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Neumann H, Daseking M, Thiels C, Köhler C, Lücke T. Cognitive development in children with new-onset Rolandic epilepsy and Rolandic discharges without seizures: Focusing on intelligence, visual perception, working memory and the role of parents' education. Epilepsy Behav 2024; 152:109596. [PMID: 38350362 DOI: 10.1016/j.yebeh.2023.109596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE Our aim was to assess intelligence, visual perception and working memory in children with new-onset Rolandic epilepsy (RE) and children with Rolandic discharges without seizures (RD). METHODS The participants in the study were 12 children with RE and 26 children with RD aged 4 to 10 years (all without medication and shortly after diagnosis) and 31 healthy controls. Their cognitive performance was assessed using the German versions of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), the Wechsler Intelligence Scale for Children (WISC-IV), the Developmental Test of Visual Perception-2 (DTVP-2), the Developmental Test of Visual Perception-Adolescent and Adult (DTVP-A) (each according to age) and the Word Order, Hand Movements and Spatial Memory subtests of the German version of the Kaufman Assessment Battery for Children (K-ABC). RESULTS The comparison of the entire group of children with RE/RD and the control group conducted in the first step of our analysis revealed a weaker performance of the children with RE/RD in all cognitive domains. Significant deficits, however, were found exclusively in the RD group. Compared to the controls, they performed significantly weaker regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.002; processing speed: p = 0.005), visual perception (general visual perception: p = 0.005; visual-motor integration: p = 0.002) and working memory (WISC working memory: p = 0.002 and K-ABC Word Order (p = 0.010) and Hand Movements (p = 0.001) subtests. Also, the children without seizures scored significantly lower than those with seizures on the WISC Working Memory Index (p = 0.010) and on the K-ABC Word Order (p = 0.021) and Hand Movements (p = 0.027) subtests. Further analysis of our data demonstrated the particular importance of the family context for child development. Significant cognitive deficits were found only in children with RD from parents with lower educational levels. This group consistently scored lower compared to the control group regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.012; processing speed: p = 0.034), visual perception (general visual perception: p = 0.018; visual-motor integration: p = 0.010) and auditory working memory (WISC working memory: p = 0.014). Furthermore, compared to the children with RE, they performed significantly weaker on verbal IQ (p = 0.020), auditory working memory consistently (WISC working memory: p = 0.027; K-ABC: Word Order: p = 0.046) as well as in one of the K-ABC spatial working memory subtests (Hand Movements: p = 0.029). Although we did not find significant deficits in children with new-onset RE compared to healthy controls, the performance of this group tended to be weaker more often. No statistically significant associations were observed between selected clinical markers (focus types: centrotemporal/other foci/laterality of foci and spread of Rolandic discharges) and cognitive test results. Except for spatial working memory, we also found no evidence that the age of our patients at the time of study participation was of significant importance to their cognitive performance. CONCLUSIONS Our study provides some evidence that children with Rolandic discharges, with and without seizures, may be at higher risk of cognitive impairment. In addition to medical care, we emphasise early differentiated psychosocial diagnostics to provide these children and their families with targeted support if developmental problems are present.
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Affiliation(s)
- Helmut Neumann
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany.
| | - Monika Daseking
- Department of Educational Psychology, Helmut Schmidt University/University of the Armed Forces Hamburg, Hamburg, Germany
| | - Charlotte Thiels
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Cornelia Köhler
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
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2
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Kaestner E, Wu X, Friedman D, Dugan P, Devinsky O, Carlson C, Doyle W, Thesen T, Halgren E. The Precentral Gyrus Contributions to the Early Time-Course of Grapheme-to-Phoneme Conversion. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2022; 3:18-45. [PMID: 37215328 PMCID: PMC10158576 DOI: 10.1162/nol_a_00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/16/2021] [Indexed: 05/24/2023]
Abstract
As part of silent reading models, visual orthographic information is transduced into an auditory phonological code in a process of grapheme-to-phoneme conversion (GPC). This process is often identified with lateral temporal-parietal regions associated with auditory phoneme encoding. However, the role of articulatory phonemic representations and the precentral gyrus in GPC is ambiguous. Though the precentral gyrus is implicated in many functional MRI studies of reading, it is not clear if the time course of activity in this region is consistent with the precentral gyrus being involved in GPC. We recorded cortical electrophysiology during a bimodal match/mismatch task from eight patients with perisylvian subdural electrodes to examine the time course of neural activity during a task that necessitated GPC. Patients made a match/mismatch decision between a 3-letter string and the following auditory bi-phoneme. We characterized the distribution and timing of evoked broadband high gamma (70-170 Hz) as well as phase-locking between electrodes. The precentral gyrus emerged with a high concentration of broadband high gamma responses to visual and auditory language as well as mismatch effects. The pars opercularis, supramarginal gyrus, and superior temporal gyrus were also involved. The precentral gyrus showed strong phase-locking with the caudal fusiform gyrus during letter-string presentation and with surrounding perisylvian cortex during the bimodal visual-auditory comparison period. These findings hint at a role for precentral cortex in transducing visual into auditory codes during silent reading.
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Affiliation(s)
- Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Xiaojing Wu
- Department of Neurology, NYU Langone School of Medicine, New York, USA
| | - Daniel Friedman
- Department of Neurology, NYU Langone School of Medicine, New York, USA
| | - Patricia Dugan
- Department of Neurology, NYU Langone School of Medicine, New York, USA
| | - Orrin Devinsky
- Department of Neurology, NYU Langone School of Medicine, New York, USA
| | - Chad Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, USA
| | - Werner Doyle
- Department of Neurology, NYU Langone School of Medicine, New York, USA
- Department of Neurosurgery, NYU Langone School of Medicine, New York, USA
| | - Thomas Thesen
- Department of Neurology, NYU Langone School of Medicine, New York, USA
| | - Eric Halgren
- Department of Neurosciences, University of California at San Diego, La Jolla, USA
- Department of Radiology, University of California at San Diego, La Jolla, USA
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3
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Vinti V, Dell'Isola GB, Tascini G, Mencaroni E, Cara GD, Striano P, Verrotti A. Temporal Lobe Epilepsy and Psychiatric Comorbidity. Front Neurol 2021; 12:775781. [PMID: 34917019 PMCID: PMC8669948 DOI: 10.3389/fneur.2021.775781] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
Most focal seizures originate in the temporal lobe and are commonly divided into mesial and lateral temporal epilepsy, depending upon the neuronal circuitry involved. The hallmark features of the mesial temporal epilepsy are aura, unconsciousness, and automatisms. Symptoms often overlap with the lateral temporal epilepsy. However, the latter present a less evident psychomotor arrest, frequent clones and dystonic postures, and common focal to bilateral tonic–clonic seizures. Sclerosis of the hippocampus is the most frequent cause of temporal lobe epilepsy (TLE). TLE is among all epilepsies the most frequently associated with psychiatric comorbidity. Anxiety, depression, and interictal dysphoria are recurrent psychiatric disorders in pediatric patients with TLE. In addition, these alterations are often combined with cognitive, learning, and behavioral impairment. These comorbidities occur more frequently in TLE with hippocampal sclerosis and with pharmacoresistance. According to the bidirectional hypothesis, the close relationship between TLE and psychiatric features should lead to considering common pathophysiology underlying these disorders. Psychiatric comorbidities considerably reduce the quality of life of these children and their families. Thus, early detection and appropriate management and therapeutic strategies could improve the prognosis of these patients. The aim of this review is to analyze TLE correlation with psychiatric disorders and its underlying conditions.
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Affiliation(s)
- Valerio Vinti
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | - Giorgia Tascini
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Giannina Gaslini (IRCCS "G. Gaslini") Institute, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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4
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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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Kaestner E, Thesen T, Devinsky O, Doyle W, Carlson C, Halgren E. An Intracranial Electrophysiology Study of Visual Language Encoding: The Contribution of the Precentral Gyrus to Silent Reading. J Cogn Neurosci 2021; 33:2197-2214. [PMID: 34347873 PMCID: PMC8497063 DOI: 10.1162/jocn_a_01764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Models of reading emphasize that visual (orthographic) processing provides input to phonological as well as lexical-semantic processing. Neurobiological models of reading have mapped these processes to distributed regions across occipital-temporal, temporal-parietal, and frontal cortices. However, the role of the precentral gyrus in these models is ambiguous. Articulatory phonemic representations in the precentral gyrus are obviously involved in reading aloud, but it is unclear if the precentral gyrus is recruited during reading silently in a time window consistent with participation in phonological processing contributions. Here, we recorded intracranial electrophysiology during a speeded semantic decision task from 24 patients to map the spatio-temporal flow of information across the cortex during silent reading. Patients selected animate nouns from a stream of nonanimate words, letter strings, and false-font stimuli. We characterized the distribution and timing of evoked high-gamma power (70-170 Hz) as well as phase-locking between electrodes. The precentral gyrus showed a proportion of electrodes responsive to linguistic stimuli (27%) that was at least as high as those of surrounding peri-sylvian regions. These precentral gyrus electrodes had significantly greater high-gamma power for words compared to both false-font and letter-string stimuli. In a patient with word-selective effects in the fusiform, superior temporal, and precentral gyri, there was significant phase-locking between the fusiform and precentral gyri starting at ∼180 msec and between the precentral and superior temporal gyri starting at ∼220 msec. Finally, our large patient cohort allowed exploratory analyses of the spatio-temporal reading network underlying silent reading. The distribution, timing, and connectivity results place the precentral gyrus as an important hub in the silent reading network.
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Affiliation(s)
| | | | | | - Werner Doyle
- New York University Comprehensive Epilepsy Center
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6
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Liu Z, Ye X, Zhang J, Wu B, Dong S, Gao P. Biallelic ADGRV1 variants are associated with Rolandic epilepsy. Neurol Sci 2021; 43:1365-1374. [PMID: 34160719 DOI: 10.1007/s10072-021-05403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/10/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Rolandic epilepsy (RE) is among the most common focal epilepsies in childhood. For the majority of patients with RE and atypical RE (ARE), the etiology remains elusive. We thus screened patients with RE/ARE in order to detect disease-causing variants.. METHODS A trios-based whole-exome sequencing approach was performed in a cohort of 28 patients with RE/ARE. Clinical data and EEGs were reviewed. Variants were validated by Sanger sequencing. RESULTS Two compound heterozygous missense variants p.Val272Ile/p.Asn3028Ser and p.Ala3657Val/p.Met4419Val of ADGRV1 were identified in two unrelated familial cases of RE/ARE. All the variants were in the calcium exchanger β domain and were suggested to be damaging by at least one web-based prediction tool. These variants are not present or are present at a very low minor allele frequency in the gnomAD database. Previously, biallelic ADGRV1 variants (p.Gly2756Arg and p.Glu4410Lys) have been observed in RE, consistent with the observation in this study and supporting the association between ADGRV1 variants and RE. Additionally, a de novo mutation, p.Asp668Asn, in GRIN2B was identified in a sporadic case of ARE, and a missense variant, p.Asn1551Ser, in RyR2 was identified in a family with RE with incomplete penetrance. These genes are all calcium homeostasis associated genes, suggesting the potential effect of calcium homeostasis in RE/ARE. CONCLUSIONS The results from the present study suggest that the genes ADGRV1, GRIN2B, and RyR2 are associated with RE/ARE. These data link defects in neuronal intracellular calcium homeostasis to RE/ARE pathogenesis implicating that these defects plays an important role in the development of these conditions.
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Affiliation(s)
- Zhigang Liu
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road 11, Foshan, 528000, Guangdong, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xingguang Ye
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road 11, Foshan, 528000, Guangdong, China
| | - Jieyan Zhang
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road 11, Foshan, 528000, Guangdong, China
| | - Benze Wu
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road 11, Foshan, 528000, Guangdong, China
| | - Shiwei Dong
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road 11, Foshan, 528000, Guangdong, China
| | - Pingming Gao
- Department of Pediatrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road 11, Foshan, 528000, Guangdong, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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7
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Measuring the effects of sleep on epileptogenicity with multifrequency entropy. Clin Neurophysiol 2021; 132:2012-2018. [PMID: 34284235 DOI: 10.1016/j.clinph.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We demonstrate that multifrequency entropy gives insight into the relationship between epileptogenicity and sleep, and forms the basis for an improved measure of medical assessment of sleep impairment in epilepsy patients. METHODS Multifrequency entropy was computed from electroencephalography measurements taken from 31 children with Benign Epilepsy with Centrotemporal Spikes and 31 non-epileptic controls while awake and during sleep. Values were compared in the epileptic zone and away from the epileptic zone in various sleep stages. RESULTS We find that (I) in lower frequencies, multifrequency entropy decreases during non-rapid eye movement sleep stages when compared with wakefulness in a general population of pediatric patients, (II) patients with Benign Epilepsy with Centrotemporal Spikes had lower multifrequency entropy across stages of sleep and wakefulness, and (III) the epileptic regions of the brain exhibit lower multifrequency entropy patterns than the rest of the brain in epilepsy patients. CONCLUSIONS Our results show that multifrequency entropy decreases during sleep, particularly sleep stage 2, confirming, in a pediatric population, an association between sleep, lower multifrequency entropy, and increased likelihood of seizure. SIGNIFICANCE We observed a correlation between lowered multifrequency entropy and increased epileptogenicity that lays preliminary groundwork for the detection of a digital biomarker for epileptogenicity.
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8
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Smith SDW, Smith AB, Richardson MP, Pal DK. Neurodevelopmental origins of self-limiting rolandic epilepsy: Systematic review of MR imaging studies. Epilepsia Open 2021; 6:310-322. [PMID: 34033258 PMCID: PMC8166787 DOI: 10.1002/epi4.12468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/29/2020] [Accepted: 12/31/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Recent neuroimaging studies have revealed differences in cortical and white matter brain structure in children with self‐limiting rolandic epilepsy (RE). Despite this, reproducibility of the findings has been difficult, and there is no consensus about where and when structural differences are most apparent. We performed a systematic review of quantitative neuroimaging studies in children with RE to explore these questions. Methods Using PRISMA guidelines, we used a multilayered search strategy to identify neuroimaging studies in RE. Publications were included if they were quantitative and derived from controlled group studies and passed a quality assessment. Findings of the studies were presented and stratified by duration of epilepsy and age of participants. Results We identified six gray matter studies and five white matter studies. Consistent findings were found inside and outside the central sulcus, predominantly within the bilateral frontal and parietal lobes, striatal structures, such as the putamen and white matter, mainly involving the left superior longitudinal fasciculus and connections between the left pre‐ and postcentral gyrus. Stratification of the T1 studies by age found that cortical thickness differences varied between the under and over 10 year olds. Furthermore, the longer the duration of epilepsy, the less likely differences were detected. In white matter studies, there was a reduction in differences with increased age and duration of epilepsy. Significance These findings would suggest that the development of regions of the cortex in children with RE is abnormal. These regions are more widespread than the suspected seizure onset zone. Moreover, the findings would suggest that these differences are evidence of neurodevelopmental delay rather than apparent “damage” from the epilepsy.
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Affiliation(s)
- Stuart D W Smith
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Evelina London Children's Hospital, London, UK
| | - Anna B Smith
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.,King's College Hospital, London, UK
| | - Deb K Pal
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Evelina London Children's Hospital, London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.,King's College Hospital, London, UK
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9
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Chacko D, Vidhukumar K. The Prevalence of Specific Learning Disorder among School-going Children in Ernakulam District, Kerala, India: Ernakulam Learning Disorder (ELD) Study. Indian J Psychol Med 2020; 42:250-255. [PMID: 32612329 PMCID: PMC7320732 DOI: 10.4103/ijpsym.ijpsym_199_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Specific learning disorder (SLD) is a neurodevelopmental disorder characterized by impairment in reading, written expression, and mathematics. The government provides several educational and social benefits to students with SLD, hence, an accurate assessment of the prevalence of SLD is important. This study is an attempt to find the prevalence of SLD and its determinants among the school-going children in Ernakulam district, Kerala, India. METHODS School-going children from the fourth standard to the seventh standard were included in the study. Multistage stratified cluster sampling was used. The screening for SLD was done using the LD screening tool, and confirmation of the diagnosis was made using the NIMHANS index for SLD and Malin's Intelligence Scale for Indian Children (MISIC). RESULTS The prevalence of SLD was 16.49% (95% CI =14.59-18.37). The prevalence of impairment in reading, written expression, and mathematics was 12.57%, 15.6%, and 9.93%, respectively. Binary logistic regression analysis showed that male gender, low birth weight, presence of developmental delay, family history of poor scholastic performance, and syllabus were independently associated with SLD. CONCLUSIONS The study found a higher prevalence of SLD (16.49%) and certain modifiable determinants of SLD were identified. It highlights the need for early detection and remedial measures for children with SLD.
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Affiliation(s)
- Deenu Chacko
- Department of Psychiatry, Government Medical College, Ernakulam, Kerala, India
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10
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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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11
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Addis L, Sproviero W, Thomas SV, Caraballo RH, Newhouse SJ, Gomez K, Hughes E, Kinali M, McCormick D, Hannan S, Cossu S, Taylor J, Akman CI, Wolf SM, Mandelbaum DE, Gupta R, van der Spek RA, Pruna D, Pal DK. Identification of new risk factors for rolandic epilepsy: CNV at Xp22.31 and alterations at cholinergic synapses. J Med Genet 2018; 55:607-616. [PMID: 29789371 PMCID: PMC6119347 DOI: 10.1136/jmedgenet-2018-105319] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/18/2018] [Accepted: 04/28/2018] [Indexed: 12/25/2022]
Abstract
Background Rolandic epilepsy (RE) is the most common genetic childhood epilepsy, consisting of focal, nocturnal seizures and frequent neurodevelopmental impairments in speech, language, literacy and attention. A complex genetic aetiology is presumed in most, with monogenic mutations in GRIN2A accounting for >5% of cases. Objective To identify rare, causal CNV in patients with RE. Methods We used high-density SNP arrays to analyse the presence of rare CNVs in 186 patients with RE from the UK, the USA, Sardinia, Argentina and Kerala, India. Results We identified 84 patients with one or more rare CNVs, and, within this group, 14 (7.5%) with recurrent risk factor CNVs and 15 (8.0%) with likely pathogenic CNVs. Nine patients carried recurrent hotspot CNVs including at 16p13.11 and 1p36, with the most striking finding that four individuals (three from Sardinia) carried a duplication, and one a deletion, at Xp22.31. Five patients with RE carried a rare CNV that disrupted genes associated with other epilepsies (KCTD7, ARHGEF15, CACNA2D1, GRIN2A and ARHGEF4), and 17 cases carried CNVs that disrupted genes associated with other neurological conditions or that are involved in neuronal signalling/development. Network analysis of disrupted genes with high brain expression identified significant enrichment in pathways of the cholinergic synapse, guanine-exchange factor activation and the mammalian target of rapamycin. Conclusion Our results provide a CNV profile of an ethnically diverse cohort of patients with RE, uncovering new areas of research focus, and emphasise the importance of studying non-western European populations in oligogenic disorders to uncover a full picture of risk variation.
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Affiliation(s)
- Laura Addis
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Neuroscience Discovery Research, Eli Lilly and Company, Surrey, UK
| | - William Sproviero
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Sanjeev V Thomas
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Roberto H Caraballo
- Department of Neurology, Hospital de Pediatría Prof. Dr. J.P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Stephen J Newhouse
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK
| | - Kumudini Gomez
- Department of Paediatrics, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Elaine Hughes
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Maria Kinali
- Department of Paediatric Neurology, Chelsea and Westminster Hospital, London, UK
| | - David McCormick
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Siobhan Hannan
- Department of Paediatric Neurology, Chelsea and Westminster Hospital, London, UK
| | - Silvia Cossu
- Neurosurgery Unit, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children Hospital, Rome, Italy.,Neurology Unit, Pediatric Hospital A. Cao, Brotzu Hospital Trust, Cagliari, Italy
| | | | - Cigdem I Akman
- Division of Pediatric Neurology, College of Physicians and Surgeons of Columbia University, New York City, New York, USA
| | - Steven M Wolf
- Department of Neurology, Mount Sinai Health System, New York City, New York, USA
| | - David E Mandelbaum
- Departments of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rajesh Gupta
- Department of Paediatrics, Tunbridge Wells Hospital, Pembury, UK
| | - Rick A van der Spek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dario Pruna
- Neurology Unit, Pediatric Hospital A. Cao, Brotzu Hospital Trust, Cagliari, Italy
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
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12
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Lee YJ, Hwang SK, Kwon S. The Clinical Spectrum of Benign Epilepsy with Centro-Temporal Spikes: a Challenge in Categorization and Predictability. J Epilepsy Res 2017; 7:1-6. [PMID: 28775948 PMCID: PMC5540684 DOI: 10.14581/jer.17001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/17/2017] [Indexed: 02/06/2023] Open
Abstract
Benign epilepsy with centro-temporal spikes (BECTS) is the most common type of focal epilepsy in children; it is age-dependent and presumably genetic. Traditionally, children with BECTS have a very good prognosis, even without medical treatment, and are thought to show no neurological symptoms or cognitive deficits. However, many previous studies have shown that BECTS can present with various clinical and electroencephalographic characteristics that are commonly associated with neuropsychological deficits, including linguistic, cognitive, and behavioral impairment. The degree of the neuropsychological deficits appears to depend on the sleep cycle and the localization of epileptiform discharges. Furthermore, based on neurobiological studies, a complex interplay between the processes of brain maturation and the involvement of genes that confer susceptibility may contribute to a variety of different childhood epileptic syndromes with various neuropsychological deficits. Thus, BECTS, atypical benign focal epilepsy during childhood, status epilepticus of BECTS, Landau-Kleffner syndrome, and epileptic encephalopathy with continuous spike-and-wave during sleep are all considered different entities, but are part of a single spectrum of disorders. In clinical practice, we have to consider BECTS as benign only when there are no or only mild neuropsychological deficits before medical treatment.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatric Neurology, Kyungpook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Su Kyeong Hwang
- Department of Pediatric Neurology, Kyungpook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Soonhak Kwon
- Department of Pediatric Neurology, Kyungpook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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13
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Bathelt J, Astle D, Barnes J, Raymond FL, Baker K. Structural brain abnormalities in a single gene disorder associated with epilepsy, language impairment and intellectual disability. Neuroimage Clin 2016; 12:655-665. [PMID: 27747153 PMCID: PMC5053034 DOI: 10.1016/j.nicl.2016.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/28/2016] [Accepted: 07/30/2016] [Indexed: 01/01/2023]
Abstract
Childhood speech and language deficits are highly prevalent and are a common feature of neurodevelopmental disorders. However, it is difficult to investigate the underlying causal pathways because many diagnostic groups have a heterogeneous aetiology. Studying disorders with a shared genetic cause and shared cognitive deficits can provide crucial insight into the cellular mechanisms and neural systems that give rise to those impairments. The current study investigated structural brain differences of individuals with mutations in ZDHHC9, which is associated with a specific neurodevelopmental phenotype including prominent speech and language impairments and intellectual disability. We used multiple structural neuroimaging methods to characterise neuroanatomy in this group, and observed bilateral reductions in cortical thickness in areas surrounding the temporo-parietal junction, parietal lobule, and inferior frontal lobe, and decreased microstructural integrity of cortical, subcortical-cortical, and interhemispheric white matter projections. These findings are compared to reports for other genetic groups and genetically heterogeneous disorders with a similar presentation. Overlap in the neuroanatomical phenotype suggests a common pathway that particularly affects the development of temporo-parietal and inferior frontal areas, and their connections.
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Affiliation(s)
- Joe Bathelt
- MRC Cognition & Brain Sciences Unit, Cambridge, United Kingdom
| | - Duncan Astle
- MRC Cognition & Brain Sciences Unit, Cambridge, United Kingdom
| | - Jessica Barnes
- MRC Cognition & Brain Sciences Unit, Cambridge, United Kingdom
| | - F. Lucy Raymond
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Kate Baker
- MRC Cognition & Brain Sciences Unit, Cambridge, United Kingdom
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
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14
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Panjwani N, Wilson MD, Addis L, Crosbie J, Wirrell E, Auvin S, Caraballo RH, Kinali M, McCormick D, Oren C, Taylor J, Trounce J, Clarke T, Akman CI, Kugler SL, Mandelbaum DE, McGoldrick P, Wolf SM, Arnold P, Schachar R, Pal DK, Strug LJ. A microRNA-328 binding site in PAX6 is associated with centrotemporal spikes of rolandic epilepsy. Ann Clin Transl Neurol 2016; 3:512-22. [PMID: 27386500 PMCID: PMC4931716 DOI: 10.1002/acn3.320] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
Objective Rolandic epilepsy is a common genetic focal epilepsy of childhood characterized by centrotemporal sharp waves on electroencephalogram. In previous genome‐wide analysis, we had reported linkage of centrotemporal sharp waves to chromosome 11p13, and fine mapping with 44 SNPs identified the ELP4‐PAX6 locus in two independent US and Canadian case–control samples. Here, we aimed to find a causative variant for centrotemporal sharp waves using a larger sample and higher resolution genotyping array. Methods We fine‐mapped the ELP4‐PAX6 locus in 186 individuals from rolandic epilepsy families and 1000 population controls of European origin using the Illumina HumanCoreExome‐12 v1.0 BeadChip. Controls were matched to cases on ethnicity using principal component analysis. We used generalized estimating equations to assess association, followed up with a bioinformatics survey and literature search to evaluate functional significance. Results Homozygosity at the T allele of SNP rs662702 in the 3′ untranslated region of PAX6 conferred increased risk of CTS: Odds ratio = 12.29 (95% CI: 3.20–47.22), P = 2.6 × 10−4 and is seen in 3.9% of cases but only 0.3% of controls. Interpretation The minor T allele of SNP rs662702 disrupts regulation by microRNA‐328, which is known to result in increased PAX6 expression in vitro. This study provides, for the first time, evidence of a noncoding genomic variant contributing to the etiology of a common human epilepsy via a posttranscriptional regulatory mechanism.
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Affiliation(s)
- Naim Panjwani
- Program in Genetics and Genome Biology The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
| | - Michael D Wilson
- Program in Genetics and Genome Biology The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Molecular Genetics University of Toronto Toronto Ontario M5S 1A1 Canada
| | - Laura Addis
- Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience King's College London London SE5 9RX United Kingdom; Neuroscience Discovery Research Eli Lilly and Company Erl Wood, Surrey GU20 6PH United Kingdom
| | - Jennifer Crosbie
- Neurosciences and Mental Health Program Research Institute The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Psychiatry The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
| | - Elaine Wirrell
- Division of Child and Adolescent Neurology Mayo Clinic Rochester Minnesota 55905
| | - Stéphane Auvin
- Service de neurologie pédiatrique/Inserm 1141 Hôpital Robert Debré AP-HP, 48 boulevard Sérurier Paris 75019 France
| | - Roberto H Caraballo
- Department of Neurology Hospital de Pediatría "Prof Dr Juan P Garrahan" Combate de los Pozos 1881 C1245AAM Buenos Aires Argentina
| | - Maria Kinali
- Chelsea and Westminster Hospital London SW10 9NH United Kingdom
| | | | - Caroline Oren
- Northwick Park Hospital Middlesex HA1 3UJ United Kingdom
| | - Jacqueline Taylor
- Barnet and Chase Farm Hospitals Enfield, Greater London EN2 8JL United Kingdom
| | - John Trounce
- Brighton and Sussex University Hospitals Brighton BN1 6AG United Kingdom
| | - Tara Clarke
- Department of Epidemiology Columbia University New York New York 10027
| | - Cigdem I Akman
- Neurological Institute Columbia University Medical Centre New York, New York 10032
| | - Steven L Kugler
- Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine Philadelphia Pennsylvania 19104
| | - David E Mandelbaum
- Hasbro Children's Hospital and the Warren Alpert Medical School of Brown University Providence Rhode Island 02903
| | | | | | - Paul Arnold
- Neurosciences and Mental Health Program Research Institute The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Psychiatry The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Mathison Centre for Mental Health Research and Education University of Calgary Calgary Alberta T2N 4Z6 Canada
| | - Russell Schachar
- Neurosciences and Mental Health Program Research Institute The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Psychiatry The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience King's College London London SE5 9RX United Kingdom; King's College Hospital London SE5 9RS United Kingdom; Evelina London Children's Hospita lLondon SE1 7EH United Kingdom
| | - Lisa J Strug
- Program in Genetics and Genome Biology The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Division of Biostatistics Dalla Lana School of Public Health University of Toronto Toronto Ontario M5T 3M7 Canada; The Centre for Applied Genomics The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
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15
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Turner SJ, Morgan AT, Perez ER, Scheffer IE. New genes for focal epilepsies with speech and language disorders. Curr Neurol Neurosci Rep 2016; 15:35. [PMID: 25921602 DOI: 10.1007/s11910-015-0554-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The last 2 years have seen exciting advances in the genetics of Landau-Kleffner syndrome and related disorders, encompassed within the epilepsy-aphasia spectrum (EAS). The striking finding of mutations in the N-methyl-D-aspartate (NMDA) receptor subunit gene GRIN2A as the first monogenic cause in up to 20% of patients with EAS suggests that excitatory glutamate receptors play a key role in these disorders. Patients with GRIN2A mutations have a recognizable speech and language phenotype that may assist with diagnosis. Other molecules involved in RNA binding and cell adhesion have been implicated in EAS; copy number variations are also found. The emerging picture highlights the overlap between the genetic determinants of EAS with speech and language disorders, intellectual disability, autism spectrum disorders and more complex developmental phenotypes.
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Affiliation(s)
- Samantha J Turner
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Australia,
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16
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Vega YH, Smith A, Cockerill H, Tang S, Agirre-Arrizubieta Z, Goyal S, Pina M, Akman CI, Jolleff N, McGinnity C, Gomez K, Gupta R, Hughes E, Jackman J, McCormick D, Oren C, Scott D, Taylor J, Trounce J, Clarke T, Kugler S, Mandelbaum DE, McGoldrick P, Wolf S, Strug LJ, Pal DK. Risk factors for reading disability in families with rolandic epilepsy. Epilepsy Behav 2015; 53:174-9. [PMID: 26580214 PMCID: PMC4719157 DOI: 10.1016/j.yebeh.2015.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The high prevalence and impact of neurodevelopmental comorbidities in childhood epilepsy are now well known, as are the increased risks and familial aggregation of reading disability (RD) and speech sound disorder (SSD) in rolandic epilepsy (RE). The risk factors for RD in the general population include male sex, SSD, and ADHD, but it is not known if these are the same in RE or whether there is a contributory role of seizure and treatment-related variables. METHODS An observational study of 108 probands with RE (age range: 3.6-22 years) and their 159 siblings (age range: 1-29 years; 83 with EEG data) were singly ascertained in the US or UK through a proband affected by RE. We used a nested case-control design, multiple logistic regression, and generalized estimating equations to test the hypothesis of an association between RD and seizure variables or antiepileptic drug treatment in RE; we also assessed an association between EEG focal sharp waves and RD in siblings. RESULTS Reading disability was reported in 42% of probands and 22% of siblings. Among probands, RD was strongly associated with a history of SSD (OR: 9.64, 95% CI: 2.45-37.21), ADHD symptoms (OR: 10.31, 95% CI: 2.15-49.44), and male sex (OR: 3.62, 95% CI: 1.11-11.75) but not with seizure or treatment variables. Among siblings, RD was independently associated only with SSD (OR: 4.30, 95% CI: 1.42-13.0) and not with the presence of interictal EEG focal sharp waves. SIGNIFICANCE The principal risk factors for RD in RE are SSD, ADHD, and male sex, the same risk factors as for RD without epilepsy. Seizure or treatment variables do not appear to be important risk factors for RD in probands with RE, and there was no evidence to support interictal EEG focal sharp waves as a risk factor for RD in siblings. Future studies should focus on the precise neuropsychological characterization of RD in families with RE and on the effectiveness of standard oral-language and reading interventions.
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Affiliation(s)
| | | | | | - Shan Tang
- King’s College London, UK,King’s Health Partners, London, UK
| | | | | | | | - Cigdem I Akman
- Department of Neurology, Columbia University, New York, USA
| | - Nicola Jolleff
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | | | | | | | | | | | | | | | | | | | - Tara Clarke
- Department of Epidemiology, Columbia University, New York, USA
| | - Steven Kugler
- Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, PA, USA
| | - David E Mandelbaum
- Hasbro Children’s Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto; Canada,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Deb K Pal
- King's College London, UK; King's Health Partners, London, UK.
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17
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Lenck-Santini PP, Scott RC. Mechanisms Responsible for Cognitive Impairment in Epilepsy. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a022772. [PMID: 26337111 DOI: 10.1101/cshperspect.a022772] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Epilepsy is often associated with cognitive and behavioral impairments that can have profound impact on the quality of life of patients. Although the mechanisms of cognitive impairment are not completely understood, we make an attempt to describe, from a systems perspective, how information processing is affected in epilepsy disorders. The aim of this review is to (1) define the nature of cognitive deficits associated with epilepsy, (2) review fundamental systems-level mechanisms underlying information processing, and (3) describe how information processing is dysfunctional in epilepsy and investigate the relative contributions of etiology, seizures, and interictal discharges (IDs). We conclude that these mechanisms are likely to be important and deserve more detailed scrutiny in the future.
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Affiliation(s)
| | - Rodney C Scott
- Institute of Child Health, University College of London, London WC1N 3JH, United Kingdom
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18
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Wu Y, Ji GJ, Zang YF, Liao W, Jin Z, Liu YL, Li K, Zeng YW, Fang F. Local Activity and Causal Connectivity in Children with Benign Epilepsy with Centrotemporal Spikes. PLoS One 2015. [PMID: 26225427 PMCID: PMC4520539 DOI: 10.1371/journal.pone.0134361] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The aim of the current study was to localize the epileptic focus and characterize its causal relation with other brain regions, to understand the cognitive deficits in children with benign childhood epilepsy with centrotemporal spikes (BECTS). Resting-state functional magnetic resonance imaging (fMRI) was performed in 37 children with BECTS and 25 children matched for age, sex and educational achievement. We identified the potential epileptogenic zone (EZ) by comparing the amplitude of low frequency fluctuation (ALFF) of spontaneous blood oxygenation level dependent fMRI signals between the groups. Granger causality analysis was applied to explore the causal effect between EZ and the whole brain. Compared with controls, children with BECTS had significantly increased ALFF in the right postcentral gyrus and bilateral calcarine, and decreased ALFF in the left anterior cingulate cortex, bilateral putaman/caudate, and left cerebellum. ALFF values in the putaman/caudate were positively correlated with verbal IQ scores in patients. The ALFF values in cerebellum and performance IQ scores were negatively correlated in patients. These results suggest that ALFF disturbances in the putaman/caudate and cerebellum play an important role in BECTS cognitive dysfunction. Compared with controls, the patients showed increased driving effect from the EZ to the right medial frontal cortex and posterior cingulate cortex and decreased causal effects from the EZ to left inferior frontal gyrus. The causal effect of the left inferior frontal gyrus negatively correlated with disease duration, which suggests a relation between the epileptiform activity and language impairment. All together, these findings provide additional insight into the neurophysiological mechanisms of epilepitogenisis and cognitive dysfunction associated with BECTS.
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Affiliation(s)
- Yun Wu
- Department of Neurology, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, China
- * E-mail: (YW); (FF)
| | - Gong-Jun Ji
- Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China
- Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Wei Liao
- Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Zhen Jin
- fMRI Center, The 306 Hospital of People’s Liberation Army, Beijing, China
| | - Ya-Li Liu
- fMRI Center, The 306 Hospital of People’s Liberation Army, Beijing, China
| | - Ke Li
- fMRI Center, The 306 Hospital of People’s Liberation Army, Beijing, China
| | - Ya-Wei Zeng
- fMRI Center, The 306 Hospital of People’s Liberation Army, Beijing, China
| | - Fang Fang
- Department of Neurology, Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing, China
- * E-mail: (YW); (FF)
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19
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Baker K, Astle DE, Scerif G, Barnes J, Smith J, Moffat G, Gillard J, Baldeweg T, Raymond FL. Epilepsy, cognitive deficits and neuroanatomy in males with ZDHHC9 mutations. Ann Clin Transl Neurol 2015; 2:559-69. [PMID: 26000327 PMCID: PMC4435709 DOI: 10.1002/acn3.196] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Systematic investigation of individuals with intellectual disability after genetic diagnosis can illuminate specific phenotypes and mechanisms relevant to common neurodevelopmental disorders. We report the neurological, cognitive and neuroanatomical characteristics of nine males from three families with loss-of-function mutations in ZDHHC9 (OMIM #300799). METHODS All known cases of X-linked intellectual disability (XLID) due to ZDHHC9 mutation in the United Kingdom were invited to participate in a study of neurocognitive and neuroimaging phenotypes. RESULTS Seven out of nine males with ZDHHC9 mutations had been diagnosed with epilepsy, exceeding epilepsy risk in XLID comparison subjects (P = 0.01). Seizure histories and EEG features amongst ZDHHC9 mutation cases shared characteristics with rolandic epilepsy (RE). Specific cognitive deficits differentiated males with ZDHHC9 mutations from XLID comparison subjects and converged with reported linguistic and nonlinguistic deficits in idiopathic RE: impaired oromotor control, reduced verbal fluency, and impaired inhibitory control on visual attention tasks. Consistent neuroanatomical abnormalities included thalamic and striatal volume reductions and hypoplasia of the corpus callosum. INTERPRETATION Mutations in ZDHHC9 are associated with susceptibility to focal seizures and specific cognitive impairments intersecting with the RE spectrum. Neurocognitive deficits are accompanied by consistent abnormalities of subcortical structures and inter-hemispheric connectivity. The biochemical, cellular and network-level mechanisms responsible for the ZDHHC9-associated neurocognitive phenotype may be relevant to cognitive outcomes in RE.
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Affiliation(s)
- Kate Baker
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge Cambridge, United Kingdom ; MRC Cognitive and Brain Sciences Unit Cambridge, United Kingdom
| | - Duncan E Astle
- MRC Cognitive and Brain Sciences Unit Cambridge, United Kingdom
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford Oxford, United Kingdom
| | - Jessica Barnes
- MRC Cognitive and Brain Sciences Unit Cambridge, United Kingdom
| | - Jennie Smith
- Speech and Language Therapy Team, Cleft.Net.East, Addenbrookes Hospital Cambridge, United Kingdom
| | - Georgina Moffat
- Speech and Language Therapy Team, Cleft.Net.East, Addenbrookes Hospital Cambridge, United Kingdom
| | - Jonathan Gillard
- Department of Radiology, University of Cambridge Cambridge, United Kingdom
| | - Torsten Baldeweg
- Developmental Neuroscience Programme, Institute of Child Health, University College London London, United Kingdom
| | - F Lucy Raymond
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge Cambridge, United Kingdom
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20
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Insights into the genetic foundations of human communication. Neuropsychol Rev 2015; 25:3-26. [PMID: 25597031 DOI: 10.1007/s11065-014-9277-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/22/2014] [Indexed: 12/19/2022]
Abstract
The human capacity to acquire sophisticated language is unmatched in the animal kingdom. Despite the discontinuity in communicative abilities between humans and other primates, language is built on ancient genetic foundations, which are being illuminated by comparative genomics. The genetic architecture of the language faculty is also being uncovered by research into neurodevelopmental disorders that disrupt the normally effortless process of language acquisition. In this article, we discuss the strategies that researchers are using to reveal genetic factors contributing to communicative abilities, and review progress in identifying the relevant genes and genetic variants. The first gene directly implicated in a speech and language disorder was FOXP2. Using this gene as a case study, we illustrate how evidence from genetics, molecular cell biology, animal models and human neuroimaging has converged to build a picture of the role of FOXP2 in neurodevelopment, providing a framework for future endeavors to bridge the gaps between genes, brains and behavior.
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21
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Turner SJ, Mayes AK, Verhoeven A, Mandelstam SA, Morgan AT, Scheffer IE. GRIN2A: an aptly named gene for speech dysfunction. Neurology 2015; 84:586-93. [PMID: 25596506 DOI: 10.1212/wnl.0000000000001228] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To delineate the specific speech deficits in individuals with epilepsy-aphasia syndromes associated with mutations in the glutamate receptor subunit gene GRIN2A. METHODS We analyzed the speech phenotype associated with GRIN2A mutations in 11 individuals, aged 16 to 64 years, from 3 families. Standardized clinical speech assessments and perceptual analyses of conversational samples were conducted. RESULTS Individuals showed a characteristic phenotype of dysarthria and dyspraxia with lifelong impact on speech intelligibility in some. Speech was typified by imprecise articulation (11/11, 100%), impaired pitch (monopitch 10/11, 91%) and prosody (stress errors 7/11, 64%), and hypernasality (7/11, 64%). Oral motor impairments and poor performance on maximum vowel duration (8/11, 73%) and repetition of monosyllables (10/11, 91%) and trisyllables (7/11, 64%) supported conversational speech findings. The speech phenotype was present in one individual who did not have seizures. CONCLUSIONS Distinctive features of dysarthria and dyspraxia are found in individuals with GRIN2A mutations, often in the setting of epilepsy-aphasia syndromes; dysarthria has not been previously recognized in these disorders. Of note, the speech phenotype may occur in the absence of a seizure disorder, reinforcing an important role for GRIN2A in motor speech function. Our findings highlight the need for precise clinical speech assessment and intervention in this group. By understanding the mechanisms involved in GRIN2A disorders, targeted therapy may be designed to improve chronic lifelong deficits in intelligibility.
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Affiliation(s)
- Samantha J Turner
- From the Department of Paediatrics (S.J.T., S.A.M., A.T.M., I.E.S.), The University of Melbourne, The Royal Children's Hospital, Parkville; Language and Literacy Group (A.K.M., A.T.M.), Population Health Theme, Murdoch Childrens Research Institute, Parkville; Speech Pathology Department (A.V.), The Royal Children's Hospital, Parkville; Department of Radiology (S.A.M.), The University of Melbourne, Parkville; Epilepsy Research Centre (I.E.S.), Department of Medicine, The University of Melbourne, Austin Health, Melbourne; and Florey Institute of Neuroscience and Mental Health (S.A.M., I.E.S.), Melbourne, Australia
| | - Angela K Mayes
- From the Department of Paediatrics (S.J.T., S.A.M., A.T.M., I.E.S.), The University of Melbourne, The Royal Children's Hospital, Parkville; Language and Literacy Group (A.K.M., A.T.M.), Population Health Theme, Murdoch Childrens Research Institute, Parkville; Speech Pathology Department (A.V.), The Royal Children's Hospital, Parkville; Department of Radiology (S.A.M.), The University of Melbourne, Parkville; Epilepsy Research Centre (I.E.S.), Department of Medicine, The University of Melbourne, Austin Health, Melbourne; and Florey Institute of Neuroscience and Mental Health (S.A.M., I.E.S.), Melbourne, Australia
| | - Andrea Verhoeven
- From the Department of Paediatrics (S.J.T., S.A.M., A.T.M., I.E.S.), The University of Melbourne, The Royal Children's Hospital, Parkville; Language and Literacy Group (A.K.M., A.T.M.), Population Health Theme, Murdoch Childrens Research Institute, Parkville; Speech Pathology Department (A.V.), The Royal Children's Hospital, Parkville; Department of Radiology (S.A.M.), The University of Melbourne, Parkville; Epilepsy Research Centre (I.E.S.), Department of Medicine, The University of Melbourne, Austin Health, Melbourne; and Florey Institute of Neuroscience and Mental Health (S.A.M., I.E.S.), Melbourne, Australia
| | - Simone A Mandelstam
- From the Department of Paediatrics (S.J.T., S.A.M., A.T.M., I.E.S.), The University of Melbourne, The Royal Children's Hospital, Parkville; Language and Literacy Group (A.K.M., A.T.M.), Population Health Theme, Murdoch Childrens Research Institute, Parkville; Speech Pathology Department (A.V.), The Royal Children's Hospital, Parkville; Department of Radiology (S.A.M.), The University of Melbourne, Parkville; Epilepsy Research Centre (I.E.S.), Department of Medicine, The University of Melbourne, Austin Health, Melbourne; and Florey Institute of Neuroscience and Mental Health (S.A.M., I.E.S.), Melbourne, Australia
| | - Angela T Morgan
- From the Department of Paediatrics (S.J.T., S.A.M., A.T.M., I.E.S.), The University of Melbourne, The Royal Children's Hospital, Parkville; Language and Literacy Group (A.K.M., A.T.M.), Population Health Theme, Murdoch Childrens Research Institute, Parkville; Speech Pathology Department (A.V.), The Royal Children's Hospital, Parkville; Department of Radiology (S.A.M.), The University of Melbourne, Parkville; Epilepsy Research Centre (I.E.S.), Department of Medicine, The University of Melbourne, Austin Health, Melbourne; and Florey Institute of Neuroscience and Mental Health (S.A.M., I.E.S.), Melbourne, Australia
| | - Ingrid E Scheffer
- From the Department of Paediatrics (S.J.T., S.A.M., A.T.M., I.E.S.), The University of Melbourne, The Royal Children's Hospital, Parkville; Language and Literacy Group (A.K.M., A.T.M.), Population Health Theme, Murdoch Childrens Research Institute, Parkville; Speech Pathology Department (A.V.), The Royal Children's Hospital, Parkville; Department of Radiology (S.A.M.), The University of Melbourne, Parkville; Epilepsy Research Centre (I.E.S.), Department of Medicine, The University of Melbourne, Austin Health, Melbourne; and Florey Institute of Neuroscience and Mental Health (S.A.M., I.E.S.), Melbourne, Australia.
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Mellish LC, Dunkley C, Ferrie CD, Pal DK. Antiepileptic drug treatment of rolandic epilepsy and Panayiotopoulos syndrome: clinical practice survey and clinical trial feasibility. Arch Dis Child 2015; 100:62-7. [PMID: 25202134 PMCID: PMC4283698 DOI: 10.1136/archdischild-2013-304211] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The evidence base for management of childhood epilepsy is poor, especially for the most common specific syndromes such as rolandic epilepsy (RE) and Panayiotopoulos syndrome (PS). Considerable international variation in management and controversy about non-treatment indicate the need for high quality randomised controlled trials (RCT). The aim of this study is, therefore, to describe current UK practice and explore the feasibility of different RCT designs for RE and PS. METHODS We conducted an online survey of 590 UK paediatricians who treat epilepsy. Thirty-two questions covered annual caseload, investigation and management practice, factors influencing treatment, antiepileptic drug preferences and hypothetical trial design preferences. RESULTS 132 responded (22%): 81% were paediatricians and 95% at consultant seniority. We estimated, annually, 751 new RE cases and 233 PS cases. Electroencephalography (EEG) is requested at least half the time in approximately 70% of cases; MRI brain at least half the time in 40%-65% cases and neuropsychological evaluation in 7%-8%. Clinicians reported non-treatment in 40%: main reasons were low frequency of seizures and parent/child preferences. Carbamazepine is the preferred older, and levetiracetam the preferred newer, RCT arm. Approximately one-half considered active and placebo designs acceptable, choosing seizures as primary and cognitive/behavioural measures as secondary outcomes. CONCLUSIONS Management among respondents is broadly in line with national guidance, although with possible overuse of brain imaging and underuse of EEG and neuropsychological assessments. A large proportion of patients in the UK remains untreated, and clinicians seem amenable to a range of RCT designs, with carbamazepine and levetiracetam the preferred active drugs.
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Affiliation(s)
| | | | - Colin D Ferrie
- Department of Paediatric Neurology, Leeds General Infirmary, Leeds, UK
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23
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Besseling RMH, Jansen JFA, Overvliet GM, van der Kruijs SJM, Ebus SCM, de Louw AJA, Hofman PAM, Aldenkamp AP, Backes WH. Delayed convergence between brain network structure and function in rolandic epilepsy. Front Hum Neurosci 2014; 8:704. [PMID: 25249968 PMCID: PMC4158874 DOI: 10.3389/fnhum.2014.00704] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/22/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction: Rolandic epilepsy (RE) manifests during a critical phase of brain development, and has been associated with language impairments. Concordant abnormalities in structural and functional connectivity (SC and FC) have been described before. As SC and FC are under mutual influence, the current study investigates abnormalities in the SC-FC synergy in RE. Methods: Twenty-two children with RE (age, mean ± SD: 11.3 ± 2.0 y) and 22 healthy controls (age 10.5 ± 1.6 y) underwent structural, diffusion weighted, and resting-state functional magnetic resonance imaging (MRI) at 3T. The probabilistic anatomical landmarks atlas was used to parcellate the (sub)cortical gray matter. Constrained spherical deconvolution tractography and correlation of time series were used to assess SC and FC, respectively. The SC-FC correlation was assessed as a function of age for the non-zero structural connections over a range of sparsity values (0.01–0.75). A modularity analysis was performed on the mean SC network of the controls to localize potential global effects to subnetworks. SC and FC were also assessed separately using graph analysis. Results: The SC-FC correlation was significantly reduced in children with RE compared to healthy controls, especially for the youngest participants. This effect was most pronounced in a left and a right centro-temporal network, as well as in a medial parietal network. Graph analysis revealed no prominent abnormalities in SC or FC network organization. Conclusion: Since SC and FC converge during normal maturation, our finding of reduced SC-FC correlation illustrates impaired synergy between brain structure and function. More specifically, since this effect was most pronounced in the youngest participants, RE may represent a developmental disorder of delayed brain network maturation. The observed effects seem especially attributable to medial parietal connections, which forms an intermediate between bilateral centro-temporal modules of epileptiform activity, and bear relevance for language function.
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Affiliation(s)
- René M H Besseling
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Radiology, Maastricht University Medical Center Maastricht, Netherlands
| | - Jacobus F A Jansen
- Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Radiology, Maastricht University Medical Center Maastricht, Netherlands
| | - Geke M Overvliet
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Sylvie J M van der Kruijs
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | | | - Anton J A de Louw
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Paul A M Hofman
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Albert P Aldenkamp
- Epilepsy Center Kempenhaeghe Heeze, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Walter H Backes
- Research School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Radiology, Maastricht University Medical Center Maastricht, Netherlands
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Gialluisi A, Newbury DF, Wilcutt EG, Olson RK, DeFries JC, Brandler WM, Pennington BF, Smith SD, Scerri TS, Simpson NH, Luciano M, Evans DM, Bates TC, Stein JF, Talcott JB, Monaco AP, Paracchini S, Francks C, Fisher SE. Genome-wide screening for DNA variants associated with reading and language traits. GENES BRAIN AND BEHAVIOR 2014; 13:686-701. [PMID: 25065397 PMCID: PMC4165772 DOI: 10.1111/gbb.12158] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/20/2014] [Accepted: 07/24/2014] [Indexed: 01/04/2023]
Abstract
Reading and language abilities are heritable traits that are likely to share some genetic influences with each other. To identify pleiotropic genetic variants affecting these traits, we first performed a genome-wide association scan (GWAS) meta-analysis using three richly characterized datasets comprising individuals with histories of reading or language problems, and their siblings. GWAS was performed in a total of 1862 participants using the first principal component computed from several quantitative measures of reading- and language-related abilities, both before and after adjustment for performance IQ. We identified novel suggestive associations at the SNPs rs59197085 and rs5995177 (uncorrected P ≈ 10–7 for each SNP), located respectively at the CCDC136/FLNC and RBFOX2 genes. Each of these SNPs then showed evidence for effects across multiple reading and language traits in univariate association testing against the individual traits. FLNC encodes a structural protein involved in cytoskeleton remodelling, while RBFOX2 is an important regulator of alternative splicing in neurons. The CCDC136/FLNC locus showed association with a comparable reading/language measure in an independent sample of 6434 participants from the general population, although involving distinct alleles of the associated SNP. Our datasets will form an important part of on-going international efforts to identify genes contributing to reading and language skills.
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Affiliation(s)
- A Gialluisi
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
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Rathouz PJ, Zhao Q, Jones JE, Jackson DC, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. Cognitive development in children with new onset epilepsy. Dev Med Child Neurol 2014; 56:635-41. [PMID: 24650092 PMCID: PMC4057956 DOI: 10.1111/dmcn.12432] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2013] [Indexed: 11/28/2022]
Abstract
AIM To characterize the prospective trajectory of cognitive development in children with new or recent onset epilepsy from baseline to 5 to 6 years after diagnosis. METHOD Sixty-nine children (40 males, 29 females; age 8-18y), with new or recent onset epilepsies underwent neuropsychological assessment shortly after diagnosis (Wave 1), 2 years (Wave 2), and 5 to 6 years after diagnosis (Wave 3). Intelligence, academic achievement, language, executive function, and psychomotor speed were evaluated. Sixty-two children (28 males, 34 females; age 8-18) with typical development served as a comparison group at each time point. The cognitive data were examined by syndrome (localization-related epilepsy [LRE]; idiopathic generalized epilepsy [IGE]; comparison group). Mixed effect regression models compared trajectories among groups with respect to time since diagnosis. RESULTS Cognitive abnormalities exhibited by children with epilepsy in arithmetic computation, response inhibition, attention, fine motor dexterity, and psychomotor speed (all p values <0.001), are detectable at or near the time of diagnosis and largely remain stable over the ensuing 5 to 6 years without evidence of progressive worsening or recovery. This course is evident across both LRE and IGE groups, with the LRE group performing better for some outcomes (arithmetic, response inhibition, psychomotor speed) and never worse than the IGE group. INTERPRETATION Cognitive development in children with LRE and IGE is not characterized by progressive deterioration or lack of age-appropriate development; rather, development lags behind that of children with typical development. Cognitive abnormalities, when detected, are present near the time of diagnosis, persist over time, and require early intervention.
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Affiliation(s)
- Paul J Rathouz
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health
| | - Qianqian Zhao
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dave A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carl E Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University, North Chicago, IL, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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26
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Jackson DC, Lin JJ, Chambers KL, Kessler-Jones A, Jones JE, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. Birth weight and cognition in children with epilepsy. Epilepsia 2014; 55:901-8. [PMID: 24735169 PMCID: PMC4057970 DOI: 10.1111/epi.12622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Birth weight is an important indicator of prenatal environment, and subtle variations of birth weight within the normal range have been associated with differential risk for cognitive and behavioral problems. Therefore, we aimed to determine if there are differences in birth weight between full-term children with uncomplicated new/recent-onset epilepsies and typically developing healthy controls. We further examined the relationships between birth weight and childhood/adolescent cognition, behavior, and academic achievement. METHODS One hundred eight children with new-onset/recent-onset epilepsy and 70 healthy controls underwent neuropsychological assessment. All participants were born full-term (>37 weeks) without birth complications. Parents were interviewed regarding their child's gestation, birth, and neurodevelopmental history. RESULTS Birth weight of children with epilepsy was significantly lower than healthy controls (p = 0.023). Whereas birth weight (covaried with age, sex, handedness, and mother's education) was significantly associated with cognition in controls in multiple domains (intelligence, language, aspects of academic achievement), this relationship was absent in children with epilepsy. Birth weight was not associated with clinical epilepsy variables (age of onset, epilepsy syndrome) and was not predictive of a variety of other academic or psychiatric comorbidities of epilepsy. SIGNIFICANCE Although the origin of lower birth weight in children with epilepsy is unknown, these findings raise the possibility that abnormal prenatal environment may affect childhood-onset epilepsy. Furthermore, the positive relationship between birth weight and cognition evident in healthy controls was disrupted in children with epilepsy. However, birth weight was not related to academic and psychiatric comorbidities of childhood epilepsy. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Affiliation(s)
- Daren C. Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Jack J. Lin
- Department of Neurology, University of California at Irvine, Irvine CA
| | - Karlee L. Chambers
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Alanna Kessler-Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - David A. Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Carl E. Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago IL
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
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Besseling RMH, Jansen JFA, Overvliet GM, van der Kruijs SJM, Ebus SCM, de Louw A, Hofman PAM, Vles JSH, Aldenkamp AP, Backes WH. Reduced structural connectivity between sensorimotor and language areas in rolandic epilepsy. PLoS One 2013; 8:e83568. [PMID: 24376719 PMCID: PMC3871667 DOI: 10.1371/journal.pone.0083568] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/12/2013] [Indexed: 12/13/2022] Open
Abstract
Introduction Rolandic epilepsy (RE) is a childhood epilepsy with centrotemporal (rolandic) spikes, that is increasingly associated with language impairment. In this study, we tested for a white matter (connectivity) correlate, employing diffusion weighted MRI and language testing. Methods Twenty-three children with RE and 23 matched controls (age: 8–14 years) underwent structural (T1-weighted) and diffusion-weighted MRI (b = 1200 s/mm2, 66 gradient directions) at 3T, as well as neuropsychological language testing. Combining tractography and a cortical segmentation derived from the T1-scan, the rolandic tract were reconstructed (pre- and postcentral gyri), and tract fractional anisotropy (FA) values were compared between patients and controls. Aberrant tracts were tested for correlations with language performance. Results Several reductions of tract FA were found in patients compared to controls, mostly in the left hemisphere; the most significant effects involved the left inferior frontal (p = 0.005) and supramarginal (p = 0.004) gyrus. In the patient group, lower tract FA values were correlated with lower language performance, among others for the connection between the left postcentral and inferior frontal gyrus (p = 0.043, R = 0.43). Conclusion In RE, structural connectivity is reduced for several connections involving the rolandic regions, from which the epileptiform activity originates. Most of these aberrant tracts involve the left (typically language mediating) hemisphere, notably the pars opercularis of the inferior frontal gyrus (Broca’s area) and the supramarginal gyrus (Wernicke’s area). For the former, reduced language performance for lower tract FA was found in the patients. These findings provide a first microstructural white matter correlate for language impairment in RE.
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Affiliation(s)
- René M. H. Besseling
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacobus F. A. Jansen
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Geke M. Overvliet
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sylvie J. M. van der Kruijs
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | | | - Anton de Louw
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul A. M. Hofman
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes S. H. Vles
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert P. Aldenkamp
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walter H. Backes
- Research School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
- * E-mail:
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Jackson DC, Dabbs K, Walker NM, Jones JE, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. The neuropsychological and academic substrate of new/recent-onset epilepsies. J Pediatr 2013; 162:1047-53.e1. [PMID: 23219245 PMCID: PMC3615134 DOI: 10.1016/j.jpeds.2012.10.046] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 09/26/2012] [Accepted: 10/18/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize neuropsychological and academic status in children, ages 8-18 years, with new-/recent-onset idiopathic generalized epilepsy (IGE) and idiopathic localization-related epilepsy (ILRE) compared with healthy controls. STUDY DESIGN Participants underwent neuropsychological assessment, and parents were interviewed regarding their child's academic history. Cognitive scores for children with epilepsy were age- and sex-adjusted and compared with controls across both broad-band (IGE n = 41 and ILRE n = 53) and narrow-band (childhood/juvenile absence, juvenile myoclonic, benign epilepsy with centro-temporal spikes, and focal [temporal/frontal/not otherwise specified]) syndromes. Academic histories were examined, including problems antecedent to epilepsy onset and diagnosis. RESULTS Children with new/recent-onset epilepsies exhibit considerable cognitive abnormality at baseline, including patterns of shared abnormalities across syndromes (eg, psychomotor slowing) as well as unique syndrome-specific cognitive effects (eg, executive function in IGE and language/verbal memory in ILRE) that are observed and sometimes exacerbated in specific IGE and ILRE syndromes. Academic difficulties are evident in approximately 50% of the children with epilepsy, affecting all syndrome groups to an equal degree. DISCUSSION Patterns of shared and syndrome-specific cognitive abnormalities and academic problems are present early in the course of virtually all epilepsy syndromes examined here, including syndromes classically viewed as benign. This is the base upon which the effects of recurrent seizures, treatment, and psychosocial effects will be added over time.
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Affiliation(s)
- DC Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - K Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - NM Walker
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - JE Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - DA Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - CE Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - M Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago IL
| | - BP Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
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Early onset of cortical thinning in children with rolandic epilepsy. NEUROIMAGE-CLINICAL 2013; 2:434-9. [PMID: 24179797 PMCID: PMC3777705 DOI: 10.1016/j.nicl.2013.03.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Rolandic epilepsy, a childhood epilepsy associated with language impairments, was investigated for language-related cortical abnormalities. METHODS Twenty-four children with rolandic epilepsy and 24 controls (age 8-14 years) were recruited and underwent the Clinical Evaluation of Language Fundamentals test. Structural MRI was performed at 3 T (voxel size 1 × 1 × 1 mm(3)) for fully automated quantitative assessment of cortical thickness. Regression analysis was used to test for differences between patients and controls and to assess the effect of age and language indices on cortical thickness. RESULTS For patients the core language score (mean ± SD: 92 ± 18) was lower than for controls (106 ± 11, p = 0.0026) and below the norm of 100 ± 15 (p = 0.047). Patients showed specific impairments in receptive language index (87 ± 19, p = 0.002) and language content index (87 ± 18, p = 0.0016). Cortical thickness was reduced in patients (p < 0.05, multiple-comparisons corrected) in left perisylvian regions. Furthermore, extensive cortical thinning with age was found in predominantly left-lateralized frontal, centro-parietal and temporal regions. No associations were found between cortical thickness and language indices in the regions of aberrant cortex. CONCLUSION The cortical abnormalities described represent subtle but significant pathomorphology in this critical phase of brain development (8-14 years) and suggest that rolandic epilepsy should not be considered merely a benign condition. Future studies employing longitudinal designs are prompted for further investigations into cerebral abnormalities in RE and associations with cognitive impairment and development.
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Addis L, Lin JJ, Pal DK, Hermann B, Caplan R. Imaging and genetics of language and cognition in pediatric epilepsy. Epilepsy Behav 2013; 26:303-12. [PMID: 23116771 PMCID: PMC3732317 DOI: 10.1016/j.yebeh.2012.09.014] [Citation(s) in RCA: 3] [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] [Received: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 12/19/2022]
Abstract
This paper presents translational aspects of imaging and genetic studies of language and cognition in children with epilepsy of average intelligence. It also discusses current unanswered translational questions in each of these research areas. A brief review of multimodal imaging and language study findings shows that abnormal structure and function, as well as plasticity and reorganization in language-related cortical regions, are found both in children with epilepsy with normal language skills and in those with linguistic deficits. The review on cognition highlights that multiple domains of impaired cognition and abnormalities in brain structure and/or connectivity are evident early on in childhood epilepsy and might be specific for epilepsy syndrome. The description of state-of-the-art genetic analyses that can be used to explain the convergence of language impairment and Rolandic epilepsy includes a discussion of the methodological difficulties involved in these analyses. Two junior researchers describe how their current and planned studies address some of the unanswered translational questions regarding cognition and imaging and the genetic analysis of speech sound disorder, reading, and centrotemporal spikes in Rolandic epilepsy.
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Affiliation(s)
- Laura Addis
- Institute of Psychiatry, University of London, London, UK
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Walker NM, Jackson DC, Dabbs K, Jones JE, Hsu DA, Stafstrom CE, Sheth RD, Koehn MA, Seidenberg M, Hermann BP. Is lower IQ in children with epilepsy due to lower parental IQ? A controlled comparison study. Dev Med Child Neurol 2013; 55:278-82. [PMID: 23216381 PMCID: PMC3570624 DOI: 10.1111/dmcn.12040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to determine the relationship between parent and child Full-scale IQ (FSIQ) in children with epilepsy and in typically developing comparison children and to examine parent-child IQ differences by epilepsy characteristics. METHOD The study participants were 97 children (50 males, 47 females; age range 8-18y; mean age 12y 3mo, SD 3y1mo) with recent-onset epilepsy including idiopathic generalized (n=43) and idiopathic localization-related epilepsies (n=54); 69 healthy comparison children (38 females, 31 males; age range 8-18y; mean age 12y 8mo, SD 3y 2mo), and one biological parent per child. All participants were administered the Wechsler Abbreviated Scale of Intelligence (WASI). FSIQ was compared in children with epilepsy and typically developing children; FSIQ was compared in the parents of typically developing children and the parents of participants with epilepsy; parent-child FSIQ differences were compared between the groups. RESULTS FSIQ was lower in children with epilepsy than in comparison children (p<0.001). FSIQ of parents of children with epilepsy did not differ from the FSIQ of the parents of typically developing children. Children with epilepsy had significantly lower FSIQ than their parents (p<0.001), whereas comparison children did not. The parent-child IQ difference was significantly higher in the group with epilepsy than the comparison group (p=0.043). Epilepsy characteristics were not related to parent-child IQ difference. INTERPRETATION Parent-child IQ difference appears to be a marker of epilepsy impact independent of familial IQ, epilepsy syndrome, and clinical seizure features. This marker is evident early in the course of idiopathic epilepsies and can be tracked over time.
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Affiliation(s)
- Natalie M Walker
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David A Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carl E Stafstrom
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Raj D Sheth
- Department of Neurology, Nemours Clinic, Jacksonville, FL
| | | | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Besseling RM, Jansen JF, Overvliet GM, van der Kruijs SJ, Vles JS, Ebus SC, Hofman PA, Louw AD, Aldenkamp AP, Backes WH. Reduced functional integration of the sensorimotor and language network in rolandic epilepsy. NEUROIMAGE-CLINICAL 2013; 2:239-46. [PMID: 24179777 PMCID: PMC3777786 DOI: 10.1016/j.nicl.2013.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 12/17/2012] [Accepted: 01/10/2013] [Indexed: 12/31/2022]
Abstract
Introduction Over the last years, evidence has accumulated that rolandic epilepsy (RE) is associated with serious cognitive comorbidities, including language impairment. However, the cerebral mechanism through which epileptiform activity in the rolandic (sensorimotor) areas may affect the language system is unknown. To investigate this, the connectivity between rolandic areas and regions involved in language processing is studied using functional MRI (fMRI). Materials and methods fMRI data was acquired from 22 children with rolandic epilepsy and 22 age-matched controls (age range: 8–14 years), both at rest and using word-generation and reading tasks. Activation map analysis revealed no group differences (FWE-corrected, p < 0.05) and was therefore used to define regions of interest for pooled (patients and controls combined) language activation. Independent component analysis with dual regression was used to identify the sensorimotor resting-state network in all subjects. The associated functional connectivity maps were compared between groups at the regions of interest for language activation identified from the task data. In addition, neuropsychological language testing (Clinical Evaluation of Language Fundamentals, 4th edition) was performed. Results Functional connectivity with the sensorimotor network was reduced in patients compared to controls (p = 0.011) in the left inferior frontal gyrus, i.e. Broca's area as identified by the word-generation task. No aberrant functional connectivity values were found in the other regions of interest, nor were any associations found between functional connectivity and language performance. Neuropsychological testing confirmed language impairment in patients relative to controls (reductions in core language score, p = 0.03; language content index, p = 0.01; receptive language index, p = 0.005). Conclusion Reduced functional connectivity was demonstrated between the sensorimotor network and the left inferior frontal gyrus (Broca's area) in children with RE, which might link epileptiform activity/seizures originating from the sensorimotor cortex to language impairment, and is in line with the identified neuropsychological profile of anterior language dysfunction.
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Affiliation(s)
- René M.H. Besseling
- Epilepsy center Kempenhaeghe, Heeze, the Netherlands
- Research School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacobus F.A. Jansen
- Research School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Geke M. Overvliet
- Epilepsy center Kempenhaeghe, Heeze, the Netherlands
- Research School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Sylvie J.M. van der Kruijs
- Epilepsy center Kempenhaeghe, Heeze, the Netherlands
- Research School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johannes S.H. Vles
- Epilepsy center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Paul A.M. Hofman
- Epilepsy center Kempenhaeghe, Heeze, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anton de Louw
- Epilepsy center Kempenhaeghe, Heeze, the Netherlands
| | - Albert P. Aldenkamp
- Epilepsy center Kempenhaeghe, Heeze, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walter H. Backes
- Research School for Mental Health & Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Corresponding author at: Department of Radiology, Maastricht University Medical Center, PB 5800, 6202 AZ Maastricht, The Netherlands. Tel.: + 31 43 3874910; fax: + 31 43 3876909.
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The relationship between nocturnal discharges and language dysfunction in rolandic epilepsy: treat the child, not the adage. Epilepsy Curr 2012; 12:192-3. [PMID: 23118605 DOI: 10.5698/1535-7511-12.5.192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pąchalska M, Kropotov ID, Mańko G, Lipowska M, Rasmus A, Łukaszewska B, Bogdanowicz M, Mirski A. Evaluation of a neurotherapy program for a child with ADHD with Benign Partial Epilepsy with Rolandic Spikes (BPERS) using event-related potentials. Med Sci Monit 2012; 18:CS94-104. [PMID: 23111748 PMCID: PMC3560598 DOI: 10.12659/msm.883531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/11/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We hypothesized that there would be a good response to relative beta training, applied to regulate the dynamics of brain function in a patient with benign partial epilepsy with Rolandic Spikes (BPERS), associated with neuropsychiatric deficits resembling the symptoms of attention deficit-hyperactivity disorder (ADHD). CASE REPORT The patient, E.Z., age 9.3, was suffering from neuropsychiatric symptoms, cognitive dysfunction, especially attention deficits, and behavioral changes, rendering him unable to function independently in school and in many situations of everyday life. He was treated for epilepsy, but only slight progress was made. The patient took part in 20 sessions of relative beta training combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment and after the completion of the neurotherapy program. Neuropsychological testing at baseline showed multiple cognitive deficits. Over the course of neurotherapy, E.Z.'s verbal and non-verbal IQ increased significantly. His cognitive functions also improved, including immediate and delayed logical and visual recall on the WMS-III, maintaining attention on the WMS-III, and executive functions, but remained below norms. Physiologically, the patient showed substantial changes after neurotherapy, including fewer spikes and an increased P300 NOGO component. CONCLUSIONS The cognitive deficits characteristic for ADHD in a child with BPERS may be unresponsive to antiepileptic treatment, but are reversible after a carefully selected neurotherapy program, combined with antiepileptic treatment. Event Related Potentials (ERPs) in the GO/NOGO task can be used to assess functional brain changes induced by neurotherapeutical programs.
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Starting at the beginning: the neuropsychological status of children with new-onset epilepsies. Epileptic Disord 2012; 14:12-21. [PMID: 22421240 DOI: 10.1684/epd.2012.0483] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This review examines the neurodevelopmental contribution to the cognitive and behavioural complications of epilepsy. Following a brief review of the lifespan complications of childhood epilepsies, attention turns to cognitive, psychiatric and social correlates of childhood epilepsies reported in population-based and tertiary care studies. The focus then becomes the neurobehavioural status of children with new-onset epilepsy; a point in time not confounded by the effects of years of recurrent seizures, medications, and social reactions to epilepsy. Recent research shows that abnormalities in cognition, brain structure and behaviour are present at or near the time of diagnosis. Further, careful history taking indicates that neurobehavioural problems may be present in advance of the first seizure suggesting the potential influence of epileptogenesis, antecedent neurodevelopmental abnormalities, genetic and environmental susceptibilities, and other risk factors. This becomes the substrate upon which to characterise the effects of epilepsy and its treatment on subsequent neurodevelopment. The review concludes with suggestions for future clinical care and research.
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Strug LJ, Addis L, Chiang T, Baskurt Z, Li W, Clarke T, Hardison H, Kugler SL, Mandelbaum DE, Novotny EJ, Wolf SM, Pal DK. The genetics of reading disability in an often excluded sample: novel loci suggested for reading disability in Rolandic epilepsy. PLoS One 2012; 7:e40696. [PMID: 22815793 PMCID: PMC3399896 DOI: 10.1371/journal.pone.0040696] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 06/12/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Reading disability (RD) is a common neurodevelopmental disorder with genetic basis established in families segregating "pure" dyslexia. RD commonly occurs in neurodevelopmental disorders including Rolandic Epilepsy (RE), a complex genetic disorder. We performed genomewide linkage analysis of RD in RE families, testing the hypotheses that RD in RE families is genetically heterogenenous to pure dyslexia, and shares genetic influences with other sub-phenotypes of RE. METHODS We initially performed genome-wide linkage analysis using 1000 STR markers in 38 US families ascertained through a RE proband; most of these families were multiplex for RD. We analyzed the data by two-point and multipoint parametric LOD score methods. We then confirmed the linkage evidence in a second US dataset of 20 RE families. We also resequenced the SEMA3C gene at the 7q21 linkage locus in members of one multiplex RE/RD pedigree and the DISC1 gene in affected pedigrees at the 1q42 locus. RESULTS In the discovery dataset there was suggestive evidence of linkage for RD to chromosome 7q21 (two-point LOD score 3.05, multipoint LOD 3.08) and at 1q42 (two-point LOD 2.87, multipoint LOD 3.03). Much of the linkage evidence at 7q21 derived from families of French-Canadian origin, whereas the linkage evidence at 1q42 was well distributed across all the families. There was little evidence for linkage at known dyslexia loci. Combining the discovery and confirmation datasets increased the evidence at 1q42 (two-point LOD = 3.49, multipoint HLOD = 4.70), but decreased evidence at 7q21 (two-point LOD = 2.28, multipoint HLOD = 1.81), possibly because the replication sample did not have French Canadian representation. DISCUSSION Reading disability in rolandic epilepsy has a genetic basis and may be influenced by loci at 1q42 and, in some populations, at 7q21; there is little evidence of a role for known DYX loci discovered in "pure" dyslexia pedigrees. 1q42 and 7q21 are candidate novel dyslexia loci.
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Affiliation(s)
- Lisa J. Strug
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laura Addis
- Department of Clinical Neurosciences, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Theodore Chiang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Zeynep Baskurt
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Weili Li
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Tara Clarke
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, United States of America
| | - Huntley Hardison
- St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania, United States of America
| | - Steven L. Kugler
- Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - David E. Mandelbaum
- Hasbro Children’s Hospital and The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Edward J. Novotny
- Yale University Medical Center, New Haven, Connecticut, United States of America
| | - Steven M. Wolf
- Beth Israel Medical Center, New York, New York, United States of America
| | - Deb K. Pal
- Department of Clinical Neurosciences, Institute of Psychiatry, King’s College London, London, United Kingdom
- Department of Psychiatry, Columbia University Medical Center, New York, New York, United States of America
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Abstract
Dyslexia is a neurodevelopmental disorder that is characterised by slow and inaccurate word recognition. Dyslexia has been reported in every culture studied, and mounting evidence draws attention to cross-linguistic similarity in its neurobiological and neurocognitive bases. Much progress has been made across research specialties spanning the behavioural, neuropsychological, neurobiological, and causal levels of analysis in the past 5 years. From a neuropsychological perspective, the phonological theory remains the most compelling, although phonological problems also interact with other cognitive risk factors. Work confirms that, neurobiologically, dyslexia is characterised by dysfunction of the normal left hemisphere language network and also implicates abnormal white matter development. Studies accounting for reading experience demonstrate that many recorded neural differences show causes rather than effects of dyslexia. Six predisposing candidate genes have been identified, and evidence shows gene by environment interaction.
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Affiliation(s)
- Robin L Peterson
- Department of Psychology, University of Denver, Denver, CO 80208, USA.
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Smith AB, Kavros PM, Clarke T, Dorta NJ, Tremont G, Pal DK. A neurocognitive endophenotype associated with rolandic epilepsy. Epilepsia 2012; 53:705-11. [PMID: 22220688 PMCID: PMC3319239 DOI: 10.1111/j.1528-1167.2011.03371.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Children with rolandic epilepsy (RE) experience difficulties with reading, language, and attention. Their siblings are at high risk of dyslexia but are not otherwise known to have neurocognitive deficits. We therefore sought evidence for an RE-associated neurocognitive endophenotype. METHODS Thirteen probands (male-to-female ratio 9:4) and 11 epilepsy-free siblings (male-to-female ratio 5:6) completed a neurocognitive evaluation within the domains of reading, language, and attention. Frequencies of impairment were compared, and mean standardized scores of children with RE and their siblings were each compared against population means. KEY FINDINGS Frequency of impairment in each domain was comparable for siblings and probands: 9% of siblings and 31% of probands were reading impaired; 36% of siblings and 54% of probands were language impaired; and 70% of siblings and 67% of probands had attention impairments. Comparison of differences between sample and population means revealed evidence of a similar pattern of language deficits in both groups, specifically for picture naming and attention to competing words. For measures of attention, both groups made significantly higher omission errors and were impaired in their ability to sustain attention. SIGNIFICANCE Children with RE and unaffected siblings demonstrate neurocognitive impairments in the domains of language and attention that are likely to remain undetected with general clinical protocols. Neurocognitively impaired probands and siblings showed a remarkably similar profile of deficits in language and attention that could explain poor academic performance. Early evaluation and intervention may benefit these children academically.
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Affiliation(s)
- Anna B Smith
- MRC Social Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, UK
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Parisi P, Verrotti A, Paolino MC, Castaldo R, Ianniello F, Ferretti A, Chiarelli F, Villa MP. "Electro-clinical syndromes" with onset in paediatric age: the highlights of the clinical-EEG, genetic and therapeutic advances. Ital J Pediatr 2011; 37:58. [PMID: 22182677 PMCID: PMC3267655 DOI: 10.1186/1824-7288-37-58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/19/2011] [Indexed: 12/13/2022] Open
Abstract
The genetic causes underlying epilepsy remain largely unknown, and the impact of available genetic data on the nosology of epilepsy is still limited. Thus, at present, classification of epileptic disorders should be mainly based on electroclinical features. Electro-clinical syndrome is a term used to identify a group of clinical entities showing a cluster of electro-clinical characteristics, with signs and symptoms that together define a distinctive, recognizable, clinical disorder. These often become the focus of treatment trials as well as of genetic, neuropsychological, and neuroimaging investigations. They are distinctive disorders identifiable on the basis of a typical age onset, specific EEG characteristics, seizure types, and often other features which, when taken together, permit a specific diagnosis which, in turn, often has implications for treatment, management, and prognosis. Each electro-clinical syndrome can be classified according to age at onset, cognitive and developmental antecedents and consequences, motor and sensory examinations, EEG features, provoking or triggering factors, and patterns of seizure occurrence with respect to sleep. Therefore, according to the age at onset, here we review the more frequently observed paediatric electro-clinical syndrome from their clinical-EEG, genetic and therapeutic point of views.
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Affiliation(s)
- Pasquale Parisi
- NESMOS Department, Chair of Pediatrics, Child Neurology, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa, 1035-1039, Rome,00189, Italy.
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Abstract
The contribution of genetics to both rare and common epilepsies is rapidly being elucidated, and neurologists are routinely considering genetic testing in the work-up of several epilepsy syndromes of both known and unknown cause. Simultaneously, advances in molecular technology foreshadow additional discoveries in epilepsy etiology, implying a greater role than ever before for genetics in the epilepsy clinic. Genetic testing can be valuable not only for diagnosis but also for guiding treatment and for informing reproductive choices. In this Review, we outline the principles of genetic evaluation and counseling, and describe how to interpret genetic test results for epilepsy in the following five common clinical scenarios: Dravet syndrome, infantile spasms, epilepsy with cortical malformation, epilepsy with mental retardation, and idiopathic epilepsy syndromes. We differentiate clinical situations in which genetic testing is of high and low utility, and predict future areas for the application of genetics in epilepsy practice.
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Hermann BP, Lin JJ, Jones JE, Seidenberg M. The emerging architecture of neuropsychological impairment in epilepsy. Neurol Clin 2009; 27:881-907. [PMID: 19853214 PMCID: PMC2811050 DOI: 10.1016/j.ncl.2009.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A new literature is now under way, one linking cognitive abnormalities directly to indices of structural, functional, metabolic, and other neurobiologic markers of cerebral integrity, independent of their association with clinical epilepsy characteristics. These trends are reviewed in this article. The focus is on temporal lobe epilepsy (TLE) as a model with which to address the core points because this form of localization-related epilepsy has been very carefully studied from both a cognitive and imaging standpoint. Some pertinent historical issues are touched on first, followed by more detailed reviews of the cognitive and neuroimaging abnormalities that have been found in TLE, followed by an overview of studies examining direct structure-function relationships in TLE and other epilepsies.
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Affiliation(s)
- Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA.
| | - Jack J Lin
- Department of Neurology, University of California-Irvine, Irvine, CA 92697, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 North Highland Avenue, Madison, WI 53792, USA
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, 3333 N. Green Bay Road, North Chicago, IL 60064, USA
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Centrotemporal sharp wave EEG trait in rolandic epilepsy maps to Elongator Protein Complex 4 (ELP4). Eur J Hum Genet 2009; 17:1171-81. [PMID: 19172991 DOI: 10.1038/ejhg.2008.267] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Rolandic epilepsy (RE) is the most common human epilepsy, affecting children between 3 and 12 years of age, boys more often than girls (3:2). Focal sharp waves in the centrotemporal area define the electroencephalographic (EEG) trait for the syndrome, are a feature of several related childhood epilepsies and are frequently observed in common developmental disorders (eg, speech dyspraxia, attention deficit hyperactivity disorder and developmental coordination disorder). Here we report the first genome-wide linkage scan in RE for the EEG trait, centrotemporal sharp waves (CTS), with genome-wide linkage of CTS to 11p13 (HLOD 4.30). Pure likelihood statistical analysis refined our linkage peak by fine mapping CTS to variants in Elongator Protein Complex 4 (ELP4) in two independent data sets; the strongest evidence was with rs986527 in intron 9 of ELP4, providing a likelihood ratio of 629:1 (P=0.0002) in favor of an association. Resequencing of ELP4 coding, flanking and promoter regions revealed no significant exonic polymorphisms. This is the first report of a gene implicated in a common focal epilepsy and the first human disease association of ELP4. ELP4 is a component of the Elongator complex, involved in transcription and tRNA modification. Elongator depletion results in the brain-specific downregulation of genes implicated in cell motility and migration. We hypothesize that a non-coding mutation in ELP4 impairs brain-specific Elongator-mediated interaction of genes implicated in brain development, resulting in susceptibility to seizures and neurodevelopmental disorders.
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