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van Dalen T, Kirkham JF, Chari A, D'Arco F, Moeller F, Eltze C, Cross JH, Tisdall MM, Thornton RC. Characterizing Frontal Lobe Seizure Semiology in Children. Ann Neurol 2024; 95:1138-1148. [PMID: 38624073 DOI: 10.1002/ana.26922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The objective was to analyze seizure semiology in pediatric frontal lobe epilepsy patients, considering age, to localize the seizure onset zone for surgical resection in focal epilepsy. METHODS Fifty patients were identified retrospectively, who achieved seizure freedom after frontal lobe resective surgery at Great Ormond Street Hospital. Video-electroencephalography recordings of preoperative ictal seizure semiology were analyzed, stratifying the data based on resection region (mesial or lateral frontal lobe) and age at surgery (≤4 vs >4). RESULTS Pediatric frontal lobe epilepsy is characterized by frequent, short, complex seizures, similar to adult cohorts. Children with mesial onset had higher occurrence of head deviation (either direction: 55.6% vs 17.4%; p = 0.02) and contralateral head deviation (22.2% vs 0.0%; p = 0.03), ictal body-turning (55.6% vs 13.0%; p = 0.006; ipsilateral: 55.6% vs 4.3%; p = 0.0003), and complex motor signs (88.9% vs 56.5%; p = 0.037). Both age groups (≤4 and >4 years) showed hyperkinetic features (21.1% vs 32.1%), contrary to previous reports. The very young group showed more myoclonic (36.8% vs 3.6%; p = 0.005) and hypomotor features (31.6% vs 0.0%; p = 0.003), and fewer behavioral features (36.8% vs 71.4%; p = 0.03) and reduced responsiveness (31.6% vs 78.6%; p = 0.002). INTERPRETATION This study presents the most extensive semiological analysis of children with confirmed frontal lobe epilepsy. It identifies semiological features that aid in differentiating between mesial and lateral onset. Despite age-dependent differences, typical frontal lobe features, including hyperkinetic seizures, are observed even in very young children. A better understanding of pediatric seizure semiology may enhance the accuracy of onset identification, and enable earlier presurgical evaluation, improving postsurgical outcomes. ANN NEUROL 2024;95:1138-1148.
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Affiliation(s)
- Thijs van Dalen
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jessica F Kirkham
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Aswin Chari
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Felice D'Arco
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Friederike Moeller
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Christin Eltze
- Department of Neurology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - J Helen Cross
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Martin M Tisdall
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Rachel C Thornton
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Neurophysiology, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
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Zhang M, Yu H, Cao G, Huang J, Lu Y, Zhang J, Liu N, Zhang W, Cheng Y, Kang G, Cai L. Enhanced focal cortical dysplasia detection in pediatric frontal lobe epilepsy with asymmetric radiomic and morphological features. Front Neurosci 2023; 17:1289897. [PMID: 38033536 PMCID: PMC10684781 DOI: 10.3389/fnins.2023.1289897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Focal cortical dysplasia (FCD) is the most common pathological cause for pediatric epilepsy, with frontal lobe epilepsy (FLE) being the most prevalent in the pediatric population. We attempted to utilize radiomic and morphological methods on MRI and PET to detect FCD in children with FLE. Methods Thirty-seven children with FLE and 20 controls were included in the primary cohort, and a five-fold cross-validation was performed. In addition, we validated the performance in an independent site of 12 FLE children. A two-stage experiments including frontal lobe and subregions were employed to detect the lesion area of FCD, incorporating the asymmetric feature between the left and right hemispheres. Specifically, for the radiomics approach, we used gray matter (GM), white matter (WM), GM and WM, and the gray-white matter boundary regions of interest to extract features. Then, we employed a Multi-Layer Perceptron classifier to achieve FCD lesion localization based on both radiomic and morphological methods. Results The Multi-Layer Perceptron model based on the asymmetric feature exhibited excellent performance both in the frontal lobe and subregions. In the primary cohort and independent site, the radiomics analysis with GM and WM asymmetric features had the highest sensitivity (89.2 and 91.7%) and AUC (98.9 and 99.3%) in frontal lobe. While in the subregions, the GM asymmetric features had the highest sensitivity (85.6 and 79.7%). Furthermore, relying on the highest sensitivity of GM and WM asymmetric features in frontal lobe, when integrated with the subregions results, our approach exhibited overlaps with GM asymmetric features (55.4 and 52.4%), as well as morphological asymmetric features (54.4 and 53.8%), both in the primary cohort and at the independent site. Significance This study demonstrates that a two-stage design based on the asymmetry of radiomic and morphological features can improve FCD detection. Specifically, incorporating regions of interest for GM, WM, GM, and WM, and the gray-white matter boundary significantly enhances the localization capabilities for lesion detection within the radiomics approach.
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Affiliation(s)
- Manli Zhang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Hao Yu
- Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Gongpeng Cao
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Jinguo Huang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yanzhu Lu
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Jing Zhang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Nana Liu
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Wenjing Zhang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yintao Cheng
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Guixia Kang
- Key Laboratory of Universal Wireless Communications, Ministry of Education, School of Information and Communication Engineering, Beijing University of Posts and Telecommunications, Beijing, China
| | - Lixin Cai
- Department of Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
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Becchetti A, Grandi LC, Cerina M, Amadeo A. Nicotinic acetylcholine receptors and epilepsy. Pharmacol Res 2023; 189:106698. [PMID: 36796465 DOI: 10.1016/j.phrs.2023.106698] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Despite recent advances in understanding the causes of epilepsy, especially the genetic, comprehending the biological mechanisms that lead to the epileptic phenotype remains difficult. A paradigmatic case is constituted by the epilepsies caused by altered neuronal nicotinic acetylcholine receptors (nAChRs), which exert complex physiological functions in mature as well as developing brain. The ascending cholinergic projections exert potent control of forebrain excitability, and wide evidence implicates nAChR dysregulation as both cause and effect of epileptiform activity. First, tonic-clonic seizures are triggered by administration of high doses of nicotinic agonists, whereas non-convulsive doses have kindling effects. Second, sleep-related epilepsy can be caused by mutations on genes encoding nAChR subunits widely expressed in the forebrain (CHRNA4, CHRNB2, CHRNA2). Third, in animal models of acquired epilepsy, complex time-dependent alterations in cholinergic innervation are observed following repeated seizures. Heteromeric nAChRs are central players in epileptogenesis. Evidence is wide for autosomal dominant sleep-related hypermotor epilepsy (ADSHE). Studies of ADSHE-linked nAChR subunits in expression systems suggest that the epileptogenic process is promoted by overactive receptors. Investigation in animal models of ADSHE indicates that expression of mutant nAChRs can lead to lifelong hyperexcitability by altering i) the function of GABAergic populations in the mature neocortex and thalamus, ii) synaptic architecture during synaptogenesis. Understanding the balance of the epileptogenic effects in adult and developing networks is essential to plan rational therapy at different ages. Combining this knowledge with a deeper understanding of the functional and pharmacological properties of individual mutations will advance precision and personalized medicine in nAChR-dependent epilepsy.
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Affiliation(s)
- Andrea Becchetti
- Department of Biotechnology and Biosciences, and NeuroMI (Milan Center of Neuroscience), University of Milano-Bicocca, Piazza della Scienza 2, Milano 20126, Italy.
| | - Laura Clara Grandi
- Department of Biotechnology and Biosciences, and NeuroMI (Milan Center of Neuroscience), University of Milano-Bicocca, Piazza della Scienza 2, Milano 20126, Italy.
| | - Marta Cerina
- Department of Biotechnology and Biosciences, and NeuroMI (Milan Center of Neuroscience), University of Milano-Bicocca, Piazza della Scienza 2, Milano 20126, Italy.
| | - Alida Amadeo
- Department of Biosciences, University of Milano, Via Celoria 26, Milano 20133, Italy.
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Wee RWS, Nash A, Angus-Leppan H. Deep phenotyping of frontal lobe epilepsy compared to other epilepsy syndromes. J Neurol 2023; 270:3072-3081. [PMID: 36847847 DOI: 10.1007/s00415-023-11639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
AIMS Frontal lobe epilepsy (FLE) is understudied and often misdiagnosed. We sought to comprehensively phenotype FLE and to differentiate FLE from other focal and generalised epilepsy syndromes. METHODS This was a retrospective, observational cohort study of 1078 cases of confirmed epilepsy in a tertiary neurology centre in London. Data sources were electronic health records, investigation reports and clinical letters. RESULTS 166 patients had FLE based on clinical findings and investigations-97 with identifiable electroencephalography (EEG) foci in frontal areas (definite FLE), while 69 had no frontal EEG foci (probable FLE). Apart from EEG findings, probable and definite FLE did not differ in other features. FLE was distinct from generalized epilepsy, which tended to present with tonic-clonic seizures and be due to genetic causes. FLE and temporal lobe epilepsy (TLE) both featured focal unaware seizures and underlying structural or metabolic aetiology. FLE, TLE and generalized epilepsy differed in their EEG (P = 0.0003) and MRI (P = 0.002) findings, where FLE had a higher rate of normal EEG and abnormal MRI findings compared to TLE. CONCLUSIONS EEG is often normal for FLE, and abnormalities are commonly identified with MRI. There was no difference in the clinical features of definite and probable FLE, suggesting they represent the same clinical entity. The diagnosis of FLE can be made even when scalp EEG is normal. This large medical cohort provides hallmark features of FLE that differentiate it from TLE and other epilepsy syndromes.
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Affiliation(s)
- Ryan W S Wee
- Barnet Hospital, London, UK.,Epilepsy Initiative Group, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK
| | - Adina Nash
- Epilepsy Initiative Group, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK
| | - Heather Angus-Leppan
- Epilepsy Initiative Group, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK. .,UCL Queen Square Institute of Neurology, London, UK.
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Meneghini S, Modena D, Colombo G, Coatti A, Milani N, Madaschi L, Amadeo A, Becchetti A. The β2V287L nicotinic subunit linked to sleep-related epilepsy differently affects fast-spiking and regular spiking somatostatin-expressing neurons in murine prefrontal cortex. Prog Neurobiol 2022; 214:102279. [DOI: 10.1016/j.pneurobio.2022.102279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
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Esteso Orduña B, Fournier Del Castillo MDLC, Cámara Barrio S, García Fernández M, Andrés Esteban EM, Álvarez-Linera Prado J, Budke M, Maldonado Belmonte MJ, González Marqués J, Pérez Jiménez MÁ. Cognitive and behavioral profiles of pediatric surgical candidates with frontal and temporal lobe epilepsy. Epilepsy Behav 2021; 117:107808. [PMID: 33640566 DOI: 10.1016/j.yebeh.2021.107808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to prospectively analyze memory and executive and social cognitive functioning in patients with drug-resistant frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE) with focal lesions and isolate the impact of intellectual ability on specific deficits. METHODS A neuropsychological evaluation was performed in 23 children with FLE, 22 children with TLE, and 36 healthy pediatric controls (HCs). Patients in the epilepsy groups had a range of lesions, including low-grade epilepsy-associated tumors (LEAT), focal cortical dysplasia (FCD) type II, and mesial temporal sclerosis (MS). RESULTS There were no significant differences between children with FLE and TLE regarding memory, executive, or social cognitive functioning. General Ability Index (GAI) was a predictor of memory, executive function, and social cognition scores and was influenced by age at onset, duration of epilepsy, and number of antiepileptic drugs (AEDs) prescribed at the time of assessment. Working Memory Index scores of patients with TLE, which measure verbal mnesic processing, were significantly lower than those of HCs and patients with TLE. The greatest differences in both clinical groups compared to HCs were recorded in cognitive executive functions, and patients with FLE had lower scores in this domain. Regarding behavioral executive functions, patients with TLE presented impaired emotional control and impulse inhibition and patients with FLE exhibited decreased flexibility. CONCLUSION Consistent with previous research, our findings provide further detailed evidence of small differences in cognitive performance among children with FLE and TLE. These differences emerge on analysis of the factors with which deficits are associated.
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Affiliation(s)
- Borja Esteso Orduña
- Clinical Neuropsychology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | | | - Silvia Cámara Barrio
- Clinical Neuropsychology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta García Fernández
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Marcelo Budke
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Javier González Marqués
- Cognitive Processes Department, Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - María Ángeles Pérez Jiménez
- Epilepsy Monitoring Unit, Clinical Neurophysiology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Yang S, Zhang Z, Chen H, Meng Y, Li J, Li Z, Xu Q, Zhang Q, Fan YS, Lu G, Liao W. Temporal variability profiling of the default mode across epilepsy subtypes. Epilepsia 2020; 62:61-73. [PMID: 33236791 DOI: 10.1111/epi.16759] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Epilepsies are a group of neurological disorders sharing certain core features, but also demonstrate remarkable pathogenic and symptomatic heterogeneities. Various subtypes of epilepsy have been identified with abnormal shift in the brain default mode network (DMN). This study aims to evaluate the fine details of shared and distinct alterations in the DMN among epileptic subtypes. METHODS We collected resting-state functional magnetic resonance imaging (MRI) data from a large epilepsy sample (n = 371) at a single center, including temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE), and genetic generalized epilepsy with generalized tonic-clonic seizures (GGE-GTCS), as well as healthy controls (HC, n = 150). We analyzed temporal dynamics profiling of the DMN, including edge-wise and node-wise temporal variabilities, and recurrent dynamic states of functional connectivity, to identify abnormalities common to epilepsies as well as those specific to each subtype. RESULTS The analyses revealed that hypervariable edges within the specific DMN subsystem were shared by all subtypes (all PNBS < .005), and deficits in node-wise temporal variability were prominent in TLE (all t(243) ≤ 2.51, PFDR < .05) and FLE (all t(302) ≤ -2.65, PFDR < .05) but relatively weak in GGE-GTCS. Moreover, dynamic states were generally less stable in patients than controls (all P's < .001). SIGNIFICANCE Collectively, these findings demonstrated general DMN abnormalities common to different epilepsies as well as distinct dysfunctions to subtypes, and provided insights into understanding the relationship of pathophysiological mechanisms and brain connectivity.
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Affiliation(s)
- Siqi Yang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Yao Meng
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiao Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Zehan Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Qirui Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Yun-Shuang Fan
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wei Liao
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
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Rémi J, Shen S, Tacke M, Probst P, Gerstl L, Peraud A, Kunz M, Vollmar C, Noachtar S, Borggraefe I. Congruence and Discrepancy of Interictal and Ictal EEG With MRI Lesions in Pediatric Epilepsies. Clin EEG Neurosci 2020; 51:412-419. [PMID: 32420750 PMCID: PMC7457449 DOI: 10.1177/1550059420921712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To evaluate the congruence or discrepancy of the localization of magnetic resonance imaging (MRI) lesions with interictal epileptiform discharges (IEDs) or epileptic seizure patterns (ESPs) in surface EEG in lesional pediatric epilepsy patients. Methods. We retrospectively analyzed presurgical MRI and video-EEG monitoring findings of patients up to age 18 years. Localization of MRI lesions were compared with ictal and interictal noninvasive EEG findings of patients with frontal, temporal, parietal, or occipital lesions. Results. A total of 71 patients were included. Localization of ESPs showed better congruence with MRI in patients with frontal lesions (n = 21, 77.5%) than in patients with temporal lesions (n = 24; 40.7%) (P = .009). No significant IED distribution differences between MRI localizations could be found. Conclusions. MRI lesions and EEG findings are rarely fully congruent. Congruence of MRI lesions and ESPs was highest in children with frontal lesions. This is in contrast to adults, in whom temporal lesions showed the highest congruency with the EEG localization of ESP. Lesional pediatric patients should be acknowledged as surgical candidates despite incongruent findings of interictal and ictal surface EEG.
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Affiliation(s)
- Jan Rémi
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Sophie Shen
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Moritz Tacke
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Philipp Probst
- Department of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
| | - Aurelia Peraud
- Department of Neurosurgery, Pediatric Section, University of Ulm, Ulm, Germany
| | - Mathias Kunz
- Department of Neurosurgery, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Soheyl Noachtar
- Department of Neurology, Ludwig Maximilians University (LMU) Munich, Klinikum Großhadern, Munich, Germany.,Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany
| | - Ingo Borggraefe
- Ludwig Maximilians University (LMU) Munich, Epilepsy Center, Munich, Germany.,Department of Pediatrics, Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Ludwig Maximilians University (LMU) Munich, Dr von Hauner Children's Hospital, Munich, Germany
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Boutzoukas EM, Crutcher J, Somoza E, Sepeta LN, You X, Gaillard WD, Wallace GL, Berl MM. Cortical thickness in childhood left focal epilepsy: Thinning beyond the seizure focus. Epilepsy Behav 2020; 102:106825. [PMID: 31816479 PMCID: PMC6962541 DOI: 10.1016/j.yebeh.2019.106825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Structural brain differences are found in adults and children with epilepsy, yet pediatric samples have been heterogeneous regarding seizure type, magnetic resonance imaging (MRI) findings, and hemisphere of seizure focus. This study examines whether cortical thickness and surface area differ between children with left-hemisphere focal epilepsy (LHE) and age-matched typically developing (TD) peers. We examined whether age differentially moderated cortical thickness between groups and if cortical thickness was associated with duration of epilepsy, seizure frequency, or neuropsychological functioning. METHODS Thirty-five children with LHE and 35 TD children completed neuropsychological testing and 3T MR imaging. Neuropsychological measures included general intelligence and executive functioning. All MRIs were normal. Surface-based morphometric processing and analyses were conducted using FreeSurfer 6.0. Regression analyses compared age by cortical thickness differences between groups. Correlational analyses examined associations between cortical thickness in these areas with neuropsychological functioning or epilepsy characteristics. RESULTS Left-hemisphere focal epilepsy displayed decreased cortical thickness bilaterally compared to TD controls across 6 brain regions but no differences in surface area. Moderation analyses revealed quadratic relationships between age and cortical thickness for left frontoparietal-cingulate and right superior frontal regions. Higher performance intelligence quotient (IQ) (PIQ) and verbal IQ (VIQ) and fewer parent reported executive function problems were associated with greater cortical thickness in TD children. SIGNIFICANCE Children with LHE displayed thinner cortex extending beyond the hemisphere of seizure focus. The nonlinear pattern of cortical thickness across age occurring in TD children is not evident in the same manner in children with LHE. These differences in cortical thickness patterns were greatest in children 8-12 years old. Greater cortical thickness was associated with higher IQ and fewer executive control problems in daily activities in TD children. Thus, differences in cortical thickness in the absence of differences in surface area, suggest cortical thickness may be a sensitive proxy of subtle neuroanatomical changes that are related to neuropsychological functioning.
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Affiliation(s)
- Emanuel M Boutzoukas
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA
| | - Jason Crutcher
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Eduardo Somoza
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA
| | - Leigh N Sepeta
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA
| | - Xiaozhen You
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics and Neurology, The George Washington University, Washington, DC, USA
| | - William D Gaillard
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics and Neurology, The George Washington University, Washington, DC, USA
| | - Gregory L Wallace
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA; Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC, USA
| | - Madison M Berl
- Comprehensive Pediatric Epilepsy Program, Children's National Medical Center, Washington, DC, USA; Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA.
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Rahatli FK, Sezer T, Has AC, Agildere AM. Evaluation of cortical thickness and brain volume on 3 Tesla magnetic resonance imaging in children with frontal lobe epilepsy. Neurol Sci 2019; 41:825-833. [DOI: 10.1007/s10072-019-04135-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
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Oyegbile TO. The role of task-based neural activation research in understanding cognitive deficits in pediatric epilepsy. Epilepsy Behav 2019; 99:106332. [PMID: 31399340 DOI: 10.1016/j.yebeh.2019.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 11/29/2022]
Abstract
Children with epilepsy can experience significant cognitive dysfunction that can lead to academic underachievement. Traditionally believed to be primarily due to the effects of factors such as the chronicity of epilepsy, medication effects, or the location of the primary epileptogenic lesion;, recent evidence has indicated that disruption of cognition-specific distributed neural networks may play a significant role as well. Specifically, over the last decade, researchers have begun to characterize the mechanisms underlying disrupted cognitive substrates by evaluating neural network abnormalities observed during specific cognitive tasks, using task-based functional magnetic resonance imaging (fMRI). This targeted review assesses the current literature investigating the relationship between neural network abnormalities and cognitive deficits in pediatric epilepsy. The findings indicate that there are indeed neural network abnormalities associated with deficits in executive function, language, processing speed, and memory. Overall, cognitive dysfunction in pediatric epilepsy is associated with a decrease in neural network activation/deactivation as well as increased recruitment of brain regions not typically related to the specific cognitive task under investigation. The research to date has focused primarily on children with focal epilepsy syndromes with small sample sizes and differing research protocols. More extensive research in children with a wider representation of epilepsy syndromes (including generalized epilepsy syndromes) is necessary to fully understand these relationships and begin to identify underlying cognitive phenotypes that may account for the variability observed across children with epilepsy. Furthermore, more uniformity in fMRI protocols and neuropsychological tasks would be ideal to advance this literature.
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Affiliation(s)
- Temitayo O Oyegbile
- Georgetown University Medical Center, Washington, D.C., United States of America.
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Klugah-Brown B, Luo C, Peng R, He H, Li J, Dong L, Yao D. Altered structural and causal connectivity in frontal lobe epilepsy. BMC Neurol 2019; 19:70. [PMID: 31023252 PMCID: PMC6485093 DOI: 10.1186/s12883-019-1300-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/11/2019] [Indexed: 01/09/2023] Open
Abstract
Background Albeit the few resting-state fMRI neuroimaging studies in frontal lobe epilepsy (FLE) patients, these studies focused on functional connectivity. The aim of this current study was to examine the effective connectivity based on voxel-based morphometry in FLE patients. Methods Resting-state structural and functional magnetic resonance imaging (fMRI) data were acquired from 19 FLE patients and 19 age and gender-matched healthy controls using the 3.0 Tesla magnetic resonance imaging (3.0 T MRI). The investigations were done by acquiring the structural information through voxel-based morphometry, then based on the seed obtained, Granger causality analysis was used to evaluate the causal flow of the designated seed to and from other significant voxels. Results Our results showed altered structural and effective connectivity. Compared with healthy controls, FLE patients showed reduced grey matter volume in bilateral putamen and right caudate as well as altered causality with increased, and decreased causal outflow from the right caudate (seed region) to inferior frontal gyrus-triangular, from bilateral putamen (seed regions) to right middle frontal gyrus and frontal gyrus medial-orbital representing the frontal executive areas, respectively. Also, significantly increased and decreased inflow from left calcarine to right caudate and from cerebellum_6 and vermis_6 to bilateral putamen, respectively. Moreover, we found that the causal alterations to and from the seed regions (from vermis_6 to right putamen and from left putamen to right middle frontal gyrus) negatively correlated with clinical scores (duration of epilepsy). Conclusions The findings point to the impairment within the executive and motor-controlled system including the cerebellum, frontal, caudate and putamen regions in FLE patients. These results would therefore enhance our understanding of structural and effective mechanisms in FLE.
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Affiliation(s)
- Benjamin Klugah-Brown
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, People's Republic of China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, People's Republic of China.
| | - Rui Peng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, People's Republic of China
| | - Hui He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, People's Republic of China
| | - Jianfu Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, People's Republic of China
| | - Li Dong
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, People's Republic of China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, People's Republic of China
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Abstract
Electroencephalographic (EEG) investigations are crucial in the diagnosis and management of patients with focal epilepsies. EEG may reveal different interictal epileptiform discharges (IEDs: abnormal spikes, sharp waves). The EEG visibility of a spike depends on the surface area of cortex involved (>10cm2) and the brain localization of cortical generators. Regions generating IEDs (defining the "irritative zone") are not necessarily equivalent to the seizure onset zone. Focal seizures are dynamic processes originating from one or several brain regions (that generate fast oscillations and are called the epileptogenic zone) before spreading to other structures (that generate lower frequency oscillations and are called the propagation zone). Several factors limit the expression of seizures on scalp EEG, such as the area involved, degree of synchronization, and depth of the cortical generators. Different scalp EEG seizure onset patterns may be observed: fast discharge, background flattening, rhythmic spikes, sinusoidal discharge, or sharp activity. However, to a large extent EEG changes are linked to seizure propagation. Finally, in the context of presurgical evaluation, the combination of interictal and ictal EEG features is crucial to provide an optimal hypothesis concerning the epileptogenic zone.
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Affiliation(s)
- Stanislas Lagarde
- Institut de Neurosciences des Systèmes, Aix Marseille Université, Marseille, France; Department of Clinical Neurophysiology, Timone Hospital, Marseille, France
| | - Fabrice Bartolomei
- Institut de Neurosciences des Systèmes, Aix Marseille Université, Marseille, France; Department of Clinical Neurophysiology, Timone Hospital, Marseille, France.
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Wu Q, Zhao CW, Long Z, Xiao B, Feng L. Anatomy Based Networks and Topology Alteration in Seizure-Related Cognitive Outcomes. Front Neuroanat 2018; 12:25. [PMID: 29681801 PMCID: PMC5898178 DOI: 10.3389/fnana.2018.00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/20/2018] [Indexed: 01/19/2023] Open
Abstract
Epilepsy is a paroxysmal neurological disorder characterized by recurrent and unprovoked seizures affecting approximately 50 million people worldwide. Cognitive dysfunction induced by seizures is a severe comorbidity of epilepsy and epilepsy syndromes and reduces patients’ quality of life. Seizures, along with accompanying histopathological and pathophysiological changes, are associated with cognitive comorbidities. Advances in imaging technology and computing allow anatomical and topological changes in neural networks to be visualized. Anatomical components including the hippocampus, amygdala, cortex, corpus callosum (CC), cerebellum and white matter (WM) are the fundamental components of seizure- and cognition-related topological networks. Damage to these structures and their substructures results in worsening of epilepsy symptoms and cognitive dysfunction. In this review article, we survey structural, network changes and topological alteration in different regions of the brain and in different epilepsy and epileptic syndromes, and discuss what these changes may mean for cognitive outcomes related to these disease states.
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Affiliation(s)
- Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Charlie W Zhao
- Department of Neuroscience, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Zhe Long
- Sydney Medical School and the Brain & Mind Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
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15
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Smith ML. Rethinking cognition and behavior in the new classification for childhood epilepsy: Examples from frontal lobe and temporal lobe epilepsies. Epilepsy Behav 2016; 64:313-317. [PMID: 27346387 DOI: 10.1016/j.yebeh.2016.04.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
The new approach to classification of the epilepsies emphasizes the role of dysfunction in networks in defining types of epilepsies. This paper reviews the structural and neuropsychological deficits in two types of childhood epilepsy: frontal lobe and temporal lobe epilepsy. The evidence for and against a pattern of specificity of deficits in executive function and memory associated with these two types of epilepsies is presented. The evidence varies with the methodologies used in the studies, but direct comparison of the two types of epilepsies does not suggest a clear-cut mapping of function onto structure. These findings are discussed in light of the concept of network dysfunction. The evidence supports the conceptualization of epilepsy as a network disease. Implications for future work in the neuropsychology of pediatric epilepsy are suggested. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".
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Affiliation(s)
- Mary Lou Smith
- University of Toronto Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada; The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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16
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Hong SJ, Bernhardt BC, Schrader DS, Bernasconi N, Bernasconi A. Whole-brain MRI phenotyping in dysplasia-related frontal lobe epilepsy. Neurology 2016; 86:643-50. [PMID: 26764030 DOI: 10.1212/wnl.0000000000002374] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/03/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To perform whole-brain morphometry in patients with frontal lobe epilepsy and evaluate the utility of group-level patterns for individualized diagnosis and prognosis. METHODS We compared MRI-based cortical thickness and folding complexity between 2 frontal lobe epilepsy cohorts with histologically verified focal cortical dysplasia (FCD) (13 type I; 28 type II) and 41 closely matched controls. Pattern learning algorithms evaluated the utility of group-level findings to predict histologic FCD subtype, the side of the seizure focus, and postsurgical seizure outcome in single individuals. RESULTS Relative to controls, FCD type I displayed multilobar cortical thinning that was most marked in ipsilateral frontal cortices. Conversely, type II showed thickening in temporal and postcentral cortices. Cortical folding also diverged, with increased complexity in prefrontal cortices in type I and decreases in type II. Group-level findings successfully guided automated FCD subtype classification (type I: 100%; type II: 96%), seizure focus lateralization (type I: 92%; type II: 86%), and outcome prediction (type I: 92%; type II: 82%). CONCLUSION FCD subtypes relate to diverse whole-brain structural phenotypes. While cortical thickening in type II may indicate delayed pruning, a thin cortex in type I likely results from combined effects of seizure excitotoxicity and the primary malformation. Group-level patterns have a high translational value in guiding individualized diagnostics.
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Affiliation(s)
- Seok-Jun Hong
- From the Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Boris C Bernhardt
- From the Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Dewi S Schrader
- From the Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada.
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Gray and White Matter Volumes and Cognitive Dysfunction in Drug-Naïve Newly Diagnosed Pediatric Epilepsy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:923861. [PMID: 26417604 PMCID: PMC4568349 DOI: 10.1155/2015/923861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 04/20/2015] [Accepted: 06/21/2015] [Indexed: 12/02/2022]
Abstract
Epilepsy patients often have cognitive dysfunction even at early stages of disease. We investigated the relationship between structural findings and neuropsychological status in drug-naïve newly diagnosed pediatric epilepsy patients. Thirty newly diagnosed pediatric epilepsy patients and 25 healthy control subjects aged 7~16 years were enrolled, who were assessed by the Korean version of the Wechsler Intelligence Scale for Children (K-WISC-III), the Stroop test, and the trail making test (TMT). Optimized voxel-based morphometry (VBM) was performed for both Gray Matter (GM) and White Matter (WM) volumes. Lower performance levels of verbal intelligence quotient, freedom from distractibility, and executive function were observed in epilepsy group. Interestingly, poor performance in these cognitive subdomains was correlated with regional VBM findings involving both GM and WM volumes, but with different patterns between groups. GM volumes revealed clear differences predominantly in the bilateral frontal regions. These findings indicate that certain cognitive functions may be affected in the early stage of epilepsy, not related to the long-standing epilepsy or medication, but more related to the neurocognitive developmental process in this age. Epilepsy can lead to neuroanatomical alterations in both GM and WM, which may affect cognitive functions, during early stages even before commencement of AED medication.
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18
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Wang Y, Liu B, Fu L, Cui Z. Use of interictal (18)F-fluorodeoxyglucose (FDG)-PET and magnetoencephalography (MEG) to localize epileptogenic foci in non-lesional epilepsy in a cohort of 16 patients. J Neurol Sci 2015; 355:120-4. [PMID: 26066558 DOI: 10.1016/j.jns.2015.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/28/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
We assessed the efficacy of interictal 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and magnetoencephalography (MEG) for localizing the epileptogenic foci in a small cohort of patients with non-lesional epilepsy. Sixteen patients, aged 8-32 years, with non-lesional epilepsy underwent MRI, continuous scalp video-electroencephalography (EEG) monitoring, interictal (FDG)-PET and MEG at our institution. Each patient subsequently underwent intracranial grid placement. The data from the intracranial grids was correlated with the previous studies to determine the efficacy of FDG-PET and MEG in localizing the epileptogenic zone. Of the 16 patients, the epileptogenic zone was accurately localized in 8 (50%) using FDG-PET and in 12 patients (75%) using MEG. Of the 11 patients with a temporal hypometabolism, only 4 were ultimately confirmed as temporal lobe epilepsy via intracranial grids and 2 additional patients were found to have extra-temporal lobe epilepsy. Compared to interictal FDG-PET, MEG appears to be more sensitive to detection of the epileptogenic zone in this small cohort of non-lesional epilepsy patients though provided more diffuse foci. Our findings can help in determining the surgical eligibility of a patient especially when MRI or video-EEG monitoring are non-localizing, and can help with placement of subdural grids and strips for EEG studies.
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Affiliation(s)
- Yuchun Wang
- Department of Neurosurgery, The Oilfield General Hospital of Daqing, Daqing 163001, China.
| | - Bo Liu
- Department of Neurosurgery, The Oilfield General Hospital of Daqing, Daqing 163001, China.
| | - Liqi Fu
- Department of Neurosurgery, The Oilfield General Hospital of Daqing, Daqing 163001, China.
| | - Zhiqiang Cui
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China.
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19
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Widjaja E, Zamyadi M, Raybaud C, Snead OC, Doesburg SM, Smith ML. Disrupted Global and Regional Structural Networks and Subnetworks in Children with Localization-Related Epilepsy. AJNR Am J Neuroradiol 2015; 36:1362-8. [PMID: 25742984 DOI: 10.3174/ajnr.a4265] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/02/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Structural connectivity has been thought to be a less sensitive measure of network changes relative to functional connectivity in children with localization-related epilepsy. The aims of this study were to investigate the structural networks in children with localization-related epilepsy and to assess the relation among structural connectivity, intelligence quotient, and clinical parameters. MATERIALS AND METHODS Forty-five children with nonlesional localization-related epilepsy and 28 healthy controls underwent DTI. Global network (network strength, clustering coefficient, characteristic path length, global efficiency, and small-world parameters), regional network (nodal efficiency), and the network-based statistic were compared between patients and controls and correlated with intelligence quotient and clinical parameters. RESULTS Patients showed disrupted global network connectivity relative to controls, including reduced network strength, increased characteristic path length and reduced global efficiency, and reduced nodal efficiency in the frontal, temporal, and occipital lobes. Connectivity in multiple subnetworks was reduced in patients, including the frontal-temporal, insula-temporal, temporal-temporal, frontal-occipital, and temporal-occipital lobes. The frontal lobe epilepsy subgroup demonstrated more areas with reduced nodal efficiency and more impaired subnetworks than the temporal lobe epilepsy subgroup. Network parameters were not significantly associated with intelligence quotient, age at seizure onset, or duration of epilepsy. CONCLUSIONS We found disruption in global and regional networks and subnetworks in children with localization-related epilepsy. Regional efficiency and subnetworks were more impaired in frontal lobe epilepsy than in temporal lobe epilepsy. Future studies are needed to evaluate the implications of disrupted networks for surgical resection and outcomes for specific epileptogenic zones and the relation of disrupted networks to more complex cognitive function.
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Affiliation(s)
- E Widjaja
- From the Department of Diagnostic Imaging (E.W., M.Z., C.R., S.M.D.) Division of Neurology (E.W., O.C.S.)
| | - M Zamyadi
- From the Department of Diagnostic Imaging (E.W., M.Z., C.R., S.M.D.)
| | - C Raybaud
- From the Department of Diagnostic Imaging (E.W., M.Z., C.R., S.M.D.)
| | - O C Snead
- Division of Neurology (E.W., O.C.S.)
| | - S M Doesburg
- From the Department of Diagnostic Imaging (E.W., M.Z., C.R., S.M.D.) Neuroscience and Mental Health at Research Institute (S.M.D.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - M L Smith
- Department of Psychology (M.L.S.), University of Toronto, Toronto, Ontario, Canada
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20
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Kim EH, Yum MS, Shim WH, Yoon HK, Lee YJ, Ko TS. Structural abnormalities in benign childhood epilepsy with centrotemporal spikes (BCECTS). Seizure 2015; 27:40-6. [DOI: 10.1016/j.seizure.2015.02.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/05/2014] [Accepted: 02/24/2015] [Indexed: 01/25/2023] Open
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Centeno M, Vollmar C, Stretton J, Symms MR, Thompson PJ, Richardson MP, O'Muircheartaigh J, Duncan JS, Koepp MJ. Structural changes in the temporal lobe and piriform cortex in frontal lobe epilepsy. Epilepsy Res 2014; 108:978-81. [PMID: 24726451 PMCID: PMC4037873 DOI: 10.1016/j.eplepsyres.2014.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 01/31/2014] [Accepted: 03/10/2014] [Indexed: 11/05/2022]
Abstract
Voxelwise analysis of structural images is performed in a group of patients with FLE. Structural abnormalities are found in piriform cortex and adjacent structures including amygdala. These common areas of structural abnormality are seen independently of the side of seizure focus lateralisation. This is concordant with previous findings in functional imaging analysis of patients with focal epilepsy.
Background Neuronal networks involved in seizure generation, maintenance and spread of epileptic activity comprise cortico-subcortical circuits. Although epileptic foci vary in location across focal epilepsy syndromes, there is evidence for common structures in the epileptogenic networks. We recently reported evidence from functional neuroimaging for a unique area in the piriform cortex, common to focal epilepsies in humans, which might play a role in modulating seizure activity. In this study, we aimed to identify common areas of structural abnormalities in patients with frontal lobe epilepsy (FLE). Methods T1-weighted MRI scans of 43 FLE patients and 25 healthy controls were analysed using voxel based morphometry. Differences in regional grey matter volume were examined across the whole brain, and correlated with age at epilepsy onset, duration and frequency of seizures. Results We detected areas of increased grey matter volume in the piriform cortex, amygdala and parahippocampal gyrus bilaterally, as well as left mid temporal gyrus of patients relative to controls, which did not correlate with any of the clinical variables tested. No common areas of atrophy were detected across the FLE group. Conclusions Structural abnormalities within the piriform cortex and adjacent structures of patients with FLE provide further evidence for the involvement of this area in the epileptogenic network of focal epilepsies. Lack of correlation with duration or age of onset of epilepsy suggests that this area of abnormality is not a consequence of seizure activity.
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Affiliation(s)
- M Centeno
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, NSE MRI Unit, National Society for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Neurology Department, Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Paseo Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - C Vollmar
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, NSE MRI Unit, National Society for Epilepsy, Chalfont St Peter SL9 0RJ, UK; Epilepsy Centre, Department of Neurology, University of Munich, Germany
| | - J Stretton
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, NSE MRI Unit, National Society for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - M R Symms
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, NSE MRI Unit, National Society for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - P J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, NSE MRI Unit, National Society for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - M P Richardson
- Department of Clinical Neuroscience, Institute of Psychiatry, King's College, De Crespigny Park, London SE5 8AF, UK
| | - J O'Muircheartaigh
- Department of Clinical Neuroscience, Institute of Psychiatry, King's College, De Crespigny Park, London SE5 8AF, UK
| | - J S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, NSE MRI Unit, National Society for Epilepsy, Chalfont St Peter SL9 0RJ, UK
| | - M J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, NSE MRI Unit, National Society for Epilepsy, Chalfont St Peter SL9 0RJ, UK.
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22
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Bilateral white matter abnormality in children with frontal lobe epilepsy. Epilepsy Res 2013; 108:289-94. [PMID: 24380759 DOI: 10.1016/j.eplepsyres.2013.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/29/2013] [Accepted: 12/05/2013] [Indexed: 11/22/2022]
Abstract
In frontal lobe epilepsy (FLE), interictal discharges and seizures are more likely to spread to contralateral hemisphere and become secondarily generalized. The aim of this study was to assess white matter (WM) integrity in children with FLE using diffusion tensor imaging (DTI). Children with FLE and normal MRI, and healthy controls with no neurological or psychiatric disorders underwent DTI on 3T MRI. Whole brain fractional anisotropy (FA) and mean diffusivity (MD) maps were compared between right and left FLE with controls. 43 children with FLE, consisting of 28 left and 15 right FLE, and 44 healthy controls were recruited. Patients with left FLE had significant FA reductions in left (p=0.002) and right (p=0.003 and p=0.034) superior longitudinal fasciculi (SLF), genu/body (p=0.0002) and splenium (p=0.011) of corpus callosum. Patients with right FLE had significant FA reductions in left (p=0.016) and right (p=0.033) SLF, genu (p=0.001) and body of corpus callosum (p=0.001 and p=0.008), and significant MD elevation in right thalamus (p=0.032). There was no significant association between FA or MD and clinical seizure parameters. The abnormal WM both ipsilateral and contralateral to seizure focus may be due to seizure activity or abnormal brain development.
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Widjaja E, Zamyadi M, Raybaud C, Snead OC, Smith ML. Abnormal functional network connectivity among resting-state networks in children with frontal lobe epilepsy. AJNR Am J Neuroradiol 2013; 34:2386-92. [PMID: 23868148 DOI: 10.3174/ajnr.a3608] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Epilepsy is considered a disorder of neural networks. The aims of this study were to assess functional connectivity within resting-state networks and functional network connectivity across resting-state networks by use of resting-state fMRI in children with frontal lobe epilepsy and to relate changes in resting-state networks with neuropsychological function. MATERIALS AND METHODS Fifteen patients with frontal lobe epilepsy and normal MR imaging and 14 healthy control subjects were recruited. Spatial independent component analysis was used to identify the resting-state networks, including frontal, attention, default mode network, sensorimotor, visual, and auditory networks. The Z-maps of resting-state networks were compared between patients and control subjects. The relation between abnormal connectivity and neuropsychological function was assessed. Correlations from all pair-wise combinations of independent components were performed for each group and compared between groups. RESULTS The frontal network was the only network that showed reduced connectivity in patients relative to control subjects. The remaining 5 networks demonstrated both reduced and increased functional connectivity within resting-state networks in patients. There was a weak association between connectivity in frontal network and executive function (P = .029) and a significant association between sensorimotor network and fine motor function (P = .004). Control subjects had 79 pair-wise independent components that showed significant temporal coherence across all resting-state networks except for default mode network-auditory network. Patients had 66 pairs of independent components that showed significant temporal coherence across all resting-state networks. Group comparison showed reduced functional network connectivity between default mode network-attention, frontal-sensorimotor, and frontal-visual networks and increased functional network connectivity between frontal-attention, default mode network-sensorimotor, and frontal-visual networks in patients relative to control subjects. CONCLUSIONS We found abnormal functional connectivity within and across resting-state networks in children with frontal lobe epilepsy. Impairment in functional connectivity was associated with impaired neuropsychological function.
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Abstract
Dorsolateral frontal lobe seizures often present as a diagnostic challenge. The diverse semiologies may not produce lateralizing or localizing signs and can appear bizarre and suggest psychogenic events. Unfortunately, scalp electroencephalographic (EEG) and magnetic resonance imaging (MRI) are often unsatisfactory. It is not uncommon that these traditional diagnostic studies are either unhelpful or even misleading. In some cases, SPECT and positron emission tomography imaging can be an effective tool to identify the origin of seizures. However, these techniques and other emerging techniques all have limitations, and new approaches are needed to improve source localization.
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Affiliation(s)
- Ricky W Lee
- Department of Neurology, Division of Clinical Neurophysiology, Mayo Clinic, Rochester, MN, USA
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Vachhrajani S, de Ribaupierre S, Otsubo H, Ochi A, Weiss SK, Donner EJ, Widjaja E, Kerr E, Smith ML, Drake J, Snead C, Rutka JT. Neurosurgical management of frontal lobe epilepsy in children. J Neurosurg Pediatr 2012; 10:206-16. [PMID: 22838737 DOI: 10.3171/2012.6.peds11125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECT Pediatric frontal lobe epilepsy (FLE) remains a challenging condition for neurosurgeons and epileptologists to manage. Postoperative seizure outcomes remain far inferior to those observed in temporal lobe epilepsies, possibly due to inherent difficulties in delineating and subsequently completely resecting responsible epileptogenic regions. In this study, the authors review their institutional experience with the surgical management of FLE and attempt to find predictors that may help to improve seizure outcome in this population. METHODS All surgically treated cases of intractable FLE from 1990 to 2008 were reviewed. Demographic information, preoperative and intraoperative imaging and electrophysiological investigations, and follow-up seizure outcome were assessed. Inferential statistics were performed to look for potential predictors of seizure outcome. RESULTS Forty patients (20 male, 20 female) underwent surgical management of FLE during the study period. Patients were an average of 5.6 years old at the time of FLE onset and 11.7 years at the time of surgery; patients were followed for a mean of 40.25 months. Most patients displayed typical FLE semiology. Twenty-eight patients had discrete lesions identified on MRI. Eight patients underwent 2 operations. Cortical dysplasia was the most common pathological diagnosis. Engel Class I outcome was obtained in 25 patients (62.5%), while Engel Class II outcome was observed in 5 patients (12.5%). No statistically significant predictors of outcome were found. CONCLUSIONS Control of FLE remains a challenging problem. Favorable seizure outcome, obtained in 62% of patients in this series, is still not as easily obtained in FLE as it is in temporal lobe epilepsy. While no statistically significant predictors of seizure outcome were revealed in this study, patients with FLE continue to require extensive workup and investigation to arrive at a logical and comprehensive neurosurgical treatment plan. Future studies with improved neuroimaging and advanced invasive monitoring strategies may well help define factors for success in this form of epilepsy that is difficult to control.
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Affiliation(s)
- Shobhan Vachhrajani
- Divisions of Pediatric Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
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Vaessen MJ, Braakman HMH, Heerink JS, Jansen JFA, Debeij-van Hall MHJA, Hofman PAM, Aldenkamp AP, Backes WH. Abnormal modular organization of functional networks in cognitively impaired children with frontal lobe epilepsy. ACTA ACUST UNITED AC 2012; 23:1997-2006. [PMID: 22772649 DOI: 10.1093/cercor/bhs186] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Many children with frontal lobe epilepsy (FLE) have significant cognitive comorbidity, for which the underlying mechanism has not yet been unraveled, but is likely related to disturbed cerebral network integrity. Using resting-state fMRI, we investigated whether cerebral network characteristics are associated with epilepsy and cognitive comorbidity. We included 37 children with FLE and 41 healthy age-matched controls. Cognitive performance was determined by means of a computerized visual searching task. A connectivity matrix for 82 cortical and subcortical brain regions was generated for each subject by calculating the inter-regional correlation of the fMRI time signals. From the connectivity matrix, graph metrics were calculated and the anatomical configuration of aberrant connections and modular organization was investigated. Both patients and controls displayed efficiently organized networks. However, FLE patients displayed a higher modularity, implying that subnetworks are less interconnected. Impaired cognition was associated with higher modularity scores and abnormal modular organization of the brain, which was mainly expressed as a decrease in long-range and an increase in interhemispheric connectivity in patients. We showed that network modularity analysis provides a sensitive marker for cognitive impairment in FLE and suggest that abnormally interconnected functional subnetworks of the brain might underlie the cognitive problems in children with FLE.
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Affiliation(s)
- M J Vaessen
- Department of Radiology, Maastricht University Medical Centre, Maastricht 6202 AZ, The Netherlands
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Wu XT, Rampp S, Hopfengärtner R, Buchfelder M, Zhou D, Stefan H. Complementary use of video-electroencephalography and magnetoencephalography in frontal lobe epilepsy. Seizure 2012; 21:426-30. [DOI: 10.1016/j.seizure.2012.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/19/2012] [Accepted: 04/20/2012] [Indexed: 11/28/2022] Open
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Widjaja E, Zarei Mahmoodabadi S, Go C, Raybaud C, Chuang S, Snead OC, Smith ML. Reduced cortical thickness in children with new-onset seizures. AJNR Am J Neuroradiol 2012; 33:673-7. [PMID: 22282450 DOI: 10.3174/ajnr.a2982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Children with new-onset seizures may have antecedent neurobiologic alterations that predispose them to developing seizures. Our aim was to evaluate hippocampal and thalamic volumes and lobar cortical thickness of children with new-onset seizures. MATERIALS AND METHODS Twenty-nine children with new-onset seizures and normal MR imaging findings were recruited. Ten patients had generalized seizures, 19 had partial seizures, and 15 were on antiepileptic medications. Twenty-three age-matched healthy controls were also recruited. Hippocampal and thalamic volumes and lobar cortical thickness, including frontal, medial temporal, lateral temporal, parietal, cingulate, and occipital cortical thickness, were assessed by using volumetric T1-weighted imaging and were compared between patients and controls. RESULTS There were no significant differences in hippocampal and thalamic volumes of patients with new-onset seizures, including the subgroups with generalized and partial seizures and those on and off antiepileptic medications, compared with controls (P > .01). There was significant reduction in cortical thickness in right cingulate (P = .004), right medial temporal (P = .006), and left frontal (P = .007) cortices in patients with new-onset seizures. Patients with generalized seizures did not demonstrate a significant reduction in cortical thickness (P > .01). Patients with partial seizures demonstrated a significant reduction in cortical thickness in the right frontal (P = .008), right parietal (P = .003), and left frontal (P = .007) cortices. There were no significant differences in cortical thickness among patients on or off antiepileptic medications (P > .01). CONCLUSIONS We found reduced cortical thickness in children with new-onset seizures. Further studies are necessary to elucidate the neurobiologic relevance of these structural changes.
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Affiliation(s)
- E Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
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Affiliation(s)
- Sebastian Bauer
- Department of Neurology, UKGM Marburg, Philipps University, Marburg, Germany.
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Hu Y, Jiang L, Yang Z. Video-EEG monitoring differences in children with frontal and temporal onset seizures. Int J Neurosci 2011; 122:92-101. [PMID: 21985561 DOI: 10.3109/00207454.2011.630545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to explore the clinical manifestations and electroencephalogram (EEG) features in children with frontal and temporal onset seizures. The method used was video-EEG monitoring that was conducted for 24 h in children with seizure disorders. The results were as follows: There were fewer children with temporal EEG onset seizure (TOS) than with frontal EEG onset seizure (FOS) (p = 0.132). Within the TOS category, PTOS was most frequent, and ATOS was rare (p = 0.001). The mean duration of ATOS was longer than that of TOS and PTOS (p < 0.05). There were no significant differences in seizure frequency and nocturnal attacks between children with TOS and children with FOS. Furthermore, we observed the interictal EEG from three aspects: the background, the location of discharges, and the time of discharges. The frequency of the multi-focal and bilateral discharges of FOS was higher than that of TOS (p < 0.01). The FOS discharged easily and quickly spread to the bilateral hemisphere and formed secondary bilateral synchrony. Focal discharges predominated in TOS, and rarely showed the paroxysm of bilateral synchronous rhythm. Bursts of fast rhythms predominated in the onset of TOS. In contrast, there were a variety of ictal EEG in FOS. Finally, it was concluded that in the group of children studied, the clinical and EEG characteristics of TOS were different from those of FOS.
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Affiliation(s)
- Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, China, 400014
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Nishimura M, Gu X, Swann JW. Seizures in early life suppress hippocampal dendrite growth while impairing spatial learning. Neurobiol Dis 2011; 44:205-14. [PMID: 21777677 PMCID: PMC3167037 DOI: 10.1016/j.nbd.2011.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/27/2011] [Accepted: 07/01/2011] [Indexed: 11/21/2022] Open
Abstract
Impaired learning and memory are common in epilepsy syndromes of childhood. Clinical investigations suggest that the developing brain may be particularly vulnerable to the effects of intractable seizure disorders. Magnetic resonance imaging (MRI) studies have demonstrated reduced volumes in brain regions involved in learning and memory. The earlier the onset of an epilepsy the larger the effects seem to be on both brain anatomy and cognition. Thus, childhood epilepsy has been proposed to interfere in some unknown way with brain development. Experiments reported here explore these ideas by examining the effects of seizures in infant mice on learning and memory and on the growth of CA1 hippocampal pyramidal cell dendrites. Fifteen brief seizures were induced by flurothyl between postnatal days 7 and 11 in mice that express green fluorescent protein (GFP) in hippocampal pyramidal cells. One to 44days later, dendritic arbors were reconstructed to measure growth. Spatial learning and memory were also assessed in a water maze. Our results show that recurrent seizures produced marked deficits in learning and memory. Seizures also dramatically slowed the growth of basilar dendrites while neurons in littermate control mice continued to add new dendritic branches and lengthen existing branches. When experiments were performed in older mice, seizures had no measureable effects on either dendrite arbor complexity or spatial learning and memory. Our results suggest that the recurring seizures of intractable childhood epilepsy contribute to associated learning and memory deficits by suppressing dendrite growth.
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Affiliation(s)
- Masataka Nishimura
- The Cain Foundation Laboratories The Jan and Dan Duncan Neurological Research Institute Departments of Pediatrics Baylor College of Medicine Houston TX 77030
| | - Xue Gu
- The Cain Foundation Laboratories The Jan and Dan Duncan Neurological Research Institute Departments of Pediatrics Baylor College of Medicine Houston TX 77030
| | - John W. Swann
- The Cain Foundation Laboratories The Jan and Dan Duncan Neurological Research Institute Departments of Pediatrics Baylor College of Medicine Houston TX 77030
- Neuroscience Baylor College of Medicine Houston TX 77030
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Widjaja E, Mahmoodabadi SZ, Snead OC, Almehdar A, Smith ML. Widespread cortical thinning in children with frontal lobe epilepsy. Epilepsia 2011; 52:1685-91. [PMID: 21627647 DOI: 10.1111/j.1528-1167.2011.03085.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elysa Widjaja
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
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Braakman HMH, Vaessen MJ, Hofman PAM, Debeij-van Hall MHJA, Backes WH, Vles JSH, Aldenkamp AP. Cognitive and behavioral complications of frontal lobe epilepsy in children: a review of the literature. Epilepsia 2011; 52:849-56. [PMID: 21480882 DOI: 10.1111/j.1528-1167.2011.03057.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Frontal lobe epilepsy (FLE) is considered the second most common type of the localization-related epilepsies of childhood. Still, the etiology of FLE in children, its impact on cognitive functioning and behavior, as well as the response to antiepileptic drug treatment in children has not been sufficiently studied. This review focuses on these aspects of FLE in childhood, and reveals that FLE in childhood is most often cryptogenic, and impacts on a broad range of cognitive functions. The nature and severity of cognitive deficits are highly variable, although impaired attention and executive functions are most frequent. Young age at seizure onset is the only potential risk factor for poor cognitive outcome that has been consistently reported. The behavioral disturbances associated with FLE are also highly variable, although attention deficit/hyperactivity disorder seems most frequent. In 40% of children with FLE satisfactory seizure control could not be achieved. This is a higher percentage than reported for the general population of children with epilepsy. Therefore, pediatric FLE, even if cryptogenic in nature, is frequently complicated by impairment of cognitive function, behavioral disturbances, and therapy-resistance. Given the impact of these complications, there is a need for studies of the etiology of frontal lobe epilepsy-associated cognitive and behavioral disturbances, as well as pharmacotherapy-resistance.
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Affiliation(s)
- Hilde M H Braakman
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Oyegbile TO, Bayless K, Dabbs K, Jones J, Rutecki P, Pierson R, Seidenberg M, Hermann B. The nature and extent of cerebellar atrophy in chronic temporal lobe epilepsy. Epilepsia 2011; 52:698-706. [PMID: 21269292 DOI: 10.1111/j.1528-1167.2010.02937.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Research indicates that patients with chronic temporal lobe epilepsy (TLE) exhibit cerebellar atrophy compared to healthy controls, but the degree to which specific regions of the cerebellum are affected remains unclear. The purpose of this study was to characterize the extent and lateralization of atrophy in individual cerebellar lobes and subregions in unilateral TLE using advanced quantitative magnetic resonance imaging (MRI) techniques. METHODS Study participants were 46 persons with TLE and 31 age- and gender- matched healthy controls. All participants underwent high-resolution MRI with manual tracing of the cerebellum yielding gray and white matter volumes of the right and left anterior lobes, superior posterior lobes, inferior posterior lobes, and corpus medullare. The degree to which asymmetric versus generalized abnormalities was evident in unilateral chronic TLE was determined and related to selected clinical seizure features (age of onset, duration of disorder). KEY FINDINGS There were no lateralized abnormalities in cerebellar gray matter or white matter in patients with right or left TLE (all p's > 0.2). Compared with controls, unilateral TLE was associated with significant bilateral reductions in the superior (p = 0.032) and inferior (p = 0.023) posterior lobes, whereas volume was significantly increased in the anterior lobes (p = 0.002), especially in patients with early onset TLE, and not significantly different in the corpus medullare (p = 0.71). Total superior cerebellar tissue volumes were reduced in association with increasing duration of epilepsy. SIGNIFICANCE Patients with unilateral TLE exhibit a pattern of bilateral cerebellar pathology characterized by atrophy of the superior and inferior posterior lobes, hypertrophy of the anterior lobe, and no effect on the corpus medullare. Cross-sectional analyses show that specific aspects of cerebellar pathology are associated with neurodevelopmental (anterior lobe) or chronicity-related (superior posterior lobe) features of the disorder.
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Affiliation(s)
- Temitayo O Oyegbile
- Department of Neurology, New York Presbyterian Hospital, New York, New York, USA
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Leite RAA, Otaduy MCG, Silva GEGE, Ferreira MLB, Aragão MDFV. Diagnostic methods for extra-temporal neocortical focal epilepsies: present and future. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:119-26. [PMID: 20339666 DOI: 10.1590/s0004-282x2010000100025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 09/14/2009] [Indexed: 11/21/2022]
Abstract
The progress of epilepsies diagnosis has been great, but, amongst the diagnostic detailing that demand research, one of the most important is the essential lateralization and localization of epileptogenic zone, considered as the cerebral cortex region, that removed, will result in a free state of seizures. The present study aims to analyze the possible uses of proton spectroscopy for clinical and pre-surgical evaluation of focal extratemporal epilepsies, since this group presents the highest difficulty degree for lateralizing and locating epileptogenic zones. In almost all cases, a non invasive diagnosis can be performed using routine electroencephalography, video-electroencephalography - considered as gold standard, and magnetic resonance imaging. However, when the results of these exams are contradictory, some patients need invasive techniques, as the intra-cranial video-EEG, using deep electrodes, sub-dural strip and grid, that are associated with increased diagnostic cost and risk of complications, as cerebral hemorrhages and intra-cranial infections. Proton spectroscopy appears as a possibility, given its capacity to evaluate cerebral metabolism, by N-acetyl-aspartate (NAA), creatine (Cre) and choline (Cho) concentrations, amongst other metabolites. This non invasive method may provide time reduction of this evaluation and reliable level improvement for this topographical diagnosis.
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Abstract
It is well known that neuropsychological impairment can be associated with chronic epilepsy. This review suggests that a broad lifespan perspective of cognition in epilepsy should include consideration of: a) neurobiological factors that antedate the first seizure and influence cognition, b) epilepsy-related factors that influence brain growth and cognitive development after epilepsy is diagnosed and treated, c) clinical epilepsy and other risk factors associated with poor cognitive prognosis in the context of chronic pharmacoresistant epilepsy, and d) the modifiable and non-modifiable risk factors that influence cognitive aging in the general population.
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Affiliation(s)
- Bruce Hermann
- Department of Neurology, University ofWisconsin School ofMedicine and PublicHealth, Madison, Wisconsin, USA.
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Hamed SA. The aspects and mechanisms of cognitive alterations in epilepsy: the role of antiepileptic medications. CNS Neurosci Ther 2009; 15:134-56. [PMID: 19254331 PMCID: PMC6494068 DOI: 10.1111/j.1755-5949.2008.00062.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Epilepsy is a major health problem. Several studies suggest a significant influence of epilepsy and its treatment on dynamic and functional properties of brain activity. Epilepsy can adversely affect mental development, cognition, and behavior. Epileptic patients may experience reduced intelligence, attention, and problems in memory, language, and frontal executive functions. Neuropsychological, functional, and quantitative neuroimaging studies revealed that epilepsy affect the brain as a whole. Mechanisms of epilepsy-related cognitive dysfunction are poorly delineated. Cognitive deficits with epilepsy may be transient, persistent, or progressive. Transient disruption of cognitive encoding processes may occur with paroxysmal focal or generalized epileptic discharges, whereas epileptogenesis-related neuronal plasticity, reorganization, sprouting, and impairment of cellular metabolism are fundamental determinants for progressive cognitive deterioration. Also antiepileptic drugs (AEDs) have differential, reversible, and sometimes cumulative cognitive adverse consequences. AEDs not only reduce neuronal irritability but also may impair neuronal excitability, neurotransmitter release, enzymes, and factors critical for information processing and memory. The present article serves as an overview of recent studies in adult and childhood epilepsy literatures present in PubMed that highlighted cognitive evaluation in epilepsy field (publications till 2008 were checked). We also checked the reference lists of the retrieved studies for additional reports of relevant studies, in addition to our experience in this field. Our search revealed that although the aspects of cognitive dysfunction, risk factors, and consequences have been explored in many studies; however, the mechanisms of contribution of epilepsy-related variables, including AEDs, to patients' cognition are largely unexplored. In this review, we discussed the differential effect of AEDs in mature and immature brains and the known mechanisms underlying epilepsy and AEDs adverse effects on cognition. The nature, timing, course, and mechanisms of cognitive alteration with epilepsy and its medications are of considerable clinical and research implications.
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Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
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Cognitive and magnetic resonance volumetric abnormalities in new-onset pediatric epilepsy. Semin Pediatr Neurol 2007; 14:173-80. [PMID: 18070673 PMCID: PMC2695488 DOI: 10.1016/j.spen.2007.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This paper addresses the issue of cognitive morbidity and abnormalities in quantitative MR volumetric in children with new and recent onset idiopathic epilepsy. The available literature suggests that mild diffuse cognitive problems are evident in children with new onset epilepsy in the context of intact whole brain and lobar volumetrics. Subsets of children can be identified with salient academic and volumetric abnormalities. These findings represent the baseline upon which any subsequent effects of chronic epilepsy may accrue.
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Carne RP, O'Brien TJ, Kilpatrick CJ, MacGregor LR, Litewka L, Hicks RJ, Cook MJ. 'MRI-negative PET-positive' temporal lobe epilepsy (TLE) and mesial TLE differ with quantitative MRI and PET: a case control study. BMC Neurol 2007; 7:16. [PMID: 17588263 PMCID: PMC1929122 DOI: 10.1186/1471-2377-7-16] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 06/24/2007] [Indexed: 12/03/2022] Open
Abstract
Background 'MRI negative PET positive temporal lobe epilepsy' represents a substantial minority of temporal lobe epilepsy (TLE). Clinicopathological and qualitative imaging differences from mesial temporal lobe epilepsy are reported. We aimed to compare TLE with hippocampal sclerosis (HS+ve) and non lesional TLE without HS (HS-ve) on MRI, with respect to quantitative FDG-PET and MRI measures. Methods 30 consecutive HS-ve patients with well-lateralised EEG were compared with 30 age- and sex-matched HS+ve patients with well-lateralised EEG. Cerebral, cortical lobar and hippocampal volumetric and co-registered FDG-PET metabolic analyses were performed. Results There was no difference in whole brain, cerebral or cerebral cortical volumes. Both groups showed marginally smaller cerebral volumes ipsilateral to epileptogenic side (HS-ve 0.99, p = 0.02, HS+ve 0.98, p < 0.001). In HS+ve, the ratio of epileptogenic cerebrum to whole brain volume was less (p = 0.02); the ratio of epileptogenic cerebral cortex to whole brain in the HS+ve group approached significance (p = 0.06). Relative volume deficits were seen in HS+ve in insular and temporal lobes. Both groups showed marked ipsilateral hypometabolism (p < 0.001), most marked in temporal cortex. Mean hypointensity was more marked in epileptogenic-to-contralateral hippocampus in HS+ve (ratio: 0.86 vs 0.95, p < 0.001). The mean FDG-PET ratio of ipsilateral to contralateral cerebral cortex however was low in both groups (ratio: HS-ve 0.97, p < 0.0001; HS+ve 0.98, p = 0.003), and more marked in HS-ve across all lobes except insula. Conclusion Overall, HS+ve patients showed more hippocampal, but also marginally more ipsilateral cerebral and cerebrocortical atrophy, greater ipsilateral hippocampal hypometabolism but similar ipsilateral cerebral cortical hypometabolism, confirming structural and functional differences between these groups.
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Affiliation(s)
- Ross P Carne
- Victorian Epilepsy Centre, St Vincent's Hospital, Melbourne, Australia
- Department of Neurology, St. Vincent's Hospital, Melbourne, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Neuroscience, The Geelong Hospital, Barwon Health, Geelong, Australia
- School of Medicine, Deakin University, Geelong, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Christine J Kilpatrick
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Lachlan R MacGregor
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Clinical Epidemiology and Biostatistics, The Royal Melbourne Hospital, Melbourne, Australia
| | - Lucas Litewka
- Victorian Epilepsy Centre, St Vincent's Hospital, Melbourne, Australia
| | - Rodney J Hicks
- PET Centre, The Peter MacCallum Cancer Institute, Melbourne, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Mark J Cook
- Victorian Epilepsy Centre, St Vincent's Hospital, Melbourne, Australia
- Department of Neurology, St. Vincent's Hospital, Melbourne, Australia
- Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Australia
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Daley M, Levitt J, Siddarth P, Mormino E, Hojatkashani C, Gurbani S, Shields WD, Sankar R, Toga A, Caplan R. Frontal and temporal volumes in children with epilepsy. Epilepsy Behav 2007; 10:470-6. [PMID: 17382595 DOI: 10.1016/j.yebeh.2007.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 01/14/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
This study examined if children with cryptogenic epilepsy and complex partial seizures (CPS) have smaller total brain, frontal, and temporal lobe volumes than normal children and how this is related to seizure, cognitive, psychiatric, and demographic variables. Forty-four children with CPS and 38 normal children, aged 5-16 years, underwent brain MRI scans at 1.5 T. Tissue was segmented, and total brain, frontal lobe, frontal parcellation, and temporal lobe volumes were computed. Other than significantly larger temporal lobe white matter volumes in the CPS group, there were no significant differences in brain volumes between the CPS and normal groups. Earlier onset, longer duration of illness, younger chronological age, and presence of a psychiatric diagnosis were significantly related to smaller frontotemporal volumes in subjects with CPS. Although these findings suggest that CPS might affect development of the temporal and frontal regions, we are unable to rule out the possibility that smaller frontotemporal volumes might predispose children to CPS. These findings highlight the need to control for seizure, cognitive, psychiatric, and demographic variables in studies of frontotemporal volumes in pediatric CPS.
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Affiliation(s)
- Melita Daley
- Department of Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-1759, USA.
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Caplin DA, Rao JK, Filloux F, Bale JF, Van Orman C. Development of Performance Indicators for the Primary Care Management of Pediatric Epilepsy: Expert Consensus Recommendations Based on the Available Evidence. Epilepsia 2006; 47:2011-9. [PMID: 17201697 DOI: 10.1111/j.1528-1167.2006.00853.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To use available evidence and expert consensus to develop performance indicators for the evaluation and management of pediatric epilepsy. METHODS We used a three-step process to develop the performance indicators. First, research findings were compiled into evidence tables focusing on different clinical issues. Second, an advisory panel of clinicians, educational and public health experts, and families of children with epilepsy reviewed the evidence. The advisory group used the evidence to draft a preliminary set of performance indicators for pediatric epilepsy management. Third, 13 internationally recognized experts in pediatric neurology or epilepsy rated the value of these indicators on a 5-point scale [1 (essential) to 5 (not necessary)] in a two-round Delphi process. Positive consensus was reached if >or=80% of experts gave an indicator a "1" rating and negative consensus if >80% gave an indicator a "5" rating. Indicators that achieved positive consensus during either round of the Delphi process constituted the final set of indicators. RESULTS Of the 68 draft performance indicators, the expert panel members achieved positive consensus on 30 performance indicators: eight indicators related to diagnostic strategies and seizure classification, nine related to antiepileptic drug use, six related to cognitive and behavioral issues, six related to quality of life, and three related to specialty referrals. CONCLUSIONS We identified 30 potential indicators for evaluating the care provided to pediatric patients with epilepsy. The next step is to examine the relation of these performance indicators to clinical outcomes and health care utilization among pediatric patients with epilepsy.
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Affiliation(s)
- Deirdre A Caplin
- Department of Pediatrics, Division of General Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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Daley M, Ott D, Blanton R, Siddarth P, Levitt J, Mormino E, Hojatkashani C, Tenorio R, Gurbani S, Shields WD, Sankar R, Toga A, Caplan R. Hippocampal volume in childhood complex partial seizures. Epilepsy Res 2006; 72:57-66. [PMID: 16930947 DOI: 10.1016/j.eplepsyres.2006.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 05/25/2006] [Accepted: 07/07/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE This study compared hippocampal volume in children with cryptogenic epilepsy, all of whom had complex partial seizures (CPS), and age and gender matched normal children controlling for between group differences in IQ and demographic variables (e.g., age, gender, ethnicity, socioeconomic status). It also examined the relationship between hippocampal volumes and seizure variables in the patients. METHODS Using quantitative magnetic resonance imaging (MRI), we compared the hippocampal volumes of 19 medically treated children with CPS, aged 6-14 years, to 21 age and gender matched normal children. RESULTS The children with CPS had significantly smaller total hippocampal volumes than the normal children. This finding was accounted for primarily by significantly smaller anterior hippocampal volumes. Within the CPS group, smaller total and posterior hippocampus volumes were significantly associated with longer duration of illness. Anterior hippocampal volumes, however, were unrelated to seizure variables. CONCLUSIONS These findings imply impaired development of the hippocampus, particularly the anterior hippocampus, and a differential effect of the underlying illness and on-going seizures on hippocampal development in medically controlled pediatric CPS.
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Affiliation(s)
- Melita Daley
- UCLA Department of Psychiatry, Psychiatry and Biobehavioral Sciences, UCLA, Semel Institute, Rm. 48-253B, 760 Westwood Plaza, Los Angeles, CA 90095-1759, USA.
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Chapman C, Tubridy N, Cook MJ, Mitchell PJ, MacGregor LR, Lovelock C, Litewka L, Sedal L, Kilpatrick TJ, Butzkueven H. Short-term effects of methylprednisolone on cerebral volume in multiple sclerosis relapses. J Clin Neurosci 2006; 13:636-8. [PMID: 16790352 DOI: 10.1016/j.jocn.2005.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 08/17/2005] [Indexed: 10/24/2022]
Abstract
We prospectively investigated the short-term effects of intravenous methyl-prednisolone (IVMP) on cerebral volume in patients suffering a multiple sclerosis (MS) relapse. Ten patients underwent MRI brain studies immediately before and after IVMP treatment, and 4 and 8 weeks later. Whole brain volumes decreased significantly over the 8-week period. The greatest change occurred during IVMP administration. This has implications for MS treatment trials using cerebral atrophy as an endpoint.
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Affiliation(s)
- C Chapman
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
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Abstract
Despite the fact that clinical characteristics of frontal lobe seizures have been recently described better, differentiating seizures of frontal lobe origin from NES on clinical grounds alone is difficult. The difficulty has been compounded by the fact that both inter-ictal and ictal EEG can be normal or nonspecific, and the same is true of imaging studies. A detailed clinical history as well as video monitoring can be helpful diagnostic tools. A multidisciplinary approach is warranted and is at times essential to improve the diagnosis and care of these difficult patients.
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Affiliation(s)
- Barbara C Jobst
- Section of Neurology, Dartmouth Epilepsy Program, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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Nolan MA, Redoblado MA, Lah S, Sabaz M, Lawson JA, Cunningham AM, Bleasel AF, Bye AME. Memory function in childhood epilepsy syndromes. J Paediatr Child Health 2004; 40:20-7. [PMID: 14717999 DOI: 10.1111/j.1440-1754.2004.00284.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Children with epilepsy are at risk of specific cognitive deficits. We aimed to compare and characterize the memory function of children with childhood absence epilepsy (CAE), frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). METHODS Epilepsy syndrome was identified by clinical data, seizure semiology, interictal and ictal electroencephalogram (EEG). Seventy children aged 6-18 years with CAE, FLE or TLE had neuropsychological assessment including memory function. After adjusting for epilepsy variables, neuropsychological results of the syndrome groups and normative data were compared. RESULTS Children from all three syndrome groups were at risk of memory difficulties. The duration of epilepsy correlated negatively with memory function. Children with TLE had the worst memory function, significantly lower in verbal memory tasks than children with CAE (P = 0.02) and children with FLE (P = 0.01). The performance of children with TLE was significantly below the normed mean across all verbal and most visual tasks. Compared to the normed means, children with FLE had results that were statistically lower in some verbal and visual tasks, and children with CAE were lower in two visual tasks only. CONCLUSIONS This study demonstrates memory dysfunction in three common childhood epilepsy syndromes. Children with TLE had the greatest impairment, children with FLE had memory difficulties not previously reported, and children with CAE had subtle memory deficits. Qualitative differences were also evident. Longer duration of intractable epilepsy was associated with reduced memory ability. Memory function and its potential impact on academic achievement are vital considerations when managing children with epilepsy.
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Affiliation(s)
- M A Nolan
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Nolan MA, Redoblado MA, Lah S, Sabaz M, Lawson JA, Cunningham AM, Bleasel AF, Bye AME. Intelligence in childhood epilepsy syndromes. Epilepsy Res 2003; 53:139-50. [PMID: 12576175 DOI: 10.1016/s0920-1211(02)00261-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Intellectual deficits play a significant role in the psychosocial comorbidity of children with epilepsy. Early educational intervention is critical. OBJECTIVE This study aims to determine the intellectual ability of children with common childhood epilepsy syndromes-generalised idiopathic epilepsy (GIE), generalised symptomatic epilepsy (GSE), temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE), central epilepsy (CE) and non-localised partial epilepsy (PE). METHODS A prospective consecutive series of 169 children were recruited. Epilepsy syndrome was identified by clinical data, seizure semiology, interictal and ictal EEG in each child, using International League Against Epilepsy criteria. Each child had neuropsychology assessment using age-normed and validated instruments. After adjusting for important epilepsy variables, 95% confidence intervals were generated for mean full-scale intelligence quotient (FSIQ) using ANCOVA. RESULTS Significant differences between epilepsy syndrome groups were found for age of onset (P<0.001), duration of active epilepsy (P=0.027), seizure frequency (P=0.037) and polytherapy (P=0.024). Analysing FSIQ, children with GIE, CE and TLE performed best, and did not differ statistically. Children with GSE had a statistically lower FSIQ than other syndrome groups except PE. FLE functioned significantly better than GSE, but did not differ statistically from other groups. CONCLUSIONS In childhood epilepsy, delineation of the syndrome has important implications when considering intellectual potential. This information is invaluable in planning educational interventions and supporting the family.
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Affiliation(s)
- Melinda A Nolan
- Department of Neurology, Sydney Children's Hospital, High St, Randwick, NSW 2031, Sydney, Australia
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Hermann B, Seidenberg M, Bell B, Rutecki P, Sheth R, Ruggles K, Wendt G, O'Leary D, Magnotta V. The neurodevelopmental impact of childhood-onset temporal lobe epilepsy on brain structure and function. Epilepsia 2002; 43:1062-71. [PMID: 12199732 DOI: 10.1046/j.1528-1157.2002.49901.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To characterize the neurodevelopmental correlates of childhood-onset temporal lobe epilepsy on brain structure and cognition compared with late-onset chronic temporal lobe epilepsy and healthy controls. METHODS Healthy controls (n = 62) and patients with early (n = 37) versus late (n = 16) age at onset of temporal lobe epilepsy were compared with high-resolution quantitative magnetic resonance imaging (MRI) volumetrics and comprehensive neuropsychological assessment. RESULTS Patients with childhood-onset temporal lobe epilepsy (mean onset age, 7.8 years) exhibited widespread compromise in neuropsychological performance and substantial reduction in brain tissue volumes extending to extratemporal regions compared with healthy controls and late-onset temporal lobe epilepsy patients (mean onset age, 23.3 years). Most evident was reduced total white-matter volume among the childhood-onset patients. Reduction in brain tissue volume, especially total white-matter volume, was associated with significantly poorer cognitive status, attesting to the clinical significance of the volumetric abnormalities. CONCLUSIONS Childhood-onset temporal lobe epilepsy appears to be associated with an adverse neurodevelopmental impact on brain structure and cognition that appears generalized in nature and especially evident in white-matter tissue volume.
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Affiliation(s)
- Bruce Hermann
- Departments of Neurology and Radiology, University of Wisconsin, Madison, Wisconsin 53792, USA.
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Millichap JG. Clinical, EEG, and MRI Differences in Frontal and Temporal Lobe Epilepsy. Pediatr Neurol Briefs 2002. [DOI: 10.15844/pedneurbriefs-16-3-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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