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Jordán Z, Szabó JP, Sákovics A, Kelemen A, Halász L, Erőss L, Fabó D. Epileptiform discharges in the anterior thalamus of epilepsy patients. iScience 2024; 27:109582. [PMID: 38726366 PMCID: PMC11079473 DOI: 10.1016/j.isci.2024.109582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/25/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Anterior thalamus (ANT) deep-brain stimulation (DBS) is an approved therapy for drug resistant epilepsy. We aimed to identify interictal epileptiform discharges (IED) in the ANT and to investigate their relationship with surface IEDs. Fifteen patients were monitored for two consecutive nights with externalized thalamic leads to analyze the intrathalamic epileptiform activities (TIED). Forty-six % of all contacts were located within the ANT. We found that all the responders had TIEDs within the ANT, while this held true only for 44% of the non-responders. The overall response rate (RR) at 1-year follow-up was 40%, while it was 44% in bilateral ANT hit patients and 45% in epileptic focus side hit. However, in case of TIEDs present in the focus side the RR reached as high as 71%. TIED activity may prove the pathophysiological connection to the seizure focus, and stimulation of this area might have a better suppressing effect on seizures.
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Affiliation(s)
- Zsófia Jordán
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
| | - Johanna-Petra Szabó
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- János Szentágothai Neuroscience Program, School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
- Lendület Laboratory of Systems Neuroscience, Institute of Experimental Medicine, 1083 Budapest, Hungary
| | - Anna Sákovics
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- János Szentágothai Neuroscience Program, School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Anna Kelemen
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary
| | - László Halász
- Functional Neurosurgery Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
| | - Loránd Erőss
- Functional Neurosurgery Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
| | - Dániel Fabó
- Epilepsy Unit, Department of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, 1145 Budapest, Hungary
- Member of the ERN EpiCARE, Budapest, Hungary
- Department of Neurology, University of Szeged, 6720 Szeged, Hungary
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Manmatharayan A, Kogan M, Matias C, Syed M, Shelley I, Chinni A, Kang K, Talekar K, Faro SH, Mohamed FB, Sharan A, Wu C, Alizadeh M. Automated subfield volumetric analysis of amygdala, hippocampus, and thalamic nuclei in mesial temporal lobe epilepsy. World Neurosurg X 2023; 19:100212. [PMID: 37304157 PMCID: PMC10250154 DOI: 10.1016/j.wnsx.2023.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose Identifying relationships between clinical features and quantitative characteristics of the amygdala-hippocampal and thalamic subregions in mesial temporal lobe epilepsy (mTLE) may offer insights into pathophysiology and the basis for imaging prognostic markers of treatment outcome. Our aim was to ascertain different patterns of atrophy or hypertrophy in mesial temporal sclerosis (MTS) patients and their associations with post-surgical seizure outcomes. To assess this aim, this study is designed in 2 folds: (1) hemispheric changes within MTS group and (2) association with postsurgical seizure outcomes. Methods and materials 27 mTLE subjects with mesial temporal sclerosis (MTS) were scanned for conventional 3D T1w MPRAGE images and T2w scans. With respect to 12 months post-surgical seizure outcomes, 15 subjects reported being seizure free (SF) and 12 reported continued seizures. Quantitative automated segmentation and cortical parcellation were performed using Freesurfer. Automatic labeling and volume estimation of hippocampal subfields, amygdala, and thalamic subnuclei were also performed. The volume ratio (VR) for each label was computed and compared between (1) between contralateral and ipsilateral MTS using Wilcoxon rank-sum test and (2) SF and not seizure free (NSF) groups using linear regression analysis. False Discovery rate (FDR) with significant level of 0.05 were used in both analyses to correct for multiple comparisons. Results Amygdala: The medial nucleus of the amygdala was the most significantly reduced in patients with continued seizures when compared to patients who remained seizure free. Hippocampus: Comparison of ipsilateral and contralateral volumes with seizure outcomes showed volume loss was most evident in the mesial hippocampal regions such as CA4 and hippocampal fissure. Volume loss was also most explicit in the presubiculum body in patients with continued seizures at the time of their follow-up. Ipsilateral MTS compared to contralateral MTS analysis showed the heads of the ipsilateral subiculum, presubiculum, parasubiculum, dentate gyrus, CA4, and CA3 were more significantly affected than their respective bodies. Volume loss was most noted in mesial hippocampal regions. Thalamus: VPL and PuL were the most significantly reduced thalamic nuclei in NSF patients. In all statistically significant areas, volume reduction was observed in the NSF group. No significant volume reductions were noted in the thalamus and amygdala when comparing ipsilateral to contralateral sides in mTLE subjects. Conclusions Varying degrees of volume loss were demonstrated in the hippocampus, thalamus, and amygdala subregions of MTS, especially between patients who remained seizure-free and those who did not. The results obtained can be used to further understand mTLE pathophysiology. Clinical relevance/application In the future, we hope these results can be used to deepen the understanding of mTLE pathophysiology, leading to improved patient outcomes and treatments.
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Affiliation(s)
- Arichena Manmatharayan
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Michael Kogan
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, 87131-0001, USA
| | - Caio Matias
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, 19107, USA
| | - Mashaal Syed
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - India Shelley
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Amar Chinni
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Kichang Kang
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Kiran Talekar
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Scott H. Faro
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Feroze B. Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Chengyuan Wu
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
| | - Mahdi Alizadeh
- Department of Neurosurgery, Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut St, Philadelphia, PA, 19107, USA
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Choi EY, Tian L, Su JH, Radovan MT, Tourdias T, Tran TT, Trelle AN, Mormino E, Wagner AD, Rutt BK. Thalamic nuclei atrophy at high and heterogenous rates during cognitively unimpaired human aging. Neuroimage 2022; 262:119584. [PMID: 36007822 PMCID: PMC9787236 DOI: 10.1016/j.neuroimage.2022.119584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023] Open
Abstract
The thalamus is a central integration structure in the brain, receiving and distributing information among the cerebral cortex, subcortical structures, and the peripheral nervous system. Prior studies clearly show that the thalamus atrophies in cognitively unimpaired aging. However, the thalamus is comprised of multiple nuclei involved in a wide range of functions, and the age-related atrophy of individual thalamic nuclei remains unknown. Using a recently developed automated method of identifying thalamic nuclei (3T or 7T MRI with white-matter-nulled MPRAGE contrast and THOMAS segmentation) and a cross-sectional design, we evaluated the age-related atrophy rate for 10 thalamic nuclei (AV, CM, VA, VLA, VLP, VPL, pulvinar, LGN, MGN, MD) and an epithalamic nucleus (habenula). We also used T1-weighted images with the FreeSurfer SAMSEG segmentation method to identify and measure age-related atrophy for 11 extra-thalamic structures (cerebral cortex, cerebral white matter, cerebellar cortex, cerebellar white matter, amygdala, hippocampus, caudate, putamen, nucleus accumbens, pallidum, and lateral ventricle). In 198 cognitively unimpaired participants with ages spanning 20-88 years, we found that the whole thalamus atrophied at a rate of 0.45% per year, and that thalamic nuclei had widely varying age-related atrophy rates, ranging from 0.06% to 1.18% per year. A functional grouping analysis revealed that the thalamic nuclei involved in cognitive (AV, MD; 0.53% atrophy per year), visual (LGN, pulvinar; 0.62% atrophy per year), and auditory/vestibular (MGN; 0.64% atrophy per year) functions atrophied at significantly higher rates than those involved in motor (VA, VLA, VLP, and CM; 0.37% atrophy per year) and somatosensory (VPL; 0.32% atrophy per year) functions. A proximity-to-CSF analysis showed that the group of thalamic nuclei situated immediately adjacent to CSF atrophied at a significantly greater atrophy rate (0.59% atrophy per year) than that of the group of nuclei located farther from CSF (0.36% atrophy per year), supporting a growing hypothesis that CSF-mediated factors contribute to neurodegeneration. We did not find any significant hemispheric differences in these rates of change for thalamic nuclei. Only the CM thalamic nucleus showed a sex-specific difference in atrophy rates, atrophying at a greater rate in male versus female participants. Roughly half of the thalamic nuclei showed greater atrophy than all extra-thalamic structures examined (0% to 0.54% per year). These results show the value of white-matter-nulled MPRAGE imaging and THOMAS segmentation for measuring distinct thalamic nuclei and for characterizing the high and heterogeneous atrophy rates of the thalamus and its nuclei across the adult lifespan. Collectively, these methods and results advance our understanding of the role of thalamic substructures in neurocognitive and disease-related changes that occur with aging.
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Affiliation(s)
- Eun Young Choi
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, MC5327, Stanford, CA 94305, USA
| | - Lu Tian
- Department of Biomedical Data Science, 1265 Welch Road, MC5464, Stanford, CA 94305, USA
| | - Jason H. Su
- Department of Radiology, Stanford University, 300 Pasteur Drive, MC5488, Stanford, CA 94305, USA,Department of Electrical Engineering, Stanford University, 350 Jane Stanford Way, MC9505, Stanford, CA 94305, USA
| | - Matthew T. Radovan
- Department of Computer Science, Stanford University, 353 Jane Stanford Way, MC9025, Stanford, CA 94305, USA
| | - Thomas Tourdias
- Department of Neuroradiology, Bordeaux University Hospital, Bordeaux, France,INSERM U1215, Neurocentre Magendie, University of Bordeaux, France
| | - Tammy T. Tran
- Department of Psychology, Stanford University, Building 420, MC2130, Stanford, CA 94305, USA
| | - Alexandra N. Trelle
- Department of Psychology, Stanford University, Building 420, MC2130, Stanford, CA 94305, USA
| | - Elizabeth Mormino
- Department of Neurology and Neurological Sciences, Stanford, University, 300 Pasteur Drive, MC5235, Stanford, CA 94305, USA,Wu Tsai Neurosciences Institute, Stanford University, 290 Jane Stanford Way, Stanford, CA 94305, USA
| | - Anthony D. Wagner
- Department of Psychology, Stanford University, Building 420, MC2130, Stanford, CA 94305, USA,Wu Tsai Neurosciences Institute, Stanford University, 290 Jane Stanford Way, Stanford, CA 94305, USA
| | - Brian K. Rutt
- Department of Radiology, Stanford University, 300 Pasteur Drive, MC5488, Stanford, CA 94305, USA,Wu Tsai Neurosciences Institute, Stanford University, 290 Jane Stanford Way, Stanford, CA 94305, USA,Corresponding author. (B.K. Rutt)
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Ballerini A, Tondelli M, Talami F, Molinari MA, Micalizzi E, Giovannini G, Turchi G, Malagoli M, Genovese M, Meletti S, Vaudano AE. Amygdala subnuclear volumes in temporal lobe epilepsy with hippocampal sclerosis and in non-lesional patients. Brain Commun 2022; 4:fcac225. [PMID: 36213310 PMCID: PMC9536297 DOI: 10.1093/braincomms/fcac225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/12/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022] Open
Abstract
Together with hippocampus, the amygdala is important in the epileptogenic network of patients with temporal lobe epilepsy. Recently, an increase in amygdala volumes (i.e. amygdala enlargement) has been proposed as morphological biomarker of a subtype of temporal lobe epilepsy patients without MRI abnormalities, although other data suggest that this finding might be unspecific and not exclusive to temporal lobe epilepsy. In these studies, the amygdala is treated as a single entity, while instead it is composed of different nuclei, each with peculiar function and connection. By adopting a recently developed methodology of amygdala’s subnuclei parcellation based of high-resolution T1-weighted image, this study aims to map specific amygdalar subnuclei participation in temporal lobe epilepsy due to hippocampal sclerosis (n = 24) and non-lesional temporal lobe epilepsy (n = 24) with respect to patients with focal extratemporal lobe epilepsies (n = 20) and healthy controls (n = 30). The volumes of amygdala subnuclei were compared between groups adopting multivariate analyses of covariance and correlated with clinical variables. Additionally, a logistic regression analysis on the nuclei resulting statistically different across groups was performed. Compared with other populations, temporal lobe epilepsy with hippocampal sclerosis showed a significant atrophy of the whole amygdala (pBonferroni = 0.040), particularly the basolateral complex (pBonferroni = 0.033), while the non-lesional temporal lobe epilepsy group demonstrated an isolated hypertrophy of the medial nucleus (pBonferroni = 0.012). In both scenarios, the involved amygdala was ipsilateral to the epileptic focus. The medial nucleus demonstrated a volume increase even in extratemporal lobe epilepsies although contralateral to the seizure onset hemisphere (pBonferroni = 0.037). Non-lesional patients with psychiatric comorbidities showed a larger ipsilateral lateral nucleus compared with those without psychiatric disorders. This exploratory study corroborates the involvement of the amygdala in temporal lobe epilepsy, particularly in mesial temporal lobe epilepsy and suggests a different amygdala subnuclei engagement depending on the aetiology and lateralization of epilepsy. Furthermore, the logistic regression analysis indicated that the basolateral complex and the medial nucleus of amygdala can be helpful to differentiate temporal lobe epilepsy with hippocampal sclerosis and with MRI negative, respectively, versus controls with a consequent potential clinical yield. Finally, the present results contribute to the literature about the amygdala enlargement in temporal lobe epilepsy, suggesting that the increased volume of amygdala can be regarded as epilepsy-related structural changes common across different syndromes whose meaning should be clarified.
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Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
| | | | - Francesca Talami
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
| | | | - Elisa Micalizzi
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia , Modena 41121 , Italy
| | - Giada Giovannini
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia , Modena 41121 , Italy
| | - Giulia Turchi
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Marcella Malagoli
- Neuroradiology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Maurilio Genovese
- Neuroradiology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena 41125 , Italy
- Neurology Unit, OCB Hospital, AOU Modena , Modena 41126 , Italy
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Middlebrooks EH, He X, Grewal SS, Keller SS. Neuroimaging and thalamic connectomics in epilepsy neuromodulation. Epilepsy Res 2022; 182:106916. [PMID: 35367691 DOI: 10.1016/j.eplepsyres.2022.106916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/05/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022]
Abstract
Neuromodulation is an increasingly utilized therapy for the treatment of people with drug-resistant epilepsy. To date, the most common and effective target has been the thalamus, which is known to play a key role in multiple forms of epilepsy. Neuroimaging has facilitated rapid developments in the understanding of functional targets, surgical and programming techniques, and the effects of thalamic stimulation. In this review, the role of neuroimaging in neuromodulation is explored. First, the structural and functional changes of the thalamus in common epilepsy syndromes are discussed as the rationale for neuromodulation of the thalamus. Next, methods for imaging different thalamic nuclei are presented, as well as rationale for the need of direct surgical targeting rather than reliance on traditional stereotactic coordinates. Lastly, we discuss the potential role of neuroimaging in assessing the effects of thalamic stimulation and as a potential biomarker for neuromodulation outcomes.
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Affiliation(s)
- Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Xiaosong He
- Department of Psychology, University of Science and Technology of China, Hefei, Anhui, China
| | | | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
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Verma G, Jacob Y, Jha M, Morris LS, Delman BN, Marcuse L, Fields M, Balchandani P. Quantification of brain age using high-resolution 7 tesla MR imaging and implications for patients with epilepsy. Epilepsy Behav Rep 2022; 18:100530. [PMID: 35492510 PMCID: PMC9043661 DOI: 10.1016/j.ebr.2022.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 10/27/2022] Open
Abstract
Purpose Epilepsy patients exhibit morphological differences on neuroimaging compared to age-matched healthy controls, including cortical and sub-cortical volume loss and altered gray-white matter ratios. The objective was to develop a model of normal aging using the 7T MRIs of healthy controls. This model can then be used to determine if the changes in epilepsy patients resemble the changes seen in aging, and potentially give a marker for the severity of those changes. Methods Sixty-nine healthy controls (24F/45M, mean age 36.5 ± 10.5 years) and forty-four epilepsy patients (24F/20M, 33.2 ± 9.9 years) non-lesional at 3T were scanned with volumetric T1-MPRAGE at 7T. These images were segmented and quantified using FreeSurfer. A linear regression-based model trained on healthy controls was developed to predict ages using derived imaging features among the epilepsy patient cohort. The model used 114 features with significant linear correlation with age. Results The regression-based model estimated brain age with mean absolute error (MAE) of 6.6 years among controls. Comparable prediction accuracy of 6.9 years MAE was seen epilepsy patients. T-test of mean absolute error showed no difference in the prediction accuracy with controls and epilepsy patients (p = 0.68). However, average signed error showed elevated (+5.0 years, p = 0.0007) predicted age differences (PAD; brain-PAD=, predicted minus biological age) among epilepsy patients. Morphological metrics in the medial temporal lobe were major contributors to PAD. Additionally, patients with seizure frequency greater than once a week showed significantly elevated brain-PAD (+8.2 ± 5.3 years, n = 13) compared to patients with lower seizure frequency (3.7 ± 6.5 years, n = 31, p = 0.033). Major conclusions Morphological patterns suggestive of premature aging were observed in non-lesional epilepsy patients vs. controls and in high seizure frequency patients vs. low frequency patients. Modeling brain age with 7T MRI may provide a sensitive imaging marker to assess the differential effects of the aging process in diseases such as epilepsy.
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Affiliation(s)
- Gaurav Verma
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Yael Jacob
- Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Manish Jha
- UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Laurel S. Morris
- Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Bradley N. Delman
- Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Lara Marcuse
- Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Madeline Fields
- Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Priti Balchandani
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Tung H, Pan SY, Lan TH, Lin YY, Peng SJ. Characterization of Hippocampal-Thalamic-Cortical Morphometric Reorganization in Temporal Lobe Epilepsy. Front Neurol 2022; 12:810186. [PMID: 35222230 PMCID: PMC8866816 DOI: 10.3389/fneur.2021.810186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
IntroductionBrain cortico-subcortical connectivity has been investigated in epilepsy using the functional MRI (MRI). Although structural images cannot demonstrate dynamic changes, they provide higher spatial resolution, which allows exploration of the organization of brain in greater detail.MethodsWe used high-resolution brain MRI to study the hippocampal-thalamic-cortical networks in temporal lobe epilepsy (TLE) using a volume-based morphometric method. We enrolled 22 right-TLE, 33 left-TLE, and 28 age/gender-matched controls retrospectively. FreeSurfer software was used for the thalamus segmentation.ResultsAmong the 50 subfields, ipsilateral anterior, lateral, and parts of the intralaminar and medial nuclei, as well as the contralateral parts of lateral nuclei had significant volume loss in both TLE. The anteroventral nucleus was most vulnerable. Most thalamic subfields were susceptible to seizure burden, especially the left-TLE. SPM12 was used to conduct an analysis of the gray matter density (GMD) maps. Decreased extratemporal GMD occurred bilaterally. Both TLE demonstrated significant GMD loss over the ipsilateral inferior frontal gyrus, precentral gyrus, and medial orbital cortices.SignificanceThalamic subfield atrophy was related to the ipsilateral inferior frontal GMD changes, which presented positively in left-TLE and negatively in right-TLE. These findings suggest prefrontal-thalamo-hippocampal network disruption in TLE.
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Affiliation(s)
- Hsin Tung
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center of Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Epilepsy, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Szu-Yen Pan
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Yang Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Syu-Jyun Peng
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Cho KH, Lee HJ, Lee DA, Park KM. Mammillary Body Atrophy in Temporal Lobe Epilepsy With Hippocampal Sclerosis. J Clin Neurol 2022; 18:635-641. [DOI: 10.3988/jcn.2022.18.6.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje Unversity College of Medicine, Busan, Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje Unversity College of Medicine, Busan, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje Unversity College of Medicine, Busan, Korea
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Peng SJ, Hsieh KLC, Lin YK, Tsai ML, Wong TT, Chang H. Febrile seizures reduce hippocampal subfield volumes but not cortical thickness in children with focal onset seizures. Epilepsy Res 2022; 179:106848. [PMID: 34992023 DOI: 10.1016/j.eplepsyres.2021.106848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Whether febrile seizures (FS) produce long-term injury to the hippocampus or other brain structures is a critical question concerning focal onset seizures in children. Our aims are to evaluate the effect of FS on subfields of the hippocampus, thalamic nuclei, amygdala, cortical thickness, and surface area quantitatively in children with FS who later developed focal seizures and to identify biomarkers based on MRI structures. METHODS Children who had focal onset seizures with or without previous FS and normal 3-T MRI findings were included retrospectively. The MRI was performed within 2 years after the onset of focal seizures. Age-matched controls were also recruited. Hippocampal subfields and thalamic nuclei, amygdala volumes, cortical thickness, and cortical surface area in individual cortical regions were segmented by FreeSurfer version 7.1.1. Volumetric and morphometric data among children who had focal seizures with or without previous FS, as well as controls, were compared and correlated with clinical parameters. RESULTS Children with a history of FS who had focal seizures exhibited smaller right cornu ammonis (CA) 1 and right molecular cell layer of the hippocampus, compared to those without FS. A larger left hippocampal fissure was also found in FS with focal seizures compared to age-matched controls. There were no statistically significant differences in each nucleus of the thalamus, amygdala, cortical thickness, and surface area of each cortical region among the three groups. A smaller whole hippocampal volume was found for the right hippocampus in children with FS and focal seizures compared to those without FS. A trend of negative correlation was found between the frequency of FS and the left and right CA1 subfield volume ratios of the hippocampus. CONCLUSIONS We concluded that multiple episodes of FS may be associated with a trivial difference in volume reduction in the CA1 and molecular layer of the right hippocampus and an enlarged hippocampal fissure of the left hippocampus, but not with individual cortical thicknesses, surface area, thalamic nuclei, or amygdala in children with focal onset seizures.The hippocampal subfield CA1 and molecular layer of the right hippocampus may be more vulnerable than the cortices in children with focal seizures who experienced multiple FS episodes. This study highlights the minimal differences in brain volumes among children with recent onset focal seizures with or without FS history and controls, suggesting that the brain injurious aspects of the FS and recent onset focal seizures may have been previously overstated. This suggests that physicians can be reassuring about brain injury associated with these seizure types when discussing outcomes with parents and patients.
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Affiliation(s)
- Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Min-Lan Tsai
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tai-Tong Wong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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10
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Chen Y, Fallon N, Kreilkamp BAK, Denby C, Bracewell M, Das K, Pegg E, Mohanraj R, Marson AG, Keller SS. Probabilistic mapping of thalamic nuclei and thalamocortical functional connectivity in idiopathic generalised epilepsy. Hum Brain Mapp 2021; 42:5648-5664. [PMID: 34432348 PMCID: PMC8559489 DOI: 10.1002/hbm.25644] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
It is well established that abnormal thalamocortical systems play an important role in the generation and maintenance of primary generalised seizures. However, it is currently unknown which thalamic nuclei and how nuclear‐specific thalamocortical functional connectivity are differentially impacted in patients with medically refractory and non‐refractory idiopathic generalised epilepsy (IGE). In the present study, we performed structural and resting‐state functional magnetic resonance imaging (MRI) in patients with refractory and non‐refractory IGE, segmented the thalamus into constituent nuclear regions using a probabilistic MRI segmentation method and determined thalamocortical functional connectivity using seed‐to‐voxel connectivity analyses. We report significant volume reduction of the left and right anterior thalamic nuclei only in patients with refractory IGE. Compared to healthy controls, patients with refractory and non‐refractory IGE had significant alterations of functional connectivity between the centromedian nucleus and cortex, but only patients with refractory IGE had altered cortical connectivity with the ventral lateral nuclear group. Patients with refractory IGE had significantly increased functional connectivity between the left and right ventral lateral posterior nuclei and cortical regions compared to patients with non‐refractory IGE. Cortical effects were predominantly located in the frontal lobe. Atrophy of the anterior thalamic nuclei and resting‐state functional hyperconnectivity between ventral lateral nuclei and cerebral cortex may be imaging markers of pharmacoresistance in patients with IGE. These structural and functional abnormalities fit well with the known importance of thalamocortical systems in the generation and maintenance of primary generalised seizures, and the increasing recognition of the importance of limbic pathways in IGE.
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Affiliation(s)
- Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | | | - Martyn Bracewell
- The Walton Centre NHS Foundation Trust, Liverpool, UK.,Schools of Medical Sciences and Psychology, Bangor University, Bangor, UK
| | - Kumar Das
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily Pegg
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Rajiv Mohanraj
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
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11
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Sämann PG, Iglesias JE, Gutman B, Grotegerd D, Leenings R, Flint C, Dannlowski U, Clarke‐Rubright EK, Morey RA, Erp TG, Whelan CD, Han LKM, Velzen LS, Cao B, Augustinack JC, Thompson PM, Jahanshad N, Schmaal L. FreeSurfer
‐based segmentation of hippocampal subfields: A review of methods and applications, with a novel quality control procedure for
ENIGMA
studies and other collaborative efforts. Hum Brain Mapp 2020; 43:207-233. [PMID: 33368865 PMCID: PMC8805696 DOI: 10.1002/hbm.25326] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 12/11/2022] Open
Abstract
Structural hippocampal abnormalities are common in many neurological and psychiatric disorders, and variation in hippocampal measures is related to cognitive performance and other complex phenotypes such as stress sensitivity. Hippocampal subregions are increasingly studied, as automated algorithms have become available for mapping and volume quantification. In the context of the Enhancing Neuro Imaging Genetics through Meta Analysis Consortium, several Disease Working Groups are using the FreeSurfer software to analyze hippocampal subregion (subfield) volumes in patients with neurological and psychiatric conditions along with data from matched controls. In this overview, we explain the algorithm's principles, summarize measurement reliability studies, and demonstrate two additional aspects (subfield autocorrelation and volume/reliability correlation) with illustrative data. We then explain the rationale for a standardized hippocampal subfield segmentation quality control (QC) procedure for improved pipeline harmonization. To guide researchers to make optimal use of the algorithm, we discuss how global size and age effects can be modeled, how QC steps can be incorporated and how subfields may be aggregated into composite volumes. This discussion is based on a synopsis of 162 published neuroimaging studies (01/2013–12/2019) that applied the FreeSurfer hippocampal subfield segmentation in a broad range of domains including cognition and healthy aging, brain development and neurodegeneration, affective disorders, psychosis, stress regulation, neurotoxicity, epilepsy, inflammatory disease, childhood adversity and posttraumatic stress disorder, and candidate and whole genome (epi‐)genetics. Finally, we highlight points where FreeSurfer‐based hippocampal subfield studies may be optimized.
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Affiliation(s)
| | - Juan Eugenio Iglesias
- Centre for Medical Image Computing University College London London UK
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital/Harvard Medical School Boston Massachusetts US
- Computer Science and AI Laboratory (CSAIL), Massachusetts Institute of Technology (MIT) Cambridge Massachusetts US
| | - Boris Gutman
- Department of Biomedical Engineering Illinois Institute of Technology Chicago USA
| | | | - Ramona Leenings
- Department of Psychiatry University of Münster Münster Germany
| | - Claas Flint
- Department of Psychiatry University of Münster Münster Germany
- Department of Mathematics and Computer Science University of Münster Germany
| | - Udo Dannlowski
- Department of Psychiatry University of Münster Münster Germany
| | - Emily K. Clarke‐Rubright
- Brain Imaging and Analysis Center, Duke University Durham North Carolina USA
- VISN 6 MIRECC, Durham VA Durham North Carolina USA
| | - Rajendra A. Morey
- Brain Imaging and Analysis Center, Duke University Durham North Carolina USA
- VISN 6 MIRECC, Durham VA Durham North Carolina USA
| | - Theo G.M. Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior University of California Irvine California USA
- Center for the Neurobiology of Learning and Memory University of California Irvine Irvine California USA
| | - Christopher D. Whelan
- Imaging Genetics Center Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Los Angeles California USA
| | - Laura K. M. Han
- Department of Psychiatry Amsterdam University Medical Centers, Vrije Universiteit and GGZ inGeest, Amsterdam Neuroscience Amsterdam The Netherlands
| | - Laura S. Velzen
- Orygen Parkville Australia
- Centre for Youth Mental Health The University of Melbourne Melbourne Australia
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry University of Alberta Edmonton Canada
| | - Jean C. Augustinack
- The Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital/Harvard Medical School Boston Massachusetts US
| | - Paul M. Thompson
- Imaging Genetics Center Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Los Angeles California USA
| | - Neda Jahanshad
- Imaging Genetics Center Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California Los Angeles California USA
| | - Lianne Schmaal
- Orygen Parkville Australia
- Centre for Youth Mental Health The University of Melbourne Melbourne Australia
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12
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Liang X, Pang X, Liu J, Zhao J, Yu L, Zheng J. Comparison of topological properties of functional brain networks with graph theory in temporal lobe epilepsy with different duration of disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1503. [PMID: 33313248 PMCID: PMC7729351 DOI: 10.21037/atm-20-6823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Our study was performed to measure the alterations in topological properties of the functional brain network of temporal lobe epilepsy (TLE) at different durations, exploring the potential progression and neuropathophysiological mechanisms of TLE. Methods Fifty-eight subjects, including 17 TLE patients with a disease duration of ≤5 years (TLE-SD), 20 TLE patients with a disease duration of >5 years (TLE-LD), and 21 healthy controls firstly underwent the Attention Network Test (ANT) to assess the alertness function and received the resting-state functional magnetic resonance imaging (rs-fMRI). Next, a functional brain network was set up, and then the related graph of theoretical network analysis was conducted. Finally, the correlation between network property and the neuropsychological score was analyzed. Results The global and local efficiencies of functional brain networks in TLE-SD patients significantly decreased and tended toward random alterations. Also, the degree centrality (DC) and nodal efficiency (Ne) in right medial pre-frontal thalamus (mPFtha) and right rostral temporal thalamus (rTtha) of TLE-SD patients significantly reduced. Further analysis showed that alertness was positively associated with the characteristic path length but negatively related to the global and local efficiencies in TLE-SD patients; alertness was negatively related to the Ne of mPFtha in TLE-LD patients. Conclusions Our study showed that the functional brain network of TLE patients might undergo compensatory reorganization as the disease progresses, which provides useful insights into the progression and mechanism of TLE.
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Affiliation(s)
- Xiulin Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaomin Pang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinping Liu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingyuan Zhao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Yu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinou Zheng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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13
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People with mesial temporal lobe epilepsy have altered thalamo-occipital brain networks. Epilepsy Behav 2020; 115:107645. [PMID: 33334720 PMCID: PMC7882020 DOI: 10.1016/j.yebeh.2020.107645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
While temporal lobe epilepsy (TLE) is a focal epilepsy, previous work demonstrates that TLE causes widespread brain-network disruptions. Impaired visuospatial attention and learning in TLE may be related to thalamic arousal nuclei connectivity. Our prior preliminary work in a smaller patient cohort suggests that patients with TLE demonstrate abnormal functional connectivity between central lateral (CL) thalamic nucleus and medial occipital lobe. Others have shown pulvinar connectivity disturbances in TLE, but it is incompletely understood how TLE affects pulvinar subnuclei. Also, the effects of epilepsy surgery on thalamic functional connectivity remains poorly understood. In this study, we examine the effects of TLE on functional connectivity of two key thalamic arousal-nuclei: lateral pulvinar (PuL) and CL. We evaluate resting-state functional connectivity of the PuL and CL in 40 patients with TLE and 40 controls using fMRI. In 25 patients, postoperative images (>1 year) were also compared with preoperative images. Compared to controls, patients with TLE exhibit loss of normal positive connectivity between PuL and lateral occipital lobe (p < 0.05), and a loss of normal negative connectivity between CL and medial occipital lobe (p < 0.01, paired t-tests). FMRI amplitude of low-frequency fluctuation (ALFF) in TLE trended higher in ipsilateral PuL (p = 0.06), but was lower in the lateral occipital (p < 0.01) and medial occipital lobe in patients versus controls (p < 0.05, paired t-tests). More abnormal ALFF in the ipsilateral lateral occipital lobe is associated with worse preoperative performance on Rey Complex Figure Test Immediate (p < 0.05, r = 0.381) and Delayed scores (p < 0.05, r = 0.413, Pearson's Correlations). After surgery, connectivity between PuL and lateral occipital lobe remains abnormal in patients (p < 0.01), but connectivity between CL and medial occipital lobe improves and is no longer different from control values (p > 0.05, ANOVA, post hoc Fischer's LSD). In conclusion, thalamic arousal nuclei exhibit abnormal connectivity with occipital lobe in TLE, and some connections may improve after surgery. Studying thalamic arousal centers may help explain distal network disturbances in TLE.
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14
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Grewal SS, Middlebrooks EH, Okromelidze L, Gosden GP, Tatum WO, Lundstrom BN, Worrell GA, Wharen RE, Van Gompel JJ. Variability Between Direct and Indirect Targeting of the Anterior Nucleus of the Thalamus. World Neurosurg 2020; 139:e70-e77. [PMID: 32302732 DOI: 10.1016/j.wneu.2020.03.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preoperative thalamic targeting methods have historically relied on indirect targeting techniques that do not fully account for variances in anatomy or for thalamic atrophy in epilepsy. We aimed to address variability noted between traditional indirect targeting and direct targeting methods for the anterior nucleus of the thalamus (ANT). METHODS Fifteen consecutive patients undergoing ANT deep brain stimulator placement were evaluated (30 thalamic nuclei). Direct ANT targeting was performed using a fast gray matter acquisition T1 inversion recovery sequence and compared with standard stereotactic coordinates. Thalamic volumes were calculated for each patient, and degree of thalamic volume loss was assessed compared with matched control subjects. Vertex analysis was performed to assess shape changes in the thalamus compared with age- and sex-matched subjects. RESULTS There was significant variation between direct and indirect targets in the y-axis and z-axis on both sides. On the left, the direct target was located at y = 2 ± 1.3 mm and z = 9.3 ± 1.8 mm (both P = 0.02). On the right, the direct target was located at y = 2.9 ± 1.8 mm and z = 9.2 ± 2 mm (both P ≤ 0.0003). There was no significant difference in the x-coordinate on either side (P > 0.5). Additionally, there was a correlation between thalamic volume and difference between direct and indirect targets in the y-axis and the z-axis. CONCLUSIONS We showed a significant difference in direct and indirect targeting in the y-axis and z-axis when targeting the ANT for deep brain stimulation for epilepsy. This difference is correlated to thalamic volume, with a larger difference noted in patients with thalamic atrophy.
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Affiliation(s)
- Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Lela Okromelidze
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Grant P Gosden
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Robert E Wharen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
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