1
|
Aud'hui M, Kachenoura A, Yochum M, Kaminska A, Nabbout R, Wendling F, Kuchenbuch M, Benquet P. Detection of seizure onset in childhood absence epilepsy. Clin Neurophysiol 2024:S1388-2457(24)00106-8. [PMID: 38644110 DOI: 10.1016/j.clinph.2024.03.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE This study aims to detect the seizure onset, in childhood absence epilepsy, as early as possible. Indeed, interfering with absence seizures with sensory simulation has been shown to be possible on the condition that the stimulation occurs soon enough after the seizure onset. METHODS We present four variations (two supervised, two unsupervised) of an algorithm designed to detect the onset of absence seizures from 4 scalp electrodes, and compare their performance with that of a state-of-the-art algorithm. We exploit the characteristic shape of spike-wave discharges to detect the seizure onset. Their performance is assessed on clinical electroencephalograms from 63 patients with confirmed childhood absence epilepsy. RESULTS The proposed approaches succeed in early detection of the seizure onset, contrary to the classical detection algorithm. Indeed, the results clearly show the superiority of the proposed methods for small delays of detection, under 750 ms from the onset. CONCLUSION The performance of the proposed unsupervised methods is equivalent to that of the supervised ones. The use of only four electrodes makes the pipeline suitable to be embedded in a wearable device. SIGNIFICANCE The proposed pipelines perform early detection of absence seizures, which constitutes a prerequisite for a closed-loop system.
Collapse
Affiliation(s)
- M Aud'hui
- Univ Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - A Kachenoura
- Univ Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - M Yochum
- Univ Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France.
| | - A Kaminska
- Department of Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Université de Paris, Paris, France
| | - R Nabbout
- Department of Clinical Neurophysiology, Hôpital Necker Enfants Malades, AP-HP, Université de Paris, Paris, France; Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Member of EPICARE Network, Institute Imagine INSERM 1163, Université de Paris, Paris, France
| | - F Wendling
- Univ Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - M Kuchenbuch
- Pediatric and Genetic Department, CHU, Nancy, France
| | - P Benquet
- Univ Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| |
Collapse
|
2
|
Li SP, Lin LC, Yang RC, Ouyang CS, Chiu YH, Wu MH, Tu YF, Chang TM, Wu RC. Predicting the therapeutic response to valproic acid in childhood absence epilepsy through electroencephalogram analysis using machine learning. Epilepsy Behav 2024; 151:109647. [PMID: 38232558 DOI: 10.1016/j.yebeh.2024.109647] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
Childhood absence epilepsy (CAE) is a common type of idiopathic generalized epilepsy, manifesting as daily multiple absence seizures. Although seizures in most patients can be adequately controlled with first-line antiseizure medication (ASM), approximately 25 % of patients respond poorly to first-line ASM. In addition, an accurate method for predicting first-line medication responsiveness is lacking. We used the quantitative electroencephalogram (QEEG) features of patients with CAE along with machine learning to predict the therapeutic effects of valproic acid in this population. We enrolled 25 patients with CAE from multiple medical centers. Twelve patients who required additional medication for seizure control or who were shifted to another ASM and 13 patients who achieved seizure freedom with valproic acid within 6 months served as the nonresponder and responder groups. Using machine learning, we analyzed the interictal background EEG data without epileptiform discharge before ASM. The following features were analyzed: EEG frequency bands, Hjorth parameters, detrended fluctuation analysis, Higuchi fractal dimension, Lempel-Ziv complexity (LZC), Petrosian fractal dimension, and sample entropy (SE). We applied leave-one-out cross-validation with support vector machine, K-nearest neighbor (KNN), random forest, decision tree, Ada boost, and extreme gradient boosting, and we tested the performance of these models. The responders had significantly higher alpha band power and lower delta band power than the nonresponders. The Hjorth mobility, LZC, and SE values in the temporal, parietal, and occipital lobes were higher in the responders than in the nonresponders. Hjorth complexity was higher in the nonresponders than in the responders in almost all the brain regions, except for the leads FP1 and FP2. Using KNN classification with theta band power in the temporal lobe yielded optimal performance, with sensitivity of 92.31 %, specificity of 76.92 %, accuracy of 84.62 %, and area under the curve of 88.46 %.We used various EEG features along with machine learning to accurately predict whether patients with CAE would respond to valproic acid. Our method could provide valuable assistance for pediatric neurologists in selecting suitable ASM.
Collapse
Affiliation(s)
- Sheng-Ping Li
- Division of Pediatric Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan
| | - Lung-Chang Lin
- Division of Pediatric Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan.
| | - Rei-Cheng Yang
- Division of Pediatric Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan
| | - Chen-Sen Ouyang
- Department of Information Management, National Kaohsiung University of Science and Technology, Taiwan
| | - Yi-Hung Chiu
- Department of Information Engineering, I-Shou University, Taiwan
| | - Mu-Han Wu
- Department of Neurology, Tainan Hospital, Ministry of Health and Welfare, Taiwan
| | - Yi-Fang Tu
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tung-Ming Chang
- Department of Pediatric Neurology, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Rong-Ching Wu
- Department of Electrical Engineering, I-Shou University, Taiwan
| |
Collapse
|
3
|
Eapen M, Iype M, Saradakutty G, Jayan BB, Sreedharan M, Ahamed S, Preethi Thomas E, Habeeb A, Cherian A. Childhood Absence Epilepsy- Electroclinical Profile and Prevalence of Attention-Deficit/Hyperactivity Disorder Among a Cohort of 47 Children. Pediatr Neurol 2024; 150:65-73. [PMID: 37981446 DOI: 10.1016/j.pediatrneurol.2023.10.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND We aimed to find the proportion of attention-deficit/hyperactivity disorder (ADHD) among children with childhood absence epilepsy (CAE) and to describe their electroclinical features. METHODS Video electroencephalography (EEG) was performed on 47 children who fulfilled International League Against Epilepsy criteria for CAE. These children were also assessed for the presence of ADHD. RESULTS Of the 47 children, 27 (57%) met criteria for the diagnosis of ADHD. Majority (74%) of them had inattentive type of ADHD. Age at onset of absences ranged from three to 12 years (mean 7.2 ± 2.47). We analyzed 219 seizures (154 electroclinical and 65 electrographic). The average seizure duration was 7.1 seconds (range 1 to 38 [S.D. 5.81]). Of the 154 clinical absences, ictal discharges were less than or equal to two seconds in nine of 154 (5.8%); greater than two to less than or equal to four seconds in 33 of 154 (21.4%), and longer than 20 seconds in 11 of 154 (7%). The longest duration of ictal discharge recorded was 38 seconds, and the shortest duration was one second. The onset of ictal discharge had a "lead in" focus in 81% (177 of 219). CONCLUSIONS The proportion of ADHD among children with CAE is high. A "lead in" focus of the generalized ictal discharges was observed frequently, lending support to the theory that the origin of seizure discharges in CAE is indeed cortical. The shortest ictal discharge recorded was one second.
Collapse
Affiliation(s)
- Merin Eapen
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India.
| | - Mary Iype
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Geetha Saradakutty
- Department of Paediatrics, Government Medical College, Konni, Kerala, India
| | - Bineej B Jayan
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Mini Sreedharan
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Shahanaz Ahamed
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | | | - Azmi Habeeb
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Anchu Cherian
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| |
Collapse
|
4
|
Azevedo M, Benbadis SR. Efficacy of highly purified cannabidiol (CBD) in typical absence seizures: A pilot study. Epilepsy Behav 2023; 149:109512. [PMID: 37980860 DOI: 10.1016/j.yebeh.2023.109512] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Clinical trials for typical absence seizures are notoriously difficult, because those seizures are clinically subtle and brief, so that seizure counts by caregivers are inaccurate. As a result, treatment options are limited. Currently, there are no published studies on the use of CBD in typical absence seizures. This pilot study aims to evaluate the efficacy of pharmaceutical grade CBD in typical absence seizures. METHODS We prospectively enrolled 14 patients aged 6 years and older, diagnosed with typical absence seizures. A baseline 24-hour ambulatory EEG was conducted, followed by a second 24-hour EEG after 90 days of treatment. The outcome was an objective measure of spike-wave complexes (SWC) burden change from pre- to post- treatment. RESULTS After taking CBD for 90 days, 9 (64.3%) patients had an increase in SWC (ranging from 8% to 2876.5%) and 5 (35.7%) had a decrease in SWC (ranging from 62.3% to 98.9%). Of the 5 patients who had a decrease, 3 (60%) were on concomitant ethosuximide (with or without other ASMs). All 3 patients on CBD and ethosuximide improved. CONCLUSIONS Although based on a small subset of patients, our results suggest that CBD may not be effective for typical absence seizures. However, patients on concomitant ethosuximide or on CBD monotherapy were more likely to improve.
Collapse
Affiliation(s)
- Marina Azevedo
- Comprehensive Epilepsy Center, University of South Florida, Tampa, FL 33606, United States.
| | - Selim R Benbadis
- Comprehensive Epilepsy Center, University of South Florida, Tampa, FL 33606, United States.
| |
Collapse
|
5
|
Eussen MJ, Jansen JF, Voncken TP, Debeij-Van Hall MH, Hendriksen JG, Vermeulen RJ, Klinkenberg S, Backes WH, Drenthen GS. Exploring the core network of the structural covariance network in childhood absence epilepsy. Heliyon 2023; 9:e22657. [PMID: 38107302 PMCID: PMC10724663 DOI: 10.1016/j.heliyon.2023.e22657] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Childhood absence epilepsy (CAE) is a generalized pediatric epilepsy, which is generally considered to be a benign condition since most children become seizure-free before reaching adulthood. However, cognitive deficits and changes of brain morphological have been previously reported in CAE. These morphological changes, even if they might be very subtle, are not independent due to the underlying network structure and can be captured by the structural covariance network (SCN). In this study, SCNs were used to quantify the structural brain network for children with CAE as well as controls. Seventeen children with CAE (6-12y) and fifteen controls (6-12y) were included. To estimate the SCN, T1-weighted images were acquired and parcellated into 68 cortical regions. Graph measures characterizing the core network architecture, i.e. the assortativity and rich-club coefficient, were calculated for all individuals. Multivariable linear regression models, including age and sex as covariates, were used to assess differences between children with CAE and controls. Additionally, potential relations between the core network and cognitive performance was investigated. A lower assortativity (i.e. less efficiently organized core network organization) was found for children with CAE compared to controls. Moreover, better cognitive performance was found to relate to stronger assortative mixing pattern (i.e. more efficient core network structure). Rich-club coefficients did not differ between groups, nor relate to cognitions. The core network organization of the SCN in children with CAE tend to be less efficient organized compared to controls, and relates to cognitive performance, and therefore this study provides novel insights into the SCN organization in relation to CAE and cognition.
Collapse
Affiliation(s)
- Merel J.A. Eussen
- Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacobus F.A. Jansen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Twan P.C. Voncken
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
| | | | - Jos G.M. Hendriksen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
| | - R. Jeroen Vermeulen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walter H. Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gerhard S. Drenthen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
6
|
Sun F, Wang Y, Li Y, Li Y, Wang S, Xu F, Wang X. Variation in functional networks between clinical and subclinical discharges in childhood absence epilepsy: A multi-frequency MEG study. Seizure 2023; 111:109-121. [PMID: 37598560 DOI: 10.1016/j.seizure.2023.08.005] [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: 04/24/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE Two types of spike-and-wave discharges (SWDs) exist in childhood absence epilepsy (CAE): clinical discharges are prolonged and manifest primarily as impaired consciousness, whereas subclinical discharges are brief with few objectively visible symptoms. This study aimed to compare neural functional network and default mode network (DMN) activity between clinical and subclinical discharges to better understand the underlying mechanism of CAE. METHODS Using magnetoencephalography (MEG) data from 21 patients, we obtained 25 segments each of clinical discharges and subclinical discharges. Amplitude envelope correlation analysis was used to construct functional networks and graph theory was used to calculate network topological data. We then compared differences in functional connectivity within the DMN between clinical and subclinical discharges. All statistical comparisons were performed using paired-sample tests. RESULTS Compared to subclinical discharges, the functional network of clinical discharges exhibited higher synchronization - particularly in the parahippocampal gyrus - as early as 10 s before the seizure. Additionally, the functional network of clinical SWDs presented an anterior shift of key nodes in the alpha frequency band. Regarding clinical discharge progression, there were gradual increases in the parameter node strengths (S), clustering coefficients (C), and global efficiency (E) of the functional networks, while the path lengths (L) decreased. These changes were most prominent at the onset of discharges and followed by some recovery in the high-frequency bands, but no significant change in the low-frequency bands. Furthermore, connections within the DMN during the discharge period were significantly stronger for clinical discharge compared to subclinical discharges. CONCLUSIONS These findings suggest that a more regular network before abnormal discharges in clinical discharges contributes to SWD explosion and that the parahippocampal gyrus plays an important role in maintaining oscillations. An absence seizure is a gradual process and the emergence of SWDs may be accompanied by initiation of inhibitory mechanisms. Enhanced functional connectivity among DMN brain regions may indicate that patients have entered a state of introspection, and functional abnormalities in the parahippocampal gyrus may be associated with patients' transient memory loss.
Collapse
Affiliation(s)
- Fangling Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzhang Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Siyi Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Fengyuan Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
7
|
Edizer S, Baysal BT, Ünalp A, Yılmaz Ü. Changes in awake and sleep electroencephalography characteristics after 1-year treatment for childhood and juvenile absence epilepsy. Seizure 2023; 110:244-252. [PMID: 37441906 DOI: 10.1016/j.seizure.2023.06.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE To compare electroencephalography (EEG) features of newly diagnosed drug-naive childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) patients and analyze their response to anti-seizure medications (ASMs). METHOD EEG characteristics between CAE and JAE patients and responders and non-responders to ASM at baseline and 12 months were compared, and the changes from baseline were analysed. RESULTS A total of 62 patients (32 CAE and 30 JAE) were included. Discharges in baseline awake and sleep EEGs and interictal and polyspike discharges in baseline sleep EEGs were more frequent in JAE patients. Although the median discharge densities (discharge containing seconds per minute) were similar in baseline awake and sleep EEGs between the groups, the median was higher in the JAE group at 12 months and decreased significantly in both groups at 12 months compared to the baseline values. Responses to initial ASMs were 94% and 77% in the CAE and JAE groups, respectively. In initial sleep EEGs of non-responders with JAE, focal onset generalized spike and slow wave discharges (GSWDs) were more frequent, and the median ictal and interictal discharge densities were higher. CONCLUSION JAE patients had more frequent disorganized discharges at baseline in both awake and sleep EEGs and interictal and polyspike discharges in sleep EEGs than those of CAE patients. Improvement in EEG was more pronounced in CAE patients than in JAE patients. Focal-onset GSWDs and higher ictal and interictal discharge densities on baseline EEG were associated with a poor response to initial ASMs in JAE patients.
Collapse
Affiliation(s)
- Selvinaz Edizer
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey.
| | - Bahar Toklu Baysal
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Aycan Ünalp
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Ünsal Yılmaz
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| |
Collapse
|
8
|
Zhang W, Xin M, Song G, Liang J. Childhood absence epilepsy patients with cognitive impairment have decreased sleep spindle density. Sleep Med 2023; 103:89-97. [PMID: 36773472 DOI: 10.1016/j.sleep.2023.01.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/22/2022] [Accepted: 01/15/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To explore the differences in sleep spindle (SS) characteristics during stage N2 sleep between children with childhood absence epilepsy and healthy controls, and between children with childhood absence epilepsy with or without cognitive impairment. METHODS We recruited 29 children (14 females, 15 males, mean age: 8 (2.5) years) with childhood absence epilepsy who did not undergone antiseizure treatments previously and 30 age-matched controls (14 females, 16 males, mean age: 9 (3.0) years). For all patients, data on medical history were collected. Each child was monitored overnight by long-term video electroencephalography and was evaluated by the Wechsler Intelligence Scale for Children-Fourth Edition. Next, we compared anterior SS characteristics, including density, frequency, cycle length, duration, amplitude, and percentage of sleep stages. RESULTS The childhood absence epilepsy group exhibited lower spindle density and duration in the first 37.5 min of stage N2 sleep than the control group (P < 0.01). A decrease in spindle density could be observed in the childhood absence epilepsy group with aggravated cognition impairment. The spindle density was substantially lower in the cognitively impaired group than in the cognitively unimpaired group (P < 0.01). No significant differences were observed in SS amplitude, SS frequency, SS cycle length, and the distribution of sleep stages. CONCLUSIONS Reduction in spindle density and duration is associated with the mechanisms underlying childhood absence epilepsy. The deficit in SS density is related with impaired cognition. This deficiency in SSs may be a useful predictive indicator of cognitive impairment in children with absence epilepsy, indicating that SSs may become a useful biomarker and potential adjuvant anti-seizure target for cognitive impairment caused by childhood absence epilepsy.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China.
| | - Meiying Xin
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China.
| | - Ge Song
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jianmin Liang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China.
| |
Collapse
|
9
|
Boesen MS, Børresen ML, Christensen SK, Klein-Petersen AW, El Mahdaoui S, Sagar MV, Schou E, Eltvedt AK, Cacic Hribljan M, Born AP, Uldall PV, Thygesen LC, Miranda MJ. School performance and psychiatric comorbidity in childhood absence epilepsy: A Danish cohort study. Eur J Paediatr Neurol 2023; 42:75-81. [PMID: 36584475 DOI: 10.1016/j.ejpn.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 10/12/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
The aim was to determine school performance and psychiatric comorbidity in children with childhood absence epilepsy (CAE). We reviewed the medical records in children with ICD-10 codes for idiopathic generalized epilepsy before 18 years of age, and pediatric neurologists confirmed the International League Against Epilepsy criteria for CAE were met. Control groups were the general pediatric population or children with non-neurological chronic disease. Outcomes were from nationwide and population-based registers on school performance and psychiatric comorbidity. We compared the mean grade point average using linear regression and estimated hazard ratios (HR) using Cox regression for the other outcomes. Analyses were adjusted for the child's sex, and year of birth, and parental highest education, receipt of cash benefits or early disability pension. We included 114 children with CAE with a median age at onset of 5.9 years (interquartile range = 4.5-7.3 years). Compared with both population controls and non-neurological chronically ill children, children with CAE had increased hazard of special needs education (HR = 2.7, 95% confidence interval (CI) = 1.8-4.1, p < 0.0001), lower grade point average at 9th grade by 1.7 grade points (95% CI = -2.5 to -1.0, p < 0.001), increased ADHD medicine use (HR = 4.4, 95% CI = 2.7-7.2, p < 0.001), increased sleep medicine use (HR = 2.7, 95% CI = 1.7-4.3, p < 0.001), and increased psychiatry visits (HR = 2.1, 95% CI = 1.1-4.0, p = 0.03). In conclusion, children with CAE have increased psychiatric comorbidity and a considerable proportion of these children receive special needs education in primary/secondary school, albeit insufficient to normalize their considerably lower grade point average in the 9th grade.
Collapse
|
10
|
Kumar A, Lyzhko E, Hamid L, Srivastav A, Stephani U, Japaridze N. Neuronal networks underlying ictal and subclinical discharges in childhood absence epilepsy. J Neurol 2023; 270:1402-1415. [PMID: 36370186 PMCID: PMC9971098 DOI: 10.1007/s00415-022-11462-8] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
Childhood absence epilepsy (CAE), involves 3 Hz generalized spikes and waves discharges (GSWDs) on the electroencephalogram (EEG), associated with ictal discharges (seizures) with clinical symptoms and impairment of consciousness and subclinical discharges without any objective clinical symptoms or impairment of consciousness. This study aims to comparatively characterize neuronal networks underlying absence seizures and subclinical discharges, using source localization and functional connectivity (FC), to better understand the pathophysiological mechanism of these discharges. Routine EEG data from 12 CAE patients, consisting of 45 ictal and 42 subclinical discharges were selected. Source localization was performed using the exact low-resolution electromagnetic tomography (eLORETA) algorithm, followed by FC based on the imaginary part of coherency. FC based on the thalamus as the seed of interest showed significant differences between ictal and subclinical GSWDs (p < 0.05). For delta (1-3 Hz) and alpha bands (8-12 Hz), the thalamus displayed stronger connectivity towards other brain regions for ictal GSWDs as compared to subclinical GSWDs. For delta band, the thalamus was strongly connected to the posterior cingulate cortex (PCC), precuneus, angular gyrus, supramarginal gyrus, parietal superior, and occipital mid-region for ictal GSWDs. The strong connections of the thalamus with other brain regions that are important for consciousness, and with components of the default mode network (DMN) suggest the severe impairment of consciousness in ictal GSWDs. However, for subclinical discharges, weaker connectivity between the thalamus and these brain regions may suggest the prevention of impairment of consciousness. This may benefit future therapeutic targets and improve the management of CAE patients.
Collapse
Affiliation(s)
- Ami Kumar
- Department of Neuropediatrics, Children's Hospital, University Medical Center Schleswig-Holstein, University of Kiel, Kiel, Germany. .,Faculty of Mathematics and Natural Sciences, University of Kiel, Kiel, Germany. .,Department of Neurology, Columbia University Irving Medical Center, New York, USA.
| | - Ekaterina Lyzhko
- Department of Neuropediatrics, Children’s Hospital, University Medical Center Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Laith Hamid
- Institute of Medical Psychology and Medical Sociology, University of Kiel, Kiel, Germany ,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Anand Srivastav
- Faculty of Mathematics and Natural Sciences, University of Kiel, Kiel, Germany
| | - Ulrich Stephani
- Department of Neuropediatrics, Children’s Hospital, University Medical Center Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Natia Japaridze
- Department of Neuropediatrics, Children’s Hospital, University Medical Center Schleswig-Holstein, University of Kiel, Kiel, Germany
| |
Collapse
|
11
|
Chen J, Liu P, Hu W, Shi K. Absence seizures during sleep in childhood absence epilepsy: A sign of drug resistance? Brain Dev 2022; 44:313-317. [PMID: 34895931 DOI: 10.1016/j.braindev.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/26/2021] [Revised: 10/31/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Childhood absence epilepsy (CAE) is a common pediatric epilepsy syndrome. It is characterized by typical absence seizures and a highly recognizable electroencephalography (EEG) pattern. But little is known about absence seizures during sleep. CASE REPORT A 7-year-old female presented with frequent typical absence seizures with 3 Hz generalized spike and wave discharges on EEG. Based on electro-clinical features she was diagnosed with CAE. When she was 8 years old, absence seizures occurred during sleep. She had refractory absence seizures even with valproic acid, lamotrigine, levetiracetam, and perampanel. CONCLUSION Absence seizures can occur during sleep in CAE. Absence seizures should be considered, especially when 3 Hz generalized spike and wave discharges last >2 s on EEG during sleep. It may be a sign of drug resistance and poor prognosis.
Collapse
Affiliation(s)
- Jialei Chen
- Pediatric Neurology Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, China
| | - Ping Liu
- Pediatric Neurology Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, China
| | - Wenguang Hu
- Pediatric Neurology Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, China.
| | - Kun Shi
- Pediatric Cardiology Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, China
| |
Collapse
|
12
|
Shu M, Yu C, Shi Q, Li Y, Niu K, Zhang S, Wang X. Alterations in white matter integrity and asymmetry in patients with benign childhood epilepsy with centrotemporal spikes and childhood absence epilepsy: An automated fiber quantification tractography study. Epilepsy Behav 2021; 123:108235. [PMID: 34411950 DOI: 10.1016/j.yebeh.2021.108235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 07/19/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate whether patients with benign childhood epilepsy with centrotemporal spikes (BECTS) and childhood absence epilepsy (CAE) show distinct patterns of white matter (WM) alterations and structural asymmetry compared with healthy controls and the relationship between WM alterations and epilepsy-related clinical variables. METHODS We used automated fiber quantification to create tract profiles of fractional anisotropy (FA) and mean diffusivity (MD) in twenty-six patients with BECTS, twenty-nine patients with CAE, and twenty-four healthy controls. Group differences in FA and MD were quantified at 100 equidistant nodes along the fiber tract and these alterations and epilepsy-related clinical variables were correlated. A lateralization index (LI) representing the structural asymmetry of the fiber tract was computed and compared between both patient groups and controls. RESULTS Compared with healthy controls, the BECTS group showed widespread FA reduction in 43.75% (7/16) and MD elevation in 50% (8/16) of identified fiber tracts, and the CAE group showed regional FA reduction in 31.25% (5/16) and MD elevation in 25% (4/16) of identified fiber tracts. In the BECTS group, FA and MD in the right anterior thalamic radiation positively and negatively correlated with the number of antiepileptic drugs, respectively, and MD in the right arcuate fasciculus (AF) positively correlated with seizure frequency. In the CAE group, the LI values were significantly lower in the inferior fronto-occipital fasciculus and the AF. CONCLUSION The two childhood epilepsy syndromes display different patterns of WM alterations and structural asymmetry, suggesting that neuroanatomical differences may underlie the different profiles of BECTS and CAE.
Collapse
|
13
|
Sun Y, Li Y, Sun J, Zhang K, Tang L, Wu C, Gao Y, Liu H, Huang S, Hu Z, Xiang J, Wang X. Functional reorganization of brain regions into a network in childhood absence epilepsy: A magnetoencephalography study. Epilepsy Behav 2021; 122:108117. [PMID: 34246893 DOI: 10.1016/j.yebeh.2021.108117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/01/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Epilepsy is considered as a network disorder. However, it is unknown how normal brain activity develops into the highly synchronized discharging activity seen in disordered networks. This study aimed to explore the epilepsy brain network and the significant re-combined brain areas in childhood absence epilepsy (CAE). METHODS Twenty-two children with CAE were recruited to study the neural source activity during ictal-onset and interictal periods at frequency bands of 1-30 Hz and 30-80 Hz with magnetoencephalography (MEG) scanning. Accumulated source imaging (ASI) was used to analyze the locations of neural source activity and peak source strength. RESULTS Most of the participants had more active source activity locations in the ictal-onset period rather than in the interictal period, both at 1-30 Hz and 30-80 Hz. The frontal lobe (FL), the temporo-parietal junction (T-P), and the parietal lobe (PL) became the main active areas of source activity during the ictal period, while the precuneus (PC), cuneus, and thalamus were relatively inactive. CONCLUSIONS Some brain areas become more excited and have increased source activity during seizures. These significant brain regions might be re-combined to form an epilepsy network that regulates the process of absence seizures. SIGNIFICANCE The study confirmed that important brain regions are reorganized in an epilepsy network, which provides a basis for exploring the network mechanism of CAE development. Imaging findings may provide a reference for clinical characteristics.
Collapse
Affiliation(s)
- Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ke Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lu Tang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Caiyun Wu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yuan Gao
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongxing Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Shuyang Huang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- Division of Neurology, MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| |
Collapse
|
14
|
Abstract
Epilepsy can now be diagnosed even in the presence of one unprovoked seizure or if the diagnosis of an epilepsy syndrome can be made. Epilepsy syndromes represent a specific set of seizure types and electroencephalographic and imaging features that tend to have age-dependent features, triggers, and prognosis. Epilepsy syndromes are the third and final level of epilepsy diagnosis, after classification of seizure and epilepsy types. Some epilepsy syndromes are self-limiting and pharmacoresponsive and others are pharmacoresistant and associated with poor developmental outcomes (epileptic and developmental encephalopathy). Features and management of 7 common age-dependent pediatric epilepsy syndromes are described.
Collapse
Affiliation(s)
- Akshat Katyayan
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701, Fannin Street, Suite 1250, Houston, TX 77030, USA; Department of Neurology, Baylor College of Medicine, Texas Children's Hospital, 6701, Fannin Street, Suite 1250, Houston, TX 77030, USA.
| | - Gloria Diaz-Medina
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701, Fannin Street, Suite 1250, Houston, TX 77030, USA; Department of Neurology, Baylor College of Medicine, Texas Children's Hospital, 6701, Fannin Street, Suite 1250, Houston, TX 77030, USA
| |
Collapse
|
15
|
Wang X, Hu T, Yang Q, Jiao D, Yan Y, Liu L. Graph-theory based degree centrality combined with machine learning algorithms can predict response to treatment with antiepileptic medications in children with epilepsy. J Clin Neurosci 2021; 91:276-282. [PMID: 34373040 DOI: 10.1016/j.jocn.2021.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/20/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the current study is to detect changes of graph-theory-based degree centrality (DC) and their relationship with the clinical treatment effects of anti-epileptic drugs (AEDs) for patients with childhood absence epilepsy (CAE) using resting-state functional MRI (RS-fMRI). METHODS RS-fMRI data from 35 CAE patients were collected and compared with findings from 35 age and gender matched healthy controls (HCs). The patients were treated with AEDs for 46.03 weeks before undergoing a second RS-fMRI scan. RESULTS CAE children at baseline showed increased DC in thalamus, postcentral and precentral and reduced DC in medial frontal cortex, superior frontal cortex, middle temporal cortex, angular and precuneus. However, those abnormalities showed a clear renormalization after AEDs treatments. We then explored the viability of graph-theory-based degree centrality to accurately classify effectiveness to AEDs. Support Vector Machine analysis using leave-one-out cross-validation achieved a correct classification rate of 84.22% [sensitivity 78.76%, specificity 89.65%, and area under the receiver operating characteristic curve (AUC) 0.96] for differentiating effective subjects from ineffective subjects. Brain areas that contributed most to the classification model were mainly located within the right thalamus, bilateral middle temporal gyrus, right medial frontal gyrus, right inferior frontal gyrus, left precuneus, bilateral angular right precentral and left postcentral. Furthermore, the DC change within the bilateral angular are positively correlated with the symptom improvements after AEDs treatment. CONCLUSION These findings suggest that graph-theory-based measures, such as DC, combined with machine-learning algorithms, can provide crucial insights into pathophysiological mechanisms and the effectiveness of AEDs.
Collapse
Affiliation(s)
- Xueyu Wang
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
| | - Tian Hu
- Department of Radiology, Yanan University Affiliated Hospital, China
| | - Qi Yang
- Department of Radiology, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, China
| | - Dongmei Jiao
- Department of Internal Medicine, The Second Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, China
| | - Yibing Yan
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Libo Liu
- Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
| |
Collapse
|
16
|
Li W, Zhao W, Wang J, Zhang X, Qian X, Gu R, He G. Identification of a novel variant p.Ser606Gly in SCN3A associated with childhood absence epilepsy. Epilepsy Res 2021; 175:106682. [PMID: 34102392 DOI: 10.1016/j.eplepsyres.2021.106682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Sodium (Na+) channels are the basis for action potential generation and propagation, which play a key role in the regulation of neuronal excitability. SCN3A is a gene encoding for sodium channel protein type 3 subunit alpha (or known as Nav1.3). This study aimed to explore SCN3A genetic variants in a cohort of childhood absence epilepsy (CAE) via whole exome sequencing. A novel SCN3A missense variant (c.A1816G, p.Ser606Gly) was identified in a patient with CAE. This variant had not been reported in both 1000G and ExAC databases. Bioinformatics analysis revealed that this variant was pathogenic and could transform the protein structure of Nav1.3. The reported phenotypes of SCN3A-related central nerve system disorders included multiple seizure types, polymicrogyria and different degrees of developmental delay/intellectual disability. The patient with p.Ser606Gly variant exhibited typical absence seizures. The MRI and CT scan results were normal, and EEG showed that 3-Hz spike-slow wave discharges. In conclusion, our findings not only broaden the pathogenic spectrum of SCN3A, but also extend the clinical phenotypes of SCN3A-related CAE.
Collapse
Affiliation(s)
- Wei Li
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Wenli Zhao
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Jing Wang
- School of Forensic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Xiaoli Zhang
- Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xinlai Qian
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China.
| | - Renjun Gu
- Department of Neurology, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
| | - Guoyang He
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China.
| |
Collapse
|
17
|
Fujiwara H, Tenney J, Kadis DS, Altaye M, Spencer C, Vannest J. Cortical and subcortical volume differences between Benign Epilepsy with Centrotemporal Spikes and Childhood Absence Epilepsy. Epilepsy Res 2020; 166:106407. [PMID: 32634725 DOI: 10.1016/j.eplepsyres.2020.106407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) and Childhood Absence Epilepsy (CAE) are the most common childhood epilepsy syndromes and they share a similar age-dependence. However, the two syndromes clearly differ in seizures and EEG patterns. The aim of this study is to investigate whether children of the same age with BECTS, CAE and typically-developing children have significant differences in grey matter volume that may underlie the different profiles of these syndromes. METHODS Twenty one patients with newly-diagnosed BECTS and 18 newly diagnosed and drug naïve CAE were included and compared to 31 typically-developing children. Voxel-based morphometry was utilized to investigate grey matter volume differences among BECTS, CAE, and controls. We also examined the effect of age on grey matter volume in all three groups. In addition to the whole brain analysis, we chose regions of interest analysis based on previous literature suggesting the involvement of these regions in BECTS or CAE. The group differences of grey matter volume was tested with 2-sample t-test for between two groups' comparisons and ANOVA for three group comparisons. RESULTS In the whole brain group comparisons, the grey matter volume in CAE was significantly decreased in the areas of right inferior frontal and anterior temporal compared to BECTS and controls (F2,67 = 27.53, p < 0.001). In the control group, grey matter volume in bifrontal lobes showed a negative correlation with age (r=-0.54, p < 0.05), whereas no correlation was found in either CAE or BECTS. With ROI analyses, the grey matter volume of posterior thalami was increased in CAE compared to other 2 groups (p < 0.05). SIGNIFICANCE This study shows that there are grey matter volume differences between CAE and BECTS. Our findings of grey matter volume differences may suggest that there may be localized, specific differences in brain structure between these two types of epilepsy.
Collapse
Affiliation(s)
- Hisako Fujiwara
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA.
| | - Jeffrey Tenney
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA.
| | - Darren S Kadis
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA.
| | - Mekibib Altaye
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA.
| | - Caroline Spencer
- University of Cincinnati, Communications Sciences and Disorders Program of the College of Allied Health Service, 3225 Eden Avenue P.O. Box 670379, Cincinnati, OH 45267, USA.
| | - Jennifer Vannest
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. Cincinnati, OH, 45229, USA.
| |
Collapse
|
18
|
Giordano L, Tambucci R, Cocco IE, Angriman M, Coppola G, Operto FF, Farello G, Savasta S, Belcastro V, Verrotti A. Infantile spasms followed by childhood absence epilepsy: A case series. Seizure 2019; 74:77-80. [PMID: 31841970 DOI: 10.1016/j.seizure.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/20/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Infantile spasms (IS) represent a severe seizure disorder of infancy and early childhood characterized by epileptic spasms along with hypsarrhythmia often accompanied by intellectual disability. According to the current classification and terminology (3) IS can be categorized as known etiology, formerly known as "symptomatic", when an underlying cause has been observed prior to the onset of spasms, or of "unknown cause" with "unfavorable" and "favorable" outcome (previously referred as "cryptogenic" or "idiopathic", respectively). Single reports described children with "unknown cause and favorable outcome" (UC/FO) IS who later developed childhood absence epilepsy (CAE). This study aims to determine the prevalence of CAE following IS. METHODS a multicenter retrospective chart review was performed; children with UC/FO IS who subsequently developed CAE during follow-up were identified. Eight Italian pediatric epilepsy centers participated in this study. RESULTS seven out of 24 (29 %) children (3 males) showing a favorable outcome (UC/FO) IS received a second diagnosis of CAE during follow-up. Mean age at IS presentation was 5.8 months (SD ± 0.9). All achieved seizure control of IS at a mean age of 8.5 months (SD ± 1.3) (3 monotherapy, 4 polytherapy). CAE was diagnosed at a mean age of 8.0 years (SD ± 3.0). Six children achieved sustained remission of CAE with valproic acid, whereas 1 child required dual therapy by adding ethosuximide. CONCLUSION although it is not possible to determine whether the association between UC/FO IS and CAE implies a causality relationship, the later occurrence of CAE in patients with UC/FO IS might support a possible role of thalamo-cortical dysfunction.
Collapse
Affiliation(s)
- Lucio Giordano
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - Renato Tambucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | | | - Marco Angriman
- Department of Pediatrics, Child Neurology and Neurorehabilitation Unit, Hospital of Bolzano, Bolzano, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Fisciano, Italy
| | - Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Farello
- Pediatric Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Savasta
- Department of Pediatrics, Pavia University Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
| |
Collapse
|
19
|
Cainelli E, Mioni G, Boniver C, Bisiacchi PS, Vecchi M. Time perception in childhood absence epilepsy: Findings from a pilot study. Epilepsy Behav 2019; 99:106460. [PMID: 31470222 DOI: 10.1016/j.yebeh.2019.106460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/20/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES With this explorative study, we aimed to examine time perception in children with childhood absence epilepsy (CAE) and to compare those children with a matched control group. The study also investigated the association between the neuropsychological performance of the group with CAE and time judgment. We hypothesize that children with CAE could fail in time perception and that this may be because of a common underlying substrate with executive impairments. METHODS Thirteen children with CAE, aged 6-13 years, and 17 healthy children were recruited. All children performed the time bisection task; the children with CAE also performed a cognitive and neuropsychological assessment. We performed a univariate analysis using each parameter of the bisection task (bisection point [BP]) and Weber ratio (WR) as dependent variables, the group (patients vs. controls) as fixed factors and age at evaluation and vocabulary scores as covariates. In the subgroup of patients, we correlated bisection task parameters with neuropsychological tests using a nonparametric partial correlation; the analysis has corrected for age at evaluation. RESULTS The BP and WR measures differed between controls and patients with CAE. In the subgroup of patients also performing a neuropsychological assessment, we found a correlation between the WR measure and performance on the inhibition test (r = -0.641, p = .025), coding test (r = -0.815, p = .014), and Trail Making Test B (TMT B) (r = 0.72, p = .042). CONCLUSIONS We found an altered time perception in a pilot study of a small group of children with CAE. A neurophysiological mechanism underlying CAE seems to influence cognitive and behavioral deficits and time sensibility.
Collapse
Affiliation(s)
- Elisa Cainelli
- Department of Development and Socialization, University of Padova, Italy; Child Neurology and Clinical Neurophysiology, Women's and Children's Health Department, Padua University Hospital, Padova, Italy.
| | - Giovanna Mioni
- Department of General Psychology, University of Padova, Italy.
| | - Clementina Boniver
- Child Neurology and Clinical Neurophysiology, Women's and Children's Health Department, Padua University Hospital, Padova, Italy.
| | - Patrizia S Bisiacchi
- Department of General Psychology, University of Padova, Italy; Padova Neuroscience Center, PNC.
| | - Marilena Vecchi
- Child Neurology and Clinical Neurophysiology, Women's and Children's Health Department, Padua University Hospital, Padova, Italy; Neuromotor Rehabilitation Center La Nostra Famiglia Association, Vicenza, Italy.
| |
Collapse
|
20
|
Xie H, Su W, Pei J, Zhang Y, Gao K, Li J, Ma X, Zhang Y, Wu X, Jiang Y. De novo SCN1A, SCN8A, and CLCN2 mutations in childhood absence epilepsy. Epilepsy Res 2019; 154:55-61. [PMID: 31054517 DOI: 10.1016/j.eplepsyres.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 12/23/2022]
Abstract
This study aimed to identify monogenic mutations from Chinese patients with childhood absence epilepsy (CAE) and summarize their characteristics. A total of 100 patients with CAE were recruited in Peking University First Hospital from 2005 to 2016 and underwent telephone and outpatient follow-up review. We used targeted disease-specific gene capture sequencing (involving 300 genes) to identify pathogenic variations for these patients. We identified three de novo epilepsy-related gene mutations, including missense mutations of SCN1A (c. 5399 T > A; p. Val1800Asp), SCN8A (c. 2371 G > T; p. Val791Phe), and CLCN2 (c. 481 G > A; p. Gly161Ser), from three patients, separately. All recruited patients presented typical CAE features and good prognosis. To date, CAE has been considered a complex disease caused by multiple susceptibility genes. In this study, we observed that 3% of typical CAE patients had a de novo mutation of a known monogenic epilepsy-related gene. Our study suggests that a significant proportion of typical CAE cases may be monogenic forms of epilepsy. For genetic generalized epilepsies, such as CAE, further studies are needed to clarify the contributions of de novo or inherited rare monogenic coding, noncoding and copy number variants.
Collapse
|
21
|
Morse E, Giblin K, Chung MH, Dohle C, Berg AT, Blumenfeld H. Historical trend toward improved long-term outcome in childhood absence epilepsy. Epilepsy Res 2019; 152:7-10. [PMID: 30856420 DOI: 10.1016/j.eplepsyres.2019.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/19/2019] [Accepted: 02/25/2019] [Indexed: 01/21/2023]
Abstract
We retrospectively analyzed published studies to investigate historical trends in outcome of childhood absence epilepsy (CAE). We included patients based on onset of absence seizures in childhood, 3 Hz bilateral spike-wave discharges on EEG, and availability of seizure-free outcome data. The primary endpoint was seizure-freedom off medications by study publication year. We also analyzed relationships between seizure-freedom and 1. treatment medication, and 2. CAE diagnostic criteria. We included 29 studies published 1945-2013, encompassing 2416 patients. Seizure-freedom off medications was higher for studies after 1985 versus before 1975 (82% versus 35%; p < 0.001). Ethosuximide and valproate were used more commonly after 1985, and patients previously treated with ethosuximide or valproate had higher seizure-freedom off medications than those treated only with other medications (64% versus 32%; χ2>10; p < 0.001). Although differences in diagnostic criteria for early vs. later studies did not reach statistical significance, later studies tended to use normal EEG background (p = 0.09) and absence of comorbid disorders (p = 0.09) as criteria more commonly. These findings demonstrate that seizure-freedom off medications has improved in published CAE studies after 1985. Our results are limited due to retrospective analysis. Further work is needed with prospective, controlled trials to establish factors leading to improved long-term prognosis in CAE.
Collapse
Affiliation(s)
- Elliot Morse
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Kathryn Giblin
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Mi Hae Chung
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Carolin Dohle
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Anne T Berg
- Department of Pediatric Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA; Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA.
| |
Collapse
|
22
|
Liu Y, Milton J, Campbell SA. Outgrowing seizures in Childhood Absence Epilepsy: time delays and bistability. J Comput Neurosci 2019; 46:197-209. [PMID: 30737596 DOI: 10.1007/s10827-019-00711-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/14/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
We formulate a conductance-based model for a 3-neuron motif associated with Childhood Absence Epilepsy (CAE). The motif consists of neurons from the thalamic relay (TC) and reticular nuclei (RT) and the cortex (CT). We focus on a genetic defect common to the mouse homolog of CAE which is associated with loss of GABAA receptors on the TC neuron, and the fact that myelination of axons as children age can increase the conduction velocity between neurons. We show the combination of low GABAA mediated inhibition of TC neurons and the long corticothalamic loop delay gives rise to a variety of complex dynamics in the motif, including bistability. This bistability disappears as the corticothalamic conduction delay shortens even though GABAA activity remains impaired. Thus the combination of deficient GABAA activity and changing axonal myelination in the corticothalamic loop may be sufficient to account for the clinical course of CAE.
Collapse
|
23
|
Abstract
The glucose transporter type 1 (Glut1) is the most important energy carrier of the brain across the blood-brain barrier. In the early nineties, the first genetic defect of Glut1 was described and known as the Glut1 deficiency syndrome (Glut1-DS). It is characterized by early infantile seizures, developmental delay, microcephaly, and ataxia. Recently, milder variants have also been described. The clinical picture of Glut1 defects and the understanding of the pathophysiology of this disease have significantly grown. A special form of transient movement disorders, the paroxysmal exertion-induced dyskinesia (PED), absence epilepsies particularly with an early onset absence epilepsy (EOAE) and childhood absence epilepsy (CAE), myoclonic astatic epilepsy (MAE), episodic choreoathetosis and spasticity (CSE), and focal epilepsy can be based on a Glut1 defect. Despite the rarity of these diseases, the Glut1 syndromes are of high clinical interest since a very effective therapy, the ketogenic diet, can improve or reverse symptoms especially if it is started as early as possible. The present article summarizes the clinical features of Glut1 syndromes and discusses the underlying genetic mutations, including the available data on functional tests as well as the genotype-phenotype correlations. This article is part of the Special Issue "Individualized Epilepsy Management: Medicines, Surgery and Beyond".
Collapse
Affiliation(s)
- Henner Koch
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Yvonne G Weber
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| |
Collapse
|
24
|
Miao A, Wang Y, Xiang J, Liu Q, Chen Q, Qiu W, Liu H, Tang L, Gao Y, Wu C, Yu Y, Sun J, Jiang W, Shi Q, Zhang T, Hu Z, Wang X. Ictal Source Locations and Cortico-Thalamic Connectivity in Childhood Absence Epilepsy: Associations with Treatment Response. Brain Topogr 2019; 32:178-91. [PMID: 30291582 DOI: 10.1007/s10548-018-0680-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
Childhood absence epilepsy (CAE), the most common pediatric epilepsy syndrome, is usually treated with valproic acid (VPA) and lamotrigine (LTG) in China. This study aimed to investigate the ictal source locations and functional connectivity (FC) networks between the cortices and thalamus that are related to treatment response. Magnetoencephalography (MEG) data from 25 patients with CAE were recorded at 300 Hz and analyzed in 1-30 Hz frequency bands. Neuromagnetic sources were volumetrically scanned with accumulated source imaging. The FC networks between the cortices and thalamus were evaluated at the source level through a connectivity analysis. Treatment outcome was assessed after 36-66 months following MEG recording. The children with CAE were divided into LTG responder, LTG non-responder, VPA responder and VPA non-responder groups. The ictal source locations and cortico-thalamic FC networks were compared to the treatment response. The ictal source locations in the post-dorsal medial frontal cortex (post-DMFC, including the medial primary motor cortex and the supplementary sensorimotor area) were observed in all LTG non-responders but in all LTG responders. At 1-7 Hz, patients with fronto-thalamo-parietal/occipital (F-T-P/O) networks were older than those with fronto-thalamic (F-T) networks or other cortico-thalamic networks (p = 0.000). The duration of seizures in patients with F-T-P/O networks at 1-7 Hz was longer than that in patients with F-T networks or other cortico-thalamic networks (p = 0.001). The ictal post-DMFC source localizations suggest that children with CAE might experience initial LTG monotherapy failure. Moreover, the cortico-thalamo-cortical network is associated with age. Finally, the cortico-thalamo-cortical network consists of anterior and posterior cortices and might contribute to the maintenance of discharges.
Collapse
|
25
|
Youssofzadeh V, Agler W, Tenney JR, Kadis DS. Whole-brain MEG connectivity-based analyses reveals critical hubs in childhood absence epilepsy. Epilepsy Res 2018; 145:102-109. [PMID: 29936300 DOI: 10.1016/j.eplepsyres.2018.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/21/2018] [Accepted: 06/03/2018] [Indexed: 01/01/2023]
Abstract
Absence seizures are thought to be linked to abnormal interplays between regions of a thalamocortical network. However, the complexity of this widespread network makes characterizing the functional interactions among various brain regions challenging. Using whole-brain functional connectivity and network analysis of magnetoencephalography (MEG) data, we explored pre-treatment brain hubs ("highly connected nodes") of patients aged 6 to 12 years with childhood absence epilepsy. We analyzed ictal MEG data of 74 seizures from 16 patients. We employed a time-domain beamformer technique to estimate MEG sources in broadband (1-40 Hz) where the greatest power changes between ictal and preictal periods were identified. A phase synchrony measure, phase locking value, and a graph theory metric, eigenvector centrality (EVC), were utilized to quantify voxel-level connectivity and network hubs of ictal > preictal periods, respectively. A volumetric atlas containing 116 regions of interests (ROIs) was utilized to summarize the network measures. ROIs with EVC (z-score) > 1.96 were reported as critical hubs. ROIs analysis revealed functional-anatomical hubs in a widespread network containing bilateral precuneus (right/left, z = 2.39, 2.18), left thalamus (z = 2.28), and three anterior cerebellar subunits of lobule "IV-V" (z = 3.9), vermis "IV-V" (z = 3.57), and lobule "III" (z = 2.03). Findings suggest that highly connected brain areas or hubs are present in focal cortical, subcortical, and cerebellar regions during absence seizures. Hubs in thalami, precuneus and cingulate cortex generally support a theory of rapidly engaging and bilaterally distributed networks of cortical and subcortical regions responsible for seizures generation, whereas hubs in anterior cerebellar regions may be linked to terminating motor automatisms frequently seen during typical absence seizures. Whole-brain network connectivity is a powerful analytic tool to reveal focal components of absence seizures in MEG. Our investigations can lead to a better understanding of the pathophysiology of CAE.
Collapse
Affiliation(s)
- Vahab Youssofzadeh
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA; Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA; Pediatric Neuroimaging Research Consortium (PNRC), Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - William Agler
- Pediatric Neuroimaging Research Consortium (PNRC), Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Jeffrey R Tenney
- Pediatric Neuroimaging Research Consortium (PNRC), Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati OH, USA.
| | - Darren S Kadis
- Pediatric Neuroimaging Research Consortium (PNRC), Cincinnati Children's Hospital Medical Center, Cincinnati OH, USA; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati OH, USA.
| |
Collapse
|
26
|
Lee HJ, Kim EH, Yum MS, Ko TS, Kim HW. Attention profiles in childhood absence epilepsy compared with attention-deficit/hyperactivity disorder. Brain Dev 2018; 40:94-99. [PMID: 28992996 DOI: 10.1016/j.braindev.2017.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/09/2016] [Revised: 09/11/2017] [Accepted: 09/15/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to compare the attention profiles of subjects with childhood absence epilepsy (CAE) to those of children with attention-deficit/hyperactivity disorder (ADHD) and controls. METHOD We retrospectively reviewed the medical records of 20 children (age 7.2 ± 1.6 years, 5 boys) in whom CAE was diagnosed at the Department of Pediatric Neurology of Asan Medical Center, Seoul, Korea. ADHD and control subjects were selected from children who visited the Department of Pediatric Psychiatry and were confirmed as having or not having ADHD based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). The 20 children with CAE, 20 with ADHD and 20 controls completed the Advanced Test of Attention (ATA), which is a computerized continuous performance task. RESULTS The CAE subjects without ADHD showed increased Omission errors (p=.013) on the visual ATA and Response time (p=0.044) on the auditory ATA than the controls, although these differences did not remain significant after multiple comparison correction. The CAE subjects without ADHD had significantly decreased Response time variability on the visual ATA than the ADHD group (p<0.001). The CAE subjects with comorbid ADHD showed increased Commission errors (p=0.020) and Response time variability (p=0.016) on the visual ATA and increased Commission errors (p=0.022) on the auditory ATA than the CAE subjects without ADHD, although statistical significance disappeared after multiple comparison adjustments. CONCLUSION These findings suggest that selective attention is impaired in children with CAE and comorbid ADHD contributes to further impairment of sustained attention and response inhibition.
Collapse
Affiliation(s)
- Hyun-Jeong Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Pediatric Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Mi-Sun Yum
- Department of Pediatric Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Sung Ko
- Department of Pediatric Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyo-Won Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
27
|
Kokkinos V, Koupparis AM, Koutroumanidis M, Kostopoulos GK. Spatiotemporal propagation patterns of generalized ictal spikes in childhood absence epilepsy. Clin Neurophysiol 2017; 128:1553-62. [PMID: 28709121 DOI: 10.1016/j.clinph.2017.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/29/2017] [Accepted: 05/31/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This work investigates the spatial distribution in time of generalized ictal spikes in the typical absences of childhood absence epilepsy (CAE). METHODS We studied twelve children with CAE, who had more than two typical absences during their routine video-EEG. Seizures were identified, and ictal spikes were marked over the maximum electronegative peak, clustered, waveform-averaged and spatiotemporaly analyzed in 2D electrode space. RESULTS Consistency of spatiotemporal patterns of ictal spikes was high between the absences of the same child, but low between children. Three main discharge patterns were identified: of anterio-posterior propagation, of posterio-anterior propagation and confined to the frontal/prefrontal regions. In 4 patients, the propagation patterns transformed during the seizure into either a lateralized diminished or a non-lateralized reverse direction form. Most spikes originated fronto-temporaly, all maximized over the frontal/prefrontal electrodes and mostly decayed prefrontaly. In 4 patients, lateralized propagation patterns were identified. CONCLUSIONS Ictal spike propagation patterns suggest that epileptogenic CAE networks are personalized, interconnect distal areas in the brain - not the entire cortex - with a tendency to generate bilateral symmetrical discharges, sometimes unsuccessfully. The transformation of propagation patterns during the seizure indicates the existence of dynamic interplay within epileptogenic networks. SIGNIFICANCE Our results support the revised concept of ictogenesis of ILAE definition in genetic (also known as idiopathic) generalized epilepsies. Understanding the focal features in CAE avoids misdiagnosis as focal epilepsy and inappropriate treatment.
Collapse
|
28
|
Martínez-Ferrández C, Martínez-Salcedo E, Casas-Fernández C, Alarcón-Martínez H, Ibáñez-Micó S, Domingo-Jiménez R. Long-term prognosis of childhood absence epilepsy. Neurologia 2017; 34:224-228. [PMID: 28325560 DOI: 10.1016/j.nrl.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Childhood absence epilepsy (CAE) is considered easily manageable with medication provided that a strict patient classification system is employed. It accounts for 10% of all childhood epilepsy cases starting before the age of 15 and it is most frequent in school-aged girls. The aim of this study is to analyse long-term outcomes of patients diagnosed with CAE according to the Loiseau and Panayiotopoulos criteria and treated during childhood. METHODS We conducted a retrospective study including 69 patients with CAE who are currently older than 11; data were gathered from medical histories, EEG records, and telephone questionnaires. RESULTS 52 patients met the Loiseau and Panayiotopoulos criteria. Mean age is now 17.16 years. Female-to-male ratio was 1.65:1; mean age at onset was 6 years and 2 months; mean duration of treatment was 3 years and 9 months. A family history of epilepsy was present in 30.8% of the patients and 7.7% had a personal history of febrile convulsions. Absence seizures were simple in 73.5% of the patients and complex in 26.5%. Response rates to first-line treatment were as follows: valproic acid, 46.3%; and valproic acid plus ethosuximide, 90.9%. The rate of response to second-line therapy (ethosuximide or lamotrigine) was 84.2%; 4% of the patients experienced further seizures after treatment discontinuation, 78.8% achieved seizure remission, and 25% needed psychological and academic support. CONCLUSIONS Our data show that epileptic patients should be classified according to strict diagnostic criteria since patients with true CAE have an excellent prognosis. The relapse rate was very low in our sample. Despite the favourable prognosis, psychological and academic support is usually necessary.
Collapse
Affiliation(s)
- C Martínez-Ferrández
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - E Martínez-Salcedo
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - C Casas-Fernández
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - H Alarcón-Martínez
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - S Ibáñez-Micó
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - R Domingo-Jiménez
- Sección Neuropediatría, Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| |
Collapse
|
29
|
Wu C, Xiang J, Jiang W, Huang S, Gao Y, Tang L, Zhou Y, Wu D, Chen Q, Hu Z, Wang X. Altered Effective Connectivity Network in Childhood Absence Epilepsy: A Multi-frequency MEG Study. Brain Topogr 2017; 30:673-84. [PMID: 28286918 DOI: 10.1007/s10548-017-0555-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 02/07/2017] [Indexed: 12/11/2022]
Abstract
Using multi-frequency magnetoencephalography (MEG) data, we investigated whether the effective connectivity (EC) network of patients with childhood absence epilepsy (CAE) is altered during the inter-ictal period in comparison with healthy controls. MEG data from 13 untreated CAE patients and 10 healthy controls were recorded. Correlation analysis and Granger causality analysis were used to construct an EC network at the source level in eight frequency bands. Alterations in the spatial pattern and topology of the network in CAE were investigated by comparing the patients with the controls. The network pattern was altered mainly in 1-4 Hz, showing strong connections within the frontal cortex and weak connections in the anterior-posterior pathways. The EC involving the precuneus/posterior cingulate cortex (PC/PCC) significantly decreased in low-frequency bands. In addition, the parameters of graph theory were significantly altered in several low- and high-frequency bands. CAE patients display frequency-specific abnormalities in the network pattern even during the inter-ictal period, and the frontal cortex and PC/PCC might play crucial roles in the pathophysiology of CAE. The EC network of CAE patients was over-connective and random during the inter-ictal period. This study is the first to reveal the frequency-specific alteration in the EC network during the inter-ictal period in CAE patients. Multiple-frequency MEG data are useful in investigating the pathophysiology of CAE, which can serve as new biomarkers of this disorder.
Collapse
|
30
|
Wang X, Jiao D, Zhang X, Lin X. Altered degree centrality in childhood absence epilepsy: A resting-state fMRI study. J Neurol Sci 2017; 373:274-9. [PMID: 28131205 DOI: 10.1016/j.jns.2016.12.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/14/2016] [Accepted: 12/26/2016] [Indexed: 12/13/2022]
Abstract
Modern network studies have suggested that the pathology of many neurological diseases is in fact not equally distributed over the brain but preferentially affects the hub regions. This study aims to investigate how hub regions were affected in Children with Childhood absence epilepsy (CAE) using resting-state fMRI (rs-fMRI). As one important measures obtained from rs-fMRI, degree centrality (DC) calculates the number of direct connections between a given node and the rest of the brain within the entire connectivity matrix of the brain. In this study, twenty-five CAE children and 25 healthy controls were recruited to investigate the DC changes in CAE patients. Compared with healthy controls, children with CAE showed significantly decreased DC in default mode network (DMN, medial prefrontal cortex, posterior cingulate cortex, precuneus and middle temporal cortex) and increased DC in thalamus. Importantly, significant negative correlation between the epilepsy duration and DC was found in precuneus. Our results suggested selective and specific disruption of hub nodes, especially thalamus and the highly connected brain regions within DMN, might underlie the pathophysiological mechanism of CAE.
Collapse
|
31
|
Schraegle WA, Nussbaum NL, Stefanatos AK. List-learning and verbal memory profiles in childhood epilepsy syndromes. Epilepsy Behav 2016; 62:159-65. [PMID: 27484747 DOI: 10.1016/j.yebeh.2016.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/27/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
Findings of material-specific influences on memory performance in pediatric epilepsy are inconsistent and merit further investigation. This study compared 90 children (aged 6years to 16years) with childhood absence epilepsy (CAE), frontal lobe epilepsy (FLE), and temporal lobe epilepsy (TLE) to determine whether they displayed distinct list-learning and verbal memory profiles on the California Verbal Learning Test - Children's Version (CVLT-C). Group comparison identified greater risk of memory impairment in children with TLE and FLE syndromes but not for those with CAE. While children with TLE performed worst overall on Short Delay Free Recall, groups with TLE and FLE performed similarly on Long Delay Free Recall. Contrast indices were then employed to explore these differences. Children with TLE demonstrated a significantly greater retroactive interference (RI) effect compared with groups with FLE and CAE. Conversely, children with FLE demonstrated a significantly worse learning efficiency index (LEI), which compares verbal memory following repetition with initial recall of the same list, than both children with TLE and CAE. These findings indicated shallow encoding related to attentional control for children with FLE and retrieval deficits in children with TLE. Finally, our combined sample showed significantly higher rates of extreme contrast indices (i.e., 1.5 SD difference) compared with the CVLT-C standardization sample. These results underscore the high prevalence of memory dysfunction in pediatric epilepsy and offer support for distinct patterns of verbal memory performance based on childhood epilepsy syndrome.
Collapse
Affiliation(s)
- William A Schraegle
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA.
| | - Nancy L Nussbaum
- Comprehensive Epilepsy Program, Dell Children's Medical Center of Central Texas, Austin, TX, USA; Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Arianna K Stefanatos
- Pediatric Neuropsychology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
32
|
Wang G, Dai ZY, Song W, Wang S, Shi H, Pan P, Chen F, Xu Y, Zhong J. Grey matter anomalies in drug-naïve childhood absence epilepsy: A voxel-based morphometry study with MRI at 3.0T. Epilepsy Res 2016; 124:63-6. [PMID: 27259070 DOI: 10.1016/j.eplepsyres.2016.05.003] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 04/28/2016] [Accepted: 05/17/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known, so far, about the cerebral structural abnormalities in drug-naïve patients with childhood absence epilepsy (CAE). We aimed to investigate regional grey matter (GM) volume differences using voxel-based morphometry (VBM) in patients and closely matched healthy control subjects. METHODS Twenty drug-naïve patients diagnosed with CAE and 20 age- and gender-matched healthy subjects were recruited. All participants underwent structural MRI scans with a 3.0T MR system. The differences in regional GM volumes between the two groups were determined by VBM analysis. Additional regression analyses were performed to identify any associations between regional GM volume and clinical seizure variables. RESULTS Compared with controls, the patients with CAE showed less GM volume in the bilateral thalami. Furthermore, the GM volume in the bilateral thalami was negatively correlated with disease duration and age of onset in the CAE group. CONCLUSIONS By excluding the potential effect of medication on brain structures, our study demonstrates less GM volume in the bilateral thalami in drug-naïve patients with idiopathic CAE. Our study further provides structural neuroimaging evidence on the pathophysiology of absence seizures.
Collapse
Affiliation(s)
- GenDi Wang
- Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing Medical University, Nanjing, PR China; Department of Neurology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Zhen Yu Dai
- Department of Radiology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - WeiGen Song
- Department of Neurology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - ShuFang Wang
- Department of Neurology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - HaiCun Shi
- Department of Neurology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - PingLei Pan
- Department of Neurology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Fei Chen
- Department of Radiology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Yun Xu
- Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing Medical University, Nanjing, PR China.
| | - JianGuo Zhong
- Department of Neurology, The Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China.
| |
Collapse
|
33
|
Leal A, Vieira JP, Lopes R, Nunes RG, Gonçalves SI, Lopes da Silva F, Figueiredo P. Dynamics of epileptic activity in a peculiar case of childhood absence epilepsy and correlation with thalamic levels of GABA. Epilepsy Behav Case Rep 2016; 5:57-65. [PMID: 27144122 PMCID: PMC4840417 DOI: 10.1016/j.ebcr.2016.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/14/2016] [Accepted: 03/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Childhood absence epilepsy (CAE) is a syndrome with well-defined electroclinical features but unknown pathological basis. An increased thalamic tonic GABA inhibition has recently been discovered on animal models (Cope et al., 2009), but its relevance for human CAE is unproven. METHODS We studied an 11-year-old boy, presenting the typical clinical features of CAE, but spike-wave discharges (SWD) restricted to one hemisphere. RESULTS High-resolution EEG failed to demonstrate independent contralateral hemisphere epileptic activity. Consistently, simultaneous EEG-fMRI revealed the typical thalamic BOLD activation, associated with caudate and default mode network deactivation, but restricted to the hemisphere with SWD. Cortical BOLD activations were localized on the ipsilateral pars transverse. Magnetic resonance spectroscopy, using MEGA-PRESS, showed that the GABA/creatine ratio was 2.6 times higher in the hemisphere with SWD than in the unaffected one, reflecting a higher GABA concentration. Similar comparisons for the patient's occipital cortex and thalamus of a healthy volunteer yielded asymmetries below 25%. SIGNIFICANCE In a clinical case of CAE with EEG and fMRI-BOLD manifestations restricted to one hemisphere, we found an associated increase in thalamic GABA concentration consistent with a role for this abnormality in human CAE.
Collapse
Affiliation(s)
- Alberto Leal
- Department of Neurophysiology, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal`
| | - José P Vieira
- Department of Pediatric Neurology, Hospital Dona Estefânia, Lisbon, Portugal
| | - Ricardo Lopes
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Rita G Nunes
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Sónia I Gonçalves
- Institute of Biomedical Imaging and Life Sciences, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Fernando Lopes da Silva
- Center of Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, The Netherlands; Department of Bioengineering and Institute for Systems and Robotics (ISR/IST), LARSyS, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| | - Patrícia Figueiredo
- Department of Bioengineering and Institute for Systems and Robotics (ISR/IST), LARSyS, Instituto Superior Técnico, Universidade de Lisboa, Portugal
| |
Collapse
|
34
|
Rozendaal YJW, van Luijtelaar G, Ossenblok PPW. Spatiotemporal mapping of interictal epileptiform discharges in human absence epilepsy: A MEG study. Epilepsy Res 2015; 119:67-76. [PMID: 26681490 DOI: 10.1016/j.eplepsyres.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/03/2015] [Accepted: 11/13/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE Although absence epilepsy is considered to be a prototypic type of generalized epilepsy, it is still under debate whether generalized 3 Hz spike-and-wave discharges (SWDs) might have a cortical focal origin. Here it is investigated whether focal interictal epileptiform discharges (IEDs), which typically occur in the electro- (EEG) and magnetoencephalogram (MEG) in case of focal epilepsy, are present in the MEG of children with absence epilepsy. Next, the location of the sources of the IEDs is established, and it is investigated whether the location is concordant to the earlier established focal cortical regions involved in the generalized SWDs of these children. METHODS Whole head MEG recordings of seven children with absence epilepsy were reviewed with respect to the presence of IEDs (spikes and sharp waves). These IEDs were grouped into distinct clusters, in which each contribution to a cluster yields a comparable magnetic field distribution. Source localization was then performed onto the average signal of each cluster using an equivalent current dipole model and a realistic head model of the cortical surface. RESULTS IEDs were detected in 6 out of 7 patients. Source reconstruction indicated most often frontal, central or parietal origins of the IED in either the left and or right hemisphere. Spatiotemporal assessment of the IEDs indicated a stable location of the averages of these discharges, indicating a single underlying cortical source. DISCUSSION The outcome of this pilot study shows that MEG is well suited for the detection of IEDs and suggests that their estimated sources coincide rather well with the cortical regions involved during the spikes of the SWDs. It is discussed whether the presence of IEDs, classically seen as a marker of focal epilepsies, indicate that absence epilepsy should be considered as a focal type of epilepsy, in which changes in the network are evolving rapidly.
Collapse
Affiliation(s)
- Yvonne J W Rozendaal
- Department Function and Medical Technology, Academic Center of Epileptology, Kempenhaeghe & Maastricht UMC+, PO Box 61, 5590AB Heeze, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600MB Eindhoven, The Netherlands.
| | - Gilles van Luijtelaar
- Donders Centre of Cognition, Radboud University, PO Box 9104, 6500HE Nijmegen, The Netherlands.
| | - Pauly P W Ossenblok
- Department Function and Medical Technology, Academic Center of Epileptology, Kempenhaeghe & Maastricht UMC+, PO Box 61, 5590AB Heeze, The Netherlands.
| |
Collapse
|
35
|
Franzoni E, Matricardi S, Di Pisa V, Capovilla G, Romeo A, Tozzi E, Pruna D, Salerno GG, Zamponi N, Accorsi P, Giordano L, Coppola G, Cerminara C, Curatolo P, Nicita F, Spalice A, Grosso S, Pavone P, Striano P, Parisi P, Boni A, Gobbi G, Carotenuto M, Esposito M, Cottone C, Verrotti A. Refractory absence seizures: An Italian multicenter retrospective study. Eur J Paediatr Neurol 2015; 19:660-4. [PMID: 26239083 DOI: 10.1016/j.ejpn.2015.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 07/27/2014] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate evidence and prognosis of refractory cases of absence seizures. METHODS Subjects with refractory absence seizures were identified retrospectively in 17 Italian epilepsy pediatrics Centers. We analyzed age at onset, family history, presence of myoclonic components, seizure frequency, treatment with antiepileptic drugs (AEDs), interictal electroencephalography (EEG) and neuropsychological assessment. Two subgroups were identified: one with patients with current absence seizures and another with patients that had become seizure free with or without AED treatment. The chi-square test was applied. RESULTS A total of 92 subjects with drug-resistant absence seizures were analyzed. 45 subjects still show absence seizures (49%) and the other 47 became seizure free (51%) after a period of drug-resistance. The statistical analysis between these two groups showed no correlation between age of onset, family history and abnormalities at interictal EEG. Statistically significant differences were observed with regard to the number of AEDs used and intellectual disability. CONCLUSION Typical absence epilepsy classifiable as Childhood Absence Epilepsy could not be considered so "benign", as suggested in literature. A longer duration of disease and a higher frequency of seizure seem to be correlated with a higher presence of cognitive impairment. No significant risk factor was observed to allow the faster and better recognition of patients with worse prognosis.
Collapse
Affiliation(s)
- Emilio Franzoni
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Veronica Di Pisa
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Antonino Romeo
- Epilepsy Center, Department of Child Neuropsychiatry and Neurophysiology, Fatebenefratelli and Oftalmico Hospital, Milan, Italy
| | - Elisabetta Tozzi
- Department of Child Neuropsychiatry, University of L'Aquila, L'Aquila, Italy
| | - Dario Pruna
- Child and Adolescent Neuropsychiatry, University of Cagliari, Cagliari, Italy
| | | | - Nelia Zamponi
- Pediatric Neurology Department, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Lucio Giordano
- Child Neuropsychiatric Unit, Civile Hospital, Brescia, Italy
| | - Giangennaro Coppola
- Department of Child and Adolescent Neuropsychiatric, Medical School, University of Salerno, Salerno, Italy
| | - Caterina Cerminara
- Department of Neurosciences, Pediatric Neurology Unit, Tor Vergata University, Roma, Italy
| | - Paolo Curatolo
- Department of Neurosciences, Pediatric Neurology Unit, Tor Vergata University, Roma, Italy
| | - Francesco Nicita
- Department of Pediatrics, Division of Child Neurology, Sapienza, University of Rome, Rome, Italy
| | - Alberto Spalice
- Department of Pediatrics, Division of Child Neurology, Sapienza, University of Rome, Rome, Italy
| | - Salvatore Grosso
- Department of Pediatrics, Pediatric Neurology Unit, S. Maria Alle Scotte Hospital, University of Siena, Italy
| | - Piero Pavone
- Department of Pediatrics and Pediatrics Emergency, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Opthalmology, Genetics and Maternal and Child Health, University of Genova, G. Gaslini Institute, Genova, Italy
| | - Pasquale Parisi
- Neuroscience, Mental Health and Sensory Organs Department, Child Neurology, Headache Pediatric Center, Pediatric Sleep Disorder, Sapienza, University of Rome, Rome, Italy
| | - Antonella Boni
- IRRCS, The Institute of Neurological Sciences of Bologna, Child Neurology Unit, Bologna, Italy
| | - Giuseppe Gobbi
- IRRCS, The Institute of Neurological Sciences of Bologna, Child Neurology Unit, Bologna, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Carlo Cottone
- Child Neuropsychiatry Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | |
Collapse
|
36
|
Affiliation(s)
- Rochelle Caplan
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, U.S.A
| |
Collapse
|
37
|
Tang L, Xiang J, Huang S, Miao A, Ge H, Liu H, Wu D, Guan Q, Wu T, Chen Q, Yang L, Lu X, Hu Z, Wang X. Neuromagnetic high-frequency oscillations correlate with seizure severity in absence epilepsy. Clin Neurophysiol 2015; 127:1120-1129. [PMID: 26384756 DOI: 10.1016/j.clinph.2015.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/15/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study quantified the clinical correlation of interictal and ictal neuromagnetic activities from low- to very-high-frequency ranges in childhood absence epilepsy (CAE). METHODS Twelve patients with clinically diagnosed drug-naïve CAE were studied using a 275-channel whole-head magnetoencephalography (MEG) system. MEG data were digitized at 6000 Hz and analyzed at both sensor and source levels with multi-frequency analyses. RESULTS Neuromagnetic changes from interictal to ictal periods predominantly occurred in medial prefrontal cortex and parieto-occipito-temporal junction in absence seizures. The changes were statistically significant in low-frequency bands only (<30 Hz, p<0.0001). There was a significant correlation between the source strength of ictal high-frequency oscillations (HFOs) in 200-1000 Hz and the number of daily seizures (r=0.734, p<0.01). CONCLUSIONS CAE has focal neuromagnetic sources. The transition from interictal to ictal periods is associated with the elevation of low-frequency brain activities. The strength of HFOs reflects the severity of absence seizures. SIGNIFICANCE Low- and high-frequency MEG signals reveal distinct brain activities in CAE. HFOs is a new biomarker for the study of absence seizures.
Collapse
Affiliation(s)
- Lu Tang
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45220, USA
| | - Shuyang Huang
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Ailiang Miao
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Huaiting Ge
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Hongxing Liu
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Di Wu
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Qingshan Guan
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Ting Wu
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Lu Yang
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaopeng Lu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Medical University, Affiliated Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China.
| |
Collapse
|
38
|
Abstract
BACKGROUND Childhood absence epilepsy (CAE) is a well-known syndrome with onset in middle childhood and is characterized by multiple typical absences per day. Pharmacological treatment is specific and usually successful with a single medication. The goal of the study was to assess on risk factors associated with failure to respond to the initial antiepileptic drug (AED). METHODS Fifty-two children with CAE were enrolled. Predictive factors were analyzed by survival methods. RESULTS Among 52 patients, 32 patients (61.5%) were girls and the remaining 20 (38.5%) were boys and the mean age at the seizure onset was 6.5±1.78 years old (3-11.5 years). Of the 52 patients, 42 (80.8%) were treated relatively successfully with the first AED treatment (Group A), and 10 (19.2%) were not responsed (Group B). Age of seizure onset, coexisting other types of seizures, and photoconvulsive EEG response were significantly associated with failure risk according to univariate analysis. In the multivariate analysis, only photoconvulsive EEG response was the risk factor influencing poor response to initial AED treatment. CONCLUSION Factors predicting failure to respond to the AED were age of seizure onset, coexisting other types of seizures, and photoconvulsive EEG response in children with CAE.
Collapse
Affiliation(s)
- Faruk Incecik
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Sakir Altunbasak
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ozlem M Herguner
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| |
Collapse
|
39
|
Xiang J, Tenney JR, Korman AM, Leiken K, Rose DF, Harris E, Yuan W, Horn PS, Holland K, Loring DW, Glauser TA. Quantification of Interictal Neuromagnetic Activity in Absence Epilepsy with Accumulated Source Imaging. Brain Topogr 2015; 28:904-14. [PMID: 25359158 DOI: 10.1007/s10548-014-0411-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
Aberrant brain activity in childhood absence epilepsy (CAE) during seizures has been well recognized as synchronous 3 Hz spike-and-wave discharges on electroencephalography. However, brain activity from low- to very high-frequency ranges in subjects with CAE between seizures (interictal) has rarely been studied. Using a high-sampling rate magnetoencephalography (MEG) system, we studied ten subjects with clinically diagnosed but untreated CAE in comparison with age- and gender-matched controls. MEG data were recorded from all subjects during the resting state. MEG sources were assessed with accumulated source imaging, a new method optimized for localizing and quantifying spontaneous brain activity. MEG data were analyzed in nine frequency bands: delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-30 Hz), low-gamma (30-55 Hz), high-gamma (65-90 Hz), ripple (90-200 Hz), high-frequency oscillation (HFO, 200-1,000 Hz), and very high-frequency oscillation (VHFO, 1,000-2,000 Hz). MEG source imaging revealed that subjects with CAE had higher odds of interictal brain activity in 200-1,000 and 1,000-2,000 Hz in the parieto-occipito-temporal junction and the medial frontal cortices as compared with controls. The strength of the interictal brain activity in these regions was significantly elevated in the frequency bands of 90-200, 200-1,000 and 1,000-2,000 Hz for subjects with CAE as compared with controls. The results indicate that CAE has significantly aberrant brain activity between seizures that can be noninvasively detected. The measurements of high-frequency neuromagnetic oscillations may open a new window for investigating the cerebral mechanisms of interictal abnormalities in CAE.
Collapse
|
40
|
Miao A, Xiang J, Tang L, Ge H, Liu H, Wu T, Chen Q, Hu Z, Lu X, Wang X. Using ictal high-frequency oscillations (80-500Hz) to localize seizure onset zones in childhood absence epilepsy: a MEG study. Neurosci Lett 2014; 566:21-6. [PMID: 24582907 DOI: 10.1016/j.neulet.2014.02.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/05/2014] [Accepted: 02/15/2014] [Indexed: 11/27/2022]
Abstract
This study aimed to use ictal high-frequency oscillations (HFOs) ranging from 80Hz to 500Hz to locate seizure onset zones in childhood absence epilepsy (CAE) using non-invasive magnetoencephalography (MEG). Ten drug-naïve children with CAE were studied using a 275-channel MEG system. MEG data were digitized at a sampling rate of 6000Hz. HFO spectral power in real-time spectrograms was assessed using Morlet continuous wavelet transform. Magnetic sources were volumetrically localized through dynamic magnetic source imaging with a slide window. HFOs were identified in all patients. The total time of fast ripples (250-500Hz) was greater than that of ripples (80-250Hz) during absence seizures. The rate of fast ripples was associated with seizure frequency. HFO duration was significantly longer when co-occurring with spikes than when occurring independently, and the maximum frequency of HFOs co-occurring with spikes was higher than that of HFOs occurring independently. HFOs were predominantly localized in the medial prefrontal cortex (MPFC), whereas spikes were widespread to a variety of regions during the absence seizures. Compared with spikes, HFOs appeared to be more focal. The findings indicate that HFOs in the MPFC have a primary function in initializing epileptic activity in CAE.
Collapse
Affiliation(s)
- Ailiang Miao
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45220, USA
| | - Lu Tang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Huaiting Ge
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongxing Liu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ting Wu
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaopeng Lu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| |
Collapse
|
41
|
Miao A, Tang L, Xiang J, Guan Q, Ge H, Liu H, Wu T, Chen Q, Yang L, Lu X, Hu Z, Wang X. Dynamic magnetic source imaging of absence seizure initialization and propagation: a magnetoencephalography study. Epilepsy Res 2014; 108:468-80. [PMID: 24534760 DOI: 10.1016/j.eplepsyres.2014.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/20/2013] [Accepted: 01/14/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The present study aims to determine the initialization and propagation of typical absence seizures using magnetoencephalography (MEG). METHOD Fourteen drug-naïve children with childhood absence epilepsy (CAE) were studied using a 275-Channel MEG system. The spectral signatures of epileptic activity were assessed using Morlet continuous wavelet transform. Magnetic sources were volumetrically localized using dynamic magnetic source imaging (dMSI) with a slide window at a millisecond temporal resolution. RESULT The initial portion of ictal activity was predominantly located to the left frontal and posterior cortices. The frontal sources were in the left medial prefrontal cortex (MPFC), the pre-supplementary motor area (pre-SMA), the primary motor cortex, and the lateral prefrontal cortex. The posterior cortical sources were predominantly localized to the left precuneus (pC) and the medial occipital cortices (MOC). The ictal activity after the initialization showed involvement of the MPFC and pC of all patients (14/14) and recursive propagation between the frontal (MPFC) and posterior cortices (pC and MOC) via either the medial portion of the brain (9/14) or the thalamus (5/14), respectively. CONCLUSION The left frontal and posterior (pC and MOC) cortices play a key role in the initialization of epileptic activity in absence seizures. The thalamus plays a key role in the propagation of absence seizures between the frontal and posterior cortical sources. Considering the MPFC and pC are the nodes of the default mode network (DMN), our results support involvement of the DMN in absence seizures.
Collapse
Affiliation(s)
- Ailiang Miao
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lu Tang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45220, USA
| | - Qingshan Guan
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Huaiting Ge
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongxing Liu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ting Wu
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Lu Yang
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaopeng Lu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| |
Collapse
|
42
|
Lin JJ, Siddarth P, Riley JD, Gurbani SG, Ly R, Yee VW, Levitt JG, Toga AW, Caplan R. Neurobehavioral comorbidities of pediatric epilepsies are linked to thalamic structural abnormalities. Epilepsia 2013; 54:2116-24. [PMID: 24304435 DOI: 10.1111/epi.12428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE Neurobehavioral comorbidities are common in pediatric epilepsy with enduring adverse effects on functioning, but their neuroanatomic underpinning is unclear. Striatal and thalamic abnormalities have been associated with childhood-onset epilepsies, suggesting that epilepsy-related changes in the subcortical circuit might be associated with the comorbidities of children with epilepsy. We aimed to compare subcortical volumes and their relationship with age in children with complex partial seizures (CPS), childhood absence epilepsy (CAE), and healthy controls (HC). We examined the shared versus unique structural-functional relationships of these volumes with behavior problems, intelligence, language, peer interaction, and epilepsy variables in these two epilepsy syndromes. METHODS We investigated volumetric differences of caudate, putamen, pallidum, and thalamus in children with CPS (N = 21), CAE (N = 20), and HC (N = 27). Study subjects underwent structural magnetic resonance imaging (MRI), intelligence, and language testing. Parent-completed Child Behavior Checklists provided behavior problem and peer interaction scores. We examined the association of age, intelligence quotient (IQ), language, behavioral problems, and epilepsy variables with subcortical volumes that were significantly different between the children with epilepsy and HC. KEY FINDINGS Both children with CPS and CAE exhibited significantly smaller left thalamic volume compared to HC. In terms of developmental trajectory, greater thalamic volume was significantly correlated with increasing age in children with CPS and CAE but not in HC. With regard to the comorbidities, reduced left thalamic volumes were related to more social problems in children with CPS and CAE. Smaller left thalamic volumes in children with CPS were also associated with poor attention, lower IQ and language scores, and impaired peer interaction. SIGNIFICANCE Our study is the first to directly compare and detect shared thalamic structural abnormalities in children with CPS and CAE. These findings highlight the vulnerability of the thalamus and provide important new insights on its possible role in the neurobehavioral comorbidities of childhood-onset epilepsy.
Collapse
Affiliation(s)
- Jack J Lin
- Department of Neurology, University of California Irvine, Irvine, California, U.S.A
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Introduction Childhood absence epilepsy is an epilepsy syndrome responding relatively well to the ketogenic diet with one-third of patients becoming seizure-free. Less restrictive variants of the classical ketogenic diet, however, have been shown to confer similar benefits. Beneficial effects of high fat, low-carbohydrate diets are often explained in evolutionary terms. However, the paleolithic diet itself which advocates a return to the human evolutionary diet has not yet been studied in epilepsy. Results Here, we present a case of a 7-year-old child with absence epilepsy successfully treated with the paleolithic ketogenic diet alone. In addition to seizure freedom achieved within 6 weeks, developmental and behavioral improvements were noted. The child remained seizure-free when subsequently shifted toward a paleolithic diet. Conclusion It is concluded that the paleolithic ketogenic diet was effective, safe and feasible in the treatment of this case of childhood absence epilepsy.
Collapse
Affiliation(s)
- Zsófia Clemens
- National Institute of Neuroscience, Amerikai út 57, Budapest, 1145 Hungary ; Department of Neurology, University of Pécs, Rét u. 2, 7623 Pecs, Hungary
| | - Anna Kelemen
- National Institute of Neuroscience, Budapest, Hungary
| | - András Fogarasi
- Department of Neurology, Bethesda Children's Hospital, Budapest, Hungary
| | - Csaba Tóth
- Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
44
|
Lopes AF, Simões MR, Monteiro JP, Fonseca MJ, Martins C, Ventosa L, Lourenço L, Robalo C. Intellectual functioning in children with epilepsy: frontal lobe epilepsy, childhood absence epilepsy and benign epilepsy with centro-temporal spikes. Seizure 2013; 22:886-92. [PMID: 23992789 DOI: 10.1016/j.seizure.2013.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/26/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The purpose of our study is to describe intellectual functioning in three common childhood epilepsy syndromes - frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE) and benign epilepsy with centro-temporal spikes (BECTS). And also to determine the influence of epilepsy related variables, type of epilepsy, age at epilepsy onset, duration and frequency of epilepsy, and treatment on the scores. METHODS Intellectual functioning was examined in a group of 90 children with epilepsy (30 FLE, 30 CAE, 30 BECTS), aged 6-15 years, and compared with a control group (30). All subjects obtained a Full Scale IQ ≥ 70 and they were receiving no more than two antiepileptic medications. Participants completed the Wechsler Intelligence Scale for Children - Third Edition. The impact of epilepsy related variables (type of epilepsy, age at epilepsy onset, duration of epilepsy, seizure frequency and anti-epileptic drugs) on intellectual functioning was examined. RESULTS Children with FLE scored significantly worse than controls on WISC-III Verbal IQ, Full Scale IQ and Processing Speed Index. There was a trend for children with FLE to have lower intelligence scores than CAE and BECTS groups. Linear regression analysis showed no effect for age at onset, frequency of seizures and treatment. Type of epilepsy and duration of epilepsy were the best indicators of intellectual functioning. CONCLUSION It is crucial that children with FLE and those with a longer active duration of epilepsy are closely monitored to allow the early identification and evaluation of cognitive problems, in order to establish adequate and timely school intervention plans.
Collapse
Affiliation(s)
- Ana Filipa Lopes
- Faculty of Psychology, University of Coimbra, Coimbra, Portugal; Neuropaediatric Unit - Garcia de Orta Hospital, Almada, Portugal.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Harty RC, Kim TH, Thomas EA, Cardamone L, Jones NC, Petrou S, Wimmer VC. Axon initial segment structural plasticity in animal models of genetic and acquired epilepsy. Epilepsy Res 2013; 105:272-9. [PMID: 23602553 DOI: 10.1016/j.eplepsyres.2013.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/24/2013] [Accepted: 03/15/2013] [Indexed: 11/21/2022]
Abstract
A novel form of neuronal plasticity, occurring at the axon initial segment (AIS), has recently been described. Lengthening of the AIS and movement away from the soma are consequences of changes in neuronal input and result in alterations in neuronal excitability. We hypothesised that AIS plasticity may play a role in epilepsy, due to chronic changes in neuronal activity. Immunohistochemistry and confocal microscopy were used to analyse AIS length and position in pyramidal neurons in deep layer 5 of the somatosensory cortex from 5 mice with genetic epilepsy and 4 controls, and from 3 rats subjected to amygdala kindling and 3 controls. The effect of a subtle alteration of AIS position was modelled computationally. We identified a difference in the position of the AIS in animals with seizures: in mice the AIS was positioned 0.2 μm further away from the soma, and in rats the AIS was positioned 0.6 μm closer to the soma compared with controls. Computational modelling indicated that a subtle alteration in AIS position could result in a change in action potential firing threshold. The identification of AIS plasticity in animal models of epilepsy is significant in furthering our understanding of the pathophysiological mechanisms involved in this disorder.
Collapse
|