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Hyppönen J, Paanila V, Äikiä M, Koskenkorva P, Könönen M, Vanninen R, Mervaala E, Kälviäinen R, Hakumäki J. Progressive myoclonic epilepsy type 1 (EPM1) patients present with abnormal 1H MRS brain metabolic profiles associated with cognitive function. Neuroimage Clin 2023; 39:103459. [PMID: 37541097 PMCID: PMC10412857 DOI: 10.1016/j.nicl.2023.103459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Progressive myoclonic epilepsy, type 1A (EPM1, Unverricht-Lundborg disease), is a rare neurodegenerative autosomal recessive disorder characterized by stimulus-sensitive and action myoclonus and tonic-clonic epileptic seizures. Patients develop neurological symptoms, including ataxia, intention tremor, and dysarthria, over time, with relatively limited and nonspecific MRI atrophy findings. The effects of the disease on brain metabolism are largely unknown. METHOD Eighteen EPM1 patients (9 M, 9F) underwent clinical evaluation and neuropsychological testing, which included the assessment of intellectual ability, verbal memory, and psychomotor and executive functions. Magnetic resonance spectroscopy (MRS) and imaging (MRI) were performed on a 1.5 T MRI system. 2D MRS chemical shift imaging (CSI) maps (TE = 270) were obtained from the following regions of the brain: basal ganglia, thalamus, insula, splenium, and occipital white and gray matter, and N-acetyl-aspartate (NAA)-, choline (Cho)-, and lactate (Lac)-to-creatine (Cr) ratios were analyzed. Ten healthy age-and sex-matched subjects (5M, 5F) were used as controls for MRS. RESULTS We found significant brain metabolic changes involving lactate, NAA, and choline, which are widespread in the basal ganglia, thalamic nuclei, insula, and occipital areas of EPM1 patients. Changes, especially in the right insula, basal ganglia, and thalamus, were associated with intellectual abilities and impairment of the psychomotor and executive functions of EPM1 patients. CONCLUSION Multiple brain metabolic alterations suggest the presence of neurodegeneration associated with EPM1 progression. The changes in metabolite ratios are associated with the neurocognitive dysfunction caused by the disease. However, the role of MRS findings in understanding pathophysiology of EPM1 warrants further studies.
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Affiliation(s)
- Jelena Hyppönen
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Vili Paanila
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Marja Äikiä
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Päivi Koskenkorva
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Juhana Hakumäki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland.
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Äikiä M, Hyppönen J, Mervaala E, Kälviäinen R. Cognitive functioning in progressive myoclonus epilepsy type 1 (Unverricht-Lundborg Disease, EPM1). Epilepsy Behav 2021; 122:108157. [PMID: 34171687 DOI: 10.1016/j.yebeh.2021.108157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this neuropsychological study of a large cohort of patients with progressive myoclonus epilepsy type 1 (Unverricht-Lundborg disease, EPM1) was to characterize the cognitive function of EPM1 patients and to explore the association between the disability caused by the disease and cognitive performance. METHOD Sixty-eight genetically verified EPM1 patients homozygous for the expansion mutation in the CSTB gene (37 males and 31 females aged 35 ± 11) participated in a neuropsychological assessment of intellectual ability, verbal memory, and executive and psychomotor function. The clinical evaluation comprised administering (and video-recording) the unified myoclonus rating scale (UMRS) to assess the severity of each patient's myoclonus. Forty-six healthy volunteers (19 males and 27 females aged 32 ± 11) served as the control group for the neuropsychological tests. RESULTS The cognitive performance of the EPM1 patient group was impaired. Verbal Intelligence Quotient (VIQ) was below the average range (VIQ < 85) in 49% of the patients; further, Performance Intelligence Quotient (PIQ) was below average in 75% of the patients. The patients performed worse than the controls in both immediate and delayed story recall (p = 0.001); however, in the word list learning task, the patients performed only slightly worse than the controls. The one-hour delayed recall of the learned words was similar in both groups, and the percentage of retained words and story contents did not differ between the patients and controls. The patients were impaired in all of the executive function tests as well as in the psychomotor speed tests (p < 0.001 for all). Also, the patients' simple psychomotor speed in the tapping task was significantly slowed in comparison to controls (p < 0.001). CONCLUSION The patients had impaired performance in the majority of the cognitive measures; they showed the highest level of impairment in all the executive function tests and in the psychomotor speed tests. The measures of these cognitive domains are timed-therefore, it is clear that severe myoclonus limits patients' performance. In contrast, verbal memory, especially delayed recall, was the least affected cognitive domain.
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Affiliation(s)
- Marja Äikiä
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland.
| | - Jelena Hyppönen
- Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland
| | - Esa Mervaala
- Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland; Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of the European Reference Network EpiCARE, Kuopio, Finland; Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Vogt VL, Äikiä M, Del Barrio A, Boon P, Borbély C, Bran E, Braun K, Carette E, Clark M, Cross JH, Dimova P, Fabo D, Foroglou N, Francione S, Gersamia A, Gil-Nagel A, Guekht A, Harrison S, Hecimovic H, Heminghyt E, Hirsch E, Javurkova A, Kälviäinen R, Kavan N, Kelemen A, Kimiskidis VK, Kirschner M, Kleitz C, Kobulashvili T, Kosmidis MH, Kurtish SY, Lesourd M, Ljunggren S, Lossius MI, Malmgren K, Mameniskiené R, Martin-Sanfilippo P, Marusic P, Miatton M, Özkara Ç, Pelle F, Rubboli G, Rudebeck S, Ryvlin P, van Schooneveld M, Schmid E, Schmidt PM, Seeck M, Steinhoff BJ, Shavel-Jessop S, Tarta-Arsene O, Trinka E, Viggedal G, Wendling AS, Witt JA, Helmstaedter C. Current standards of neuropsychological assessment in epilepsy surgery centers across Europe. Epilepsia 2017; 58:343-355. [PMID: 28067423 DOI: 10.1111/epi.13646] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 11/29/2022]
Abstract
We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe.
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Affiliation(s)
- Viola Lara Vogt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
| | - Marja Äikiä
- Epilepsy Center/Neurocenter, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antonio Del Barrio
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Paul Boon
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Csaba Borbély
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Ema Bran
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Kees Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelien Carette
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Maria Clark
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Judith Helen Cross
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petia Dimova
- Clinic of Child Neurology, St Naum University Hospital of Neurology and Psychiatry, Sofia, Bulgaria
| | - Daniel Fabo
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Stefano Francione
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Anna Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Antonio Gil-Nagel
- Department of Neurology, Epilepsy Program, Hospital Ruber International, Madrid, Spain
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Department of Neurology and Neurosurgery of the Russian National Research Medical University, Moscow, Russia
| | - Sue Harrison
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Hrvoje Hecimovic
- Department of Neurology, Zagreb Epilepsy Center, University Hospital, Zagreb, Croatia
| | - Einar Heminghyt
- National Center for Epilepsy (SSE), Oslo University Hospital, Oslo, Norway
| | | | - Alena Javurkova
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | | | - Nicole Kavan
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | - Anna Kelemen
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Margarita Kirschner
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Teia Kobulashvili
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Selin Yagci Kurtish
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mathieu Lesourd
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Sofia Ljunggren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Kristina Malmgren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ruta Mameniskiené
- Faculty of Medicine, Clinic of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania.,Department of Neurology, Vilnius University Hospital Santariškių klinikos, Vilnius, Lithuania
| | - Patricia Martin-Sanfilippo
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Petr Marusic
- 2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Marijke Miatton
- Department of Neurology, Center for Refractory Epilepsy, University Hospital Ghent, Ghent, Belgium
| | - Çiğdem Özkara
- Division of Clinical Electro-Neurophysiology, Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Federica Pelle
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Guido Rubboli
- Danish Epilepsy Center, Filadelfia/University of Copenhagen, EEMA (European Epilepsy Monitoring Unit Association), Dianalund, Denmark.,Epilepsy Institute, IDEE, Lyon, France
| | - Sarah Rudebeck
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.,Epilepsy Institute, IDEE, Lyon, France
| | - Monique van Schooneveld
- Department of Pediatric Psychology, Sector of Neuropsychology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth Schmid
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Margitta Seeck
- EEG & Epilepsy Unit, Hospital of Geneva & Functional Neurology and Neurosurgery Program, University Hospitals of Geneva and Lausanne, Geneva, Switzerland
| | | | - Sara Shavel-Jessop
- University College London Institute of Child Health & Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Oana Tarta-Arsene
- Department of Clinical Neurosciences, Pediatric Neurology Clinic, Carol Davila University of Medicine, Bucharest, Romania.,Alexandu Obregia Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Bucharest, Romania
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gerd Viggedal
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Juri-Alexander Witt
- Department of Epileptology, Medical Center, University of Bonn, Bonn, Germany
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