28/2022]
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Iqbal N, Caswell H, Muir R, Cadden A, Ferguson S, Mackenzie H, Watson P, Duncan S. Neuropsychological profiles of patients with juvenile myoclonic epilepsy and their siblings: An extended study. Epilepsia 2015; 56:1301-8. [PMID: 26075864 DOI: 10.1111/epi.13061] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine executive function, intelligence, visuospatial skills, language, memory, attention, reaction time, anxiety, depression, and emotional and behavioral traits most frequently associated with executive dysfunction in patients with juvenile myoclonic epilepsy (JME) compared with a sibling and a normal control group under video-electroencephalography (video-EEG) conditions. METHODS Twenty-two sibling pairs, one with JME, were compared with 44 controls matched for age, gender, and educational level. All participants were administered a comprehensive set of neuropsychological and questionnaire measures during and without video-EEG recording. RESULTS The JME group differed significantly from controls in measures of phonemic and semantic verbal fluency. They scored significantly higher on the dysexecutive self-rating questionnaire, being more likely to report traits associated with executive dysfunction than both siblings and controls. Patients with JME reported significantly low mood than both controls and their siblings. Unaffected siblings differed significantly from controls on psychomotor speed, phonemic verbal fluency and were considered to exhibit traits associated with executive dysfunction by others. Qualitative inspection of data suggested a convincing trend for patients with JME and their siblings to perform worse than controls on most measures. SIGNIFICANCE This study supports the existence of a distinct neuropsychological profile among patients with JME and their siblings, which is likely to be genetically determined. The similarity of neuropsychological profiles between JME patients and their siblings is independent of antiepileptic drug effects or subclinical EEG activity. The significant differences between the sibling and controls suggests that there is a neurocognitive endophenotype for JME.
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Affiliation(s)
- Nasur Iqbal
- Department of Clinical Psychology, North Manchester General Hospital, Crumpsall, Manchester, United Kingdom
| | - Helen Caswell
- Department of Clinical Neuropsychology, Salford Royal Hospital, Salford, Manchester, United Kingdom
| | - Robin Muir
- Division of Clinical Psychology, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
| | - Amy Cadden
- Edinburgh and South East Scotland Epilepsy Service, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom
| | - Stuart Ferguson
- Department of Neurophysiology, Western General Hospital, Edinburgh, United Kingdom
| | - Holly Mackenzie
- Department of Neurophysiology, Western General Hospital, Edinburgh, United Kingdom
| | - Philip Watson
- Department of Neurophysiology, Western General Hospital, Edinburgh, United Kingdom
| | - Susan Duncan
- Edinburgh and South East Scotland Epilepsy Service, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom
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