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Bala A, Olejnik A, Mojżeszek M, Rysz A, Kunert P. Navigating Social Waters: Understanding Theory-of-Mind Challenges in Patients with Mesial Temporal Lobe Epilepsy. J Clin Med 2024; 13:1410. [PMID: 38592233 PMCID: PMC10932399 DOI: 10.3390/jcm13051410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Temporal lobe epilepsy is a common neurological disease that affects many areas of patients' lives, including social competence. The aim of the study was to assess theory of mind in patients with temporal lobe epilepsy and to investigate the demographic and clinical factors associated with this function. Methods: A total of 65 participants took part in the study, which included 44 patients with epilepsy and 21 demographically matched healthy individuals. The following neuropsychological tests were used to examine theory of mind: the Faux Pas Test, the Hinting Task, the Emotion Comprehension Test, and a cognitive function screen, the Montreal Cognitive Assessment. Results: Patients with epilepsy scored lower on all measures of the theory-of-mind tests. Moreover, in the clinical group, numerous moderate and strong correlations were found between the theory-of-mind tests and education, age at onset of epilepsy, lateralization of epileptic focus, cognitive status, and, to a lesser degree, number of anti-epileptic drugs, frequency of seizures, and age. In contrast, in the control group, significant correlations were found mostly between the theory-of-mind tests and sex, and, to a lesser degree, age. Education and cognitive functioning were not associated. Conclusions: Patients with epilepsy experience difficulties in theory of mind, which may have a negative impact on the quality of their social relationships. The level of theory-of-mind abilities correlates with particular clinical and demographic indicators. Recognizing these issues allows clinicians to implement tailored interventions, potentially improving patients' quality of life.
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Affiliation(s)
- Aleksandra Bala
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
| | - Agnieszka Olejnik
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
| | - Maria Mojżeszek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland
| | - Andrzej Rysz
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
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Harmata GI, Rhone AE, Kovach CK, Kumar S, Mowla MR, Sainju RK, Nagahama Y, Oya H, Gehlbach BK, Ciliberto MA, Mueller RN, Kawasaki H, Pattinson KT, Simonyan K, Davenport PW, Howard MA, Steinschneider M, Chan AC, Richerson GB, Wemmie JA, Dlouhy BJ. Failure to breathe persists without air hunger or alarm following amygdala seizures. JCI Insight 2023; 8:e172423. [PMID: 37788112 PMCID: PMC10721319 DOI: 10.1172/jci.insight.172423] [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: 05/24/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023] Open
Abstract
Postictal apnea is thought to be a major cause of sudden unexpected death in epilepsy (SUDEP). However, the mechanisms underlying postictal apnea are unknown. To understand causes of postictal apnea, we used a multimodal approach to study brain mechanisms of breathing control in 20 patients (ranging from pediatric to adult) undergoing intracranial electroencephalography for intractable epilepsy. Our results indicate that amygdala seizures can cause postictal apnea. Moreover, we identified a distinct region within the amygdala where electrical stimulation was sufficient to reproduce prolonged breathing loss persisting well beyond the end of stimulation. The persistent apnea was resistant to rising CO2 levels, and air hunger failed to occur, suggesting impaired CO2 chemosensitivity. Using es-fMRI, a potentially novel approach combining electrical stimulation with functional MRI, we found that amygdala stimulation altered blood oxygen level-dependent (BOLD) activity in the pons/medulla and ventral insula. Together, these findings suggest that seizure activity in a focal subregion of the amygdala is sufficient to suppress breathing and air hunger for prolonged periods of time in the postictal period, likely via brainstem and insula sites involved in chemosensation and interoception. They further provide insights into SUDEP, may help identify those at greatest risk, and may lead to treatments to prevent SUDEP.
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Affiliation(s)
- Gail I.S. Harmata
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Pharmacological Sciences Training Program
- Department of Psychiatry
| | | | | | | | | | | | | | - Hiroyuki Oya
- Department of Neurosurgery
- Iowa Neuroscience Institute
| | | | | | - Rashmi N. Mueller
- Department of Neurosurgery
- Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
| | | | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kristina Simonyan
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul W. Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA
| | - Matthew A. Howard
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
| | | | | | - George B. Richerson
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Department of Neurology
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA
- Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - John A. Wemmie
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
- Interdisciplinary Graduate Program in Neuroscience
- Department of Psychiatry
- Department of Internal Medicine
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
| | - Brian J. Dlouhy
- Department of Neurosurgery
- Iowa Neuroscience Institute
- Pappajohn Biomedical Institute
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Social Cognition in Temporal and Frontal Lobe Epilepsy: Systematic Review, Meta-analysis, and Clinical Recommendations. J Int Neuropsychol Soc 2023; 29:205-229. [PMID: 35249578 DOI: 10.1017/s1355617722000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Despite the importance of social cognitive functions to mental health and social adjustment, examination of these functions is absent in routine assessment of epilepsy patients. Thus, this review aims to provide a comprehensive overview of the literature on four major aspects of social cognition among temporal and frontal lobe epilepsy, which is a critical step toward designing new interventions. METHOD Papers from 1990 to 2021 were reviewed and examined for inclusion in this study. After the deduplication process, a systematic review and meta-analysis of 44 and 40 articles, respectively, involving 113 people with frontal lobe epilepsy and 1482 people with temporal lobe epilepsy were conducted. RESULTS Our results indicated that while patients with frontal or temporal lobe epilepsy have difficulties in all aspects of social cognition relative to nonclinical controls, the effect sizes were larger for theory of mind (g = .95), than for emotion recognition (g = .69) among temporal lobe epilepsy group. The frontal lobe epilepsy group exhibited significantly greater impairment in emotion recognition compared to temporal lobe. Additionally, people with right temporal lobe epilepsy (g = 1.10) performed more poorly than those with a left-sided (g = .90) seizure focus, specifically in the theory of mind domain. CONCLUSIONS These data point to a potentially important difference in the severity of deficits within the emotion recognition and theory of mind abilities depending on the laterlization of seizure side. We also suggest a guide for the assessment of impairments in social cognition that can be integrated into multidisciplinary clinical evaluation for people with epilepsy.
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Singh V, Grewal KS, Vibha D, Singh RK, Ramanujam B, Nehra A, Chandra SP, Gaikwad S, Babu I, Tripathi M. Cortico-limbic disruption, material-specificity, and deficits in cognitive-affective theory of mind. Brain Commun 2023; 5:fcad100. [PMID: 37101833 PMCID: PMC10123397 DOI: 10.1093/braincomms/fcad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/20/2022] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
The Theory of Mind deficit due to cognitive-affective disintegration is a poorly understood cognitive consequence of cortical and subcortical disruption in right temporal lobe epilepsy. Following Marr's trilevel approach, we used the material-specific processing model to understand the Theory of Mind deficit in drug-resistant epilepsy (N = 30). We examined pre- and post-surgery changes in first-order (somatic-affective, non-verbal component) and second-order Theory of Mind (cognitive-verbal component) in three groups formed using: (i) seizure side (right versus left), (ii) right temporal epilepsy (right temporal lobe epilepsy versus non-right temporal lobe epilepsy), and (iii) right temporal lobe epilepsy with amygdalohippocampectomy (right temporal lobe epilepsy versus left temporal lobe epilepsy amygdalohippocampectomy versus non-amygdalohippocampectomy). We observed a marked deficit in the first-order Theory of Mind in the right temporal lobe amygdalohippocampectomy group; we mapped this deficit to decline in the non-verbal component of Theory of Mind (somatic-affective component). Preliminary results support using a material-specific processing model to understand the Theory of Mind deficits in right temporal lobe epilepsy amygdalohippocampectomy. Malleability of verbal processing in presence of deterioration of non-verbal processing might have clinical relevance for post-surgery recovery in right temporal lobe epilepsy amygdalohippocampectomy. Documenting the material-specific nature of deficits (verbal versus non-verbal) in non-western, linguistically, and socioeconomically diverse country enables us to understand the problem of heterogeneity in post-surgery cognitive consequences in the right amygdalohippocampectomy.
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Affiliation(s)
- Varsha Singh
- Psychology, Department of Humanities and Social Sciences, Indian Institute of Technology Delhi (IIT), New Delhi, 110016, India
| | - Kirat S Grewal
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Deepti Vibha
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Rajesh K Singh
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Bhargavi Ramanujam
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi (AIIMS), Delhi, New Delhi 110029, India
| | - Ashima Nehra
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), Delhi, New Delhi 110029, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Delhi, New Delhi 110029, India
| | - Shailesh Gaikwad
- Department of Neuroimaging Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), Delhi, New Delhi 110029, India
| | - Indupriya Babu
- The UQIDAR Joint Ph.D. program, Indian Institute of Technology Delhi (IIT), New Delhi 110016.India
| | - Manjari Tripathi
- Correspondence to: Manjari Tripathi Room no 705, 7th Floor Department of Neurology AIIMS, New Delhi, Delhi, 110029, India E-mail:
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5
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Eicher M, Jokeit H. Toward social neuropsychology of epilepsy: a meta-analysis on social cognition in epilepsy phenotypes and a critical narrative review on assessment methods. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00093-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this review is to (a) characterize social cognition impairments in the domains of emotion recognition (ER) and theory of mind (ToM) in patients with epilepsy and (b) to review assessment tools with a focus on their validity and usability in clinical practice.
Methods
An electronic search for clinical studies investigating social cognition in epilepsy populations vs healthy control subjects (HC) yielded 53 studies for the meta-analysis and descriptive review.
Results
Results suggest that (1) social cognition is significantly impaired in patients with temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE) and patients with epilepsy not originating within the temporal or frontal lobes including idiopathic generalized epilepsies (eTLE/eFLE); (2) there is no significant difference between eTLE/eFLE and TLE regarding ER, while TLE and FLE patients perform worse than those with eTLE/eFLE, without significant differences between FLE and TLE regarding ToM ability. A descriptive analysis of the most commonly used assessment tools and stimulus material in this field revealed a lack of ecological validity, usability, and economic viability for everyday clinical practice.
Conclusions
Our meta-analysis shows that patients with epilepsy are at a significantly increased risk of deficits in social cognition. However, the underlying multifactorial mechanisms remain unclear. Future research should therefore specifically address the impairment of processing and methodological problems of testing.
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Morningstar M, Grannis C, Mattson WI, Nelson EE. Functional patterns of neural activation during vocal emotion recognition in youth with and without refractory epilepsy. Neuroimage Clin 2022; 34:102966. [PMID: 35182929 PMCID: PMC8859003 DOI: 10.1016/j.nicl.2022.102966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/12/2022] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
Epilepsy has been associated with deficits in the social cognitive ability to decode others' nonverbal cues to infer their emotional intent (emotion recognition). Studies have begun to identify potential neural correlates of these deficits, but have focused primarily on one type of nonverbal cue (facial expressions) to the detriment of other crucial social signals that inform the tenor of social interactions (e.g., tone of voice). Less is known about how individuals with epilepsy process these forms of social stimuli, with a particular gap in knowledge about representation of vocal cues in the developing brain. The current study compared vocal emotion recognition skills and functional patterns of neural activation to emotional voices in youth with and without refractory focal epilepsy. We made novel use of inter-subject pattern analysis to determine brain areas in which activation to emotional voices was predictive of epilepsy status. Results indicated that youth with epilepsy were comparatively less able to infer emotional intent in vocal expressions than their typically developing peers. Activation to vocal emotional expressions in regions of the mentalizing and/or default mode network (e.g., right temporo-parietal junction, right hippocampus, right medial prefrontal cortex, among others) differentiated youth with and without epilepsy. These results are consistent with emerging evidence that pediatric epilepsy is associated with altered function in neural networks subserving social cognitive abilities. Our results contribute to ongoing efforts to understand the neural markers of social cognitive deficits in pediatric epilepsy, in order to better tailor and funnel interventions to this group of youth at risk for poor social outcomes.
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Affiliation(s)
- M Morningstar
- Department of Psychology, Queen's University, Kingston, ON, Canada; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - C Grannis
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - W I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - E E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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7
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Kuchukhidze G, Unterberger I, Schmid E, Zamarian L, Siedentopf CM, Koppelstaetter F, Gizewski E, Kronbichler M, Luef G, Jokeit H, Trinka E. Emotional Recognition in Patients With Mesial Temporal Epilepsy Associated With Enlarged Amygdala. Front Neurol 2022; 12:803787. [PMID: 35126298 PMCID: PMC8815259 DOI: 10.3389/fneur.2021.803787] [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: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Amygdalae play a central role in emotional processing by interconnecting frontal cortex and other brain structures. Unilateral amygdala enlargement (AE) is associated with mesial temporal lobe epilepsy (mTLE). In a relatively large sample of patients with mTLE and AE, we aimed to evaluate functional integration of AE in emotion processing and to determine possible associations between fMRI activation patterns in amygdala and deficits in emotion recognition as assessed by neuropsychological testing. METHODS Twenty-two patients with drug resistant unilateral mTLE due to ipsilateral AE were prospectively recruited in a large epilepsy unit and compared with 17 healthy control subjects in terms of amygdala volume, fMRI activation patterns and performance in emotion recognition as assessed by comprehensive affect testing system (CATS) and Ekman faces. All patients underwent structural and functional 1.5 Tesla MRI, electro-clinical assessment and neuropsychological testing. RESULTS We observed BOLD signal ipsilateral to AE (n = 7; group PAT1); contralateral to AE (n = 6; group PAT2) and no activation (n = 9; group PAT3). In the region of interest (ROI) analysis, beta estimates for fearful face > landscape contrast in the left amygdala region did not differ significantly in patients with left TLE vs. patients with right TLE [T (16) = -1.481; p = 0.158]. However, beta estimates for fearful face > landscape contrast in the right amygdala region were significantly reduced in patients with right TLE vs. patients with left TLE [T (16) = -2,922; p = 0.010]. Patients showed significantly lower total scores in CATS and Ekman faces compared to healthy controls. CONCLUSION In our cohort, patients with unilateral mesial TLE and ipsilateral AE, an amygdala could display either functional integration in emotion recognition or dysfunction as demonstrated by fMRI. Perception and recognition of emotions were impaired more in right-sided mTLE as compared to left-sided mTLE. Neuropsychological tests showed deficits in emotion recognition in patients as compared to healthy controls.
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Affiliation(s)
- Giorgi Kuchukhidze
- Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
| | - Iris Unterberger
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Schmid
- Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Elke Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Gerhard Luef
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hennric Jokeit
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland
| | - Eugen Trinka
- Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- Institute of Neuropsychological Diagnostics and Imaging, Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
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8
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Wang H, Zhao P, Zhao J, Zhong J, Pan P, Wang G, Yi Z. Theory of Mind and Empathy in Adults With Epilepsy: A Meta-Analysis. Front Psychiatry 2022; 13:877957. [PMID: 35573343 PMCID: PMC9093035 DOI: 10.3389/fpsyt.2022.877957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence suggests that social cognitive abilities [including theory of mind (ToM) and empathy] are impaired in adult patients with epilepsy. Although the deficits in overall ToM in epilepsy have been documented well, the effects of epilepsy on empathic ability and specific subcomponents of ToM remain unclear. The primary aim of this study was to provide the first meta-analytic integration of ToM and empathy in adult patients with epilepsy, and to decompose these constructs to clearly differentiate their distinct (cognitive ToM and affective empathy) and overlapping (affective ToM/cognitive empathy) components. This meta-analysis included 28 studies. Adult patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) showed impairments in cognitive ToM and affective ToM/cognitive empathy compared to the healthy controls (HCs); no group differences were identified for affective empathy. Besides, cognitive ToM was impaired in adult patients with idiopathic generalized epilepsy (IGE) and focal seizures (caused by epileptogenic foci) outside the temporal and frontal lobes (extra-TLE/FLE) and no group differences were evident for affective ToM/cognitive empathy compared to the HCs. Moreover, relative to the HCs, no group differences were identified for affective empathy in adult patients with IGE. Additionally, no (statistically) significant difference was observed between the magnitude of ToM/empathy impairment in adult patients who underwent and those who did not undergo epilepsy surgery. These quantitative findings suggest differential impairment of the core aspects of social cognitive processing in adult patients with epilepsy, which may contribute to the development of structured cognitive interventions (i.e., social cognitive training) for adult patients with epilepsy.
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Affiliation(s)
- HongZhou Wang
- Department of Neurology, Anting Hospital, Shanghai, China
| | - PanWen Zhao
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Jing Zhao
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China.,Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - GenDi Wang
- Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - ZhongQuan Yi
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
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9
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Kegel LC, Frühholz S, Grunwald T, Mersch D, Rey A, Jokeit H. Temporal lobe epilepsy alters neural responses to human and avatar facial expressions in the face perception network. Brain Behav 2021; 11:e02140. [PMID: 33951323 PMCID: PMC8213650 DOI: 10.1002/brb3.2140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Although avatars are now widely used in advertisement, entertainment, and business today, no study has investigated whether brain lesions in neurological patients interfere with brain activation in response to dynamic avatar facial expressions. The aim of our event-related fMRI study was to compare brain activation differences in people with epilepsy and controls during the processing of fearful and neutral dynamic expressions displayed by human or avatar faces. METHODS Using functional magnetic resonance imaging (fMRI), we examined brain responses to dynamic facial expressions of trained actors and their avatar look-alikes in 16 people with temporal lobe epilepsy (TLE) and 26 controls. The actors' fearful and neutral expressions were recorded on video and conveyed onto their avatar look-alikes by face tracking. RESULTS Our fMRI results show that people with TLE exhibited reduced response differences between fearful and neutral expressions displayed by humans in the right amygdala and the left superior temporal sulcus (STS). Further, TLE was associated with reduced response differences between human and avatar fearful expressions in the dorsal pathway of the face perception network (STS and inferior frontal gyrus) as well as in the medial prefrontal cortex. CONCLUSIONS Taken together, these findings suggest that brain responses to dynamic facial expressions are altered in people with TLE compared to neurologically healthy individuals-regardless of whether the face is human or computer-generated. In TLE, areas sensitive to dynamic facial features and associated with processes relating to the self and others are particularly affected when processing dynamic human and avatar expressions. Our findings highlight that the impact of TLE on facial emotion processing must be extended to artificial faces and should be considered when applying dynamic avatars in the context of neurological conditions.
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Affiliation(s)
- Lorena Chantal Kegel
- Swiss Epilepsy Center, Zurich, Switzerland.,Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Sascha Frühholz
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Dieter Mersch
- Institute for Critical Theory, Zurich University of the Arts, Zurich, Switzerland
| | - Anton Rey
- Institute for the Performing Arts and Film, Zurich University of the Arts, Zurich, Switzerland
| | - Hennric Jokeit
- Swiss Epilepsy Center, Zurich, Switzerland.,Department of Psychology, University of Zurich, Zurich, Switzerland
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10
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Morningstar M, French RC, Mattson WI, Englot DJ, Nelson EE. Social brain networks: Resting-state and task-based connectivity in youth with and without epilepsy. Neuropsychologia 2021; 157:107882. [PMID: 33964273 DOI: 10.1016/j.neuropsychologia.2021.107882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022]
Abstract
Individuals with epilepsy often experience social difficulties and deficits in social cognition. It remains unknown how disruptions to neural networks underlying such skills may contribute to this clinical phenotype. The current study compared the organization of relevant brain circuits-the "mentalizing network" and a salience-related network centered on the amygdala-in youth with and without epilepsy. Functional connectivity between the nodes of these networks was assessed, both at rest and during engagement in a social cognitive task (facial emotion recognition), using functional magnetic resonance imaging. There were no group differences in resting-state connectivity within either neural network. In contrast, youth with epilepsy showed comparatively lower connectivity between the left posterior superior temporal sulcus and the medial prefrontal cortex-but greater connectivity within the left temporal lobe-when viewing faces in the task. These findings suggest that the organization of a mentalizing network underpinning social cognition may be disrupted in youth with epilepsy, though differences in connectivity within this circuit may shift depending on task demands. Our results highlight the importance of considering functional task-based engagement of neural systems in characterizations of network dysfunction in epilepsy.
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Affiliation(s)
- M Morningstar
- Department of Psychology, Queen's University, Kingston, ON, Canada; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - R C French
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - W I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - D J Englot
- Department of Neurological Surgery, Radiology and Radiological Sciences, and Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - E E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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11
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Blunted neural response to emotional faces in the fusiform and superior temporal gyrus may be marker of emotion recognition deficits in pediatric epilepsy. Epilepsy Behav 2020; 112:107432. [PMID: 32919203 PMCID: PMC7895303 DOI: 10.1016/j.yebeh.2020.107432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/17/2020] [Accepted: 08/12/2020] [Indexed: 01/13/2023]
Abstract
Individuals with epilepsy are at risk for social cognition deficits, including impairments in the ability to recognize nonverbal cues of emotion (i.e., emotion recognition [ER] skills). Such deficits are particularly pronounced in adult patients with childhood-onset seizures and are already evident in children and adolescents with epilepsy. Though these impairments have been linked to blunted neural response to emotional information in faces in adult patients, little is known about the neural correlates of ER deficits in youth with epilepsy. The current study compared ER accuracy and neural response to emotional faces during functional magnetic resonance imaging (fMRI) in youth with intractable focal epilepsy and typically developing youth. Relative to typically developing participants, individuals with epilepsy showed a) reduced accuracy in the ER task and b) blunted response to emotional faces (vs. neutral faces) in the bilateral fusiform gyri and right superior temporal gyrus (STG). Activation in these regions was correlated with performance, suggesting that aberrant response within these face-responsive regions may play a functional role in ER impairments. Reduced engagement of neural circuits relevant to processing socioemotional cues may be markers of risk for social cognitive deficits in youth with focal epilepsy.
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Jiang Y, Liu DF, Zhang X, Liu HG, Zhang JG. Microstructure and functional connectivity-based evidence for memory-related regional impairments in the brains of pilocarpine-treated rats. Brain Res Bull 2019; 154:127-134. [PMID: 31756422 DOI: 10.1016/j.brainresbull.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/09/2019] [Accepted: 11/17/2019] [Indexed: 12/21/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) frequently suffer from memory disorders, and the pathological changes show widespread regional impairments in the brain. In lithium-pilocarpine (LIP)-treated rats with TLE, an abnormal hippocampal microstructure and functional connectivity have been observed. However, changes in other brain regions are still unclear. In the present study, diffusion tensor imaging and functional magnetic resonance imaging (MRI) signals were collected in LIP-TLE rats and controls using a 7.0 T MRI. Microstructural parameters and functional connectivity were calculated among regions of interest (ROIs), including the bilateral prefrontal cortex, amygdala, hippocampus and entorhinal cortex. A correlation analysis was further performed between the neuroimaging results and the behavioral performance in the novel object and novel location memory tests. In our results, TLE rats showed increased fractional anisotropy (FA) values in the hippocampus and decreased FA values in the amygdala and entorhinal cortex. In addition, decreased functional connectivity between the amygdala and the CA3, and increased connectivity between the prefrontal cortex and the CA1 were observed in the TLE rats compared to control rats. Moreover, FA values in the amygdala, the hippocampus and the entorhinal cortex, as well as the amygdala-CA3 and the prefrontal-CA1 connectivity correlated with the memory performance. Based on our results, both the microstructure and functional connections were impaired in memory-related brain regions of LIP-TLE rats. Furthermore, the abnormal changes in the microstructure and functional connectivity were related to behavioral deficits in object and location memory.
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Affiliation(s)
- Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
| | - De-Feng Liu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Huan-Guang Liu
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China; Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Ives-Deliperi VL, Jokeit H. Impaired Social Cognition in Epilepsy: A Review of What We Have Learnt From Neuroimaging Studies. Front Neurol 2019; 10:940. [PMID: 31572284 PMCID: PMC6752178 DOI: 10.3389/fneur.2019.00940] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Social cognition refers to specific mental processes that subserve social interaction. Impaired social cognition has been increasingly reported in patients with epilepsy and negatively affects overall quality of life (QOL). In this article, we will review neuroimaging studies of social cognition in people with epilepsy. Methods: An electronic search of the literature was conducted and 14 studies qualified for inclusion in the review. Results: Although the studies reviewed revealed a varied pattern of neural activations in response to emotion recognition and theory of mind tasks, consensual findings included altered pattern of signal activation in the social cognition network in patients with mesial temporal lobe epilepsy (MTLE) compared to healthy controls and significantly reduced signal activations and functional connectivity within this network in patients with right mesial temporal lobe pathology. Conclusion: This review contextualizes our current understanding of the pathophysiology of impaired social cognition in epilepsy and makes recommendations for further research.
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Affiliation(s)
| | - Hennric Jokeit
- Department of Neuropsychology, Swiss Epilepsy Centre, Zurich, Switzerland
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14
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Nass RD, Hampel KG, Elger CE, Surges R. Blood Pressure in Seizures and Epilepsy. Front Neurol 2019; 10:501. [PMID: 31139142 PMCID: PMC6527757 DOI: 10.3389/fneur.2019.00501] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/25/2019] [Indexed: 12/18/2022] Open
Abstract
In this narrative review, we summarize the current knowledge of neurally mediated blood pressure (BP) control and discuss how recently described epilepsy- and seizure-related BP alterations may contribute to premature mortality and sudden unexpected death in epilepsy (SUDEP). Although people with epilepsy display disturbed interictal autonomic function with a shift toward predominant sympathetic activity, prevalence of arterial hypertension is similar in people with and without epilepsy. BP is transiently increased in association with most types of epileptic seizures but may also decrease in some, illustrating that seizure activity can cause both a decrease and increase of BP, probably because of stimulation or inhibition of distinct central autonomic function by epileptic activity that propagates into different neuronal networks of the central autonomic nervous system. The principal regulatory neural loop for short-term BP control is termed baroreflex, mainly involving peripheral sensors and brain stem nuclei. The baroreflex sensitivity (BRS, expressed as change of interbeat interval per change in BP) is intact after focal seizures, whereas BRS is markedly impaired in the early postictal period following generalized convulsive seizures (GCS), possibly due to metabolically mediated muscular hyperemia in skeletal muscles, a massive release of catecholamines and compromised brain stem function. Whilst most SUDEP cases are probably caused by a cardiorespiratory failure during the early postictal period following GCS, a profoundly disturbed BRS may allow a life-threatening drop of systemic BP in the aftermath of GCS, as recently reported in a patient as a plausible cause of SUDEP in a few patients.
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Affiliation(s)
- Robert D Nass
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Kevin G Hampel
- Department of Neurology, University Hospital La Fe, Valencia, Spain
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Tong X, An D, Xiao F, Lei D, Niu R, Li W, Ren J, Liu W, Tang Y, Zhang L, Zhou B, Gong Q, Zhou D. Real‐time effects of interictal spikes on hippocampus and amygdala functional connectivity in unilateral temporal lobe epilepsy: AnEEG‐fMRIstudy. Epilepsia 2019; 60:246-254. [PMID: 30653664 DOI: 10.1111/epi.14646] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Xin Tong
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Dongmei An
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Fenglai Xiao
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Du Lei
- Huaxi MR Research Center Department of Radiology West China Hospital Sichuan University Chengdu Sichuan China
| | - Running Niu
- Huaxi MR Research Center Department of Radiology West China Hospital Sichuan University Chengdu Sichuan China
| | - Wei Li
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Jiechuan Ren
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Wenyu Liu
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Yingying Tang
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Le Zhang
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
| | - Baiwan Zhou
- Huaxi MR Research Center Department of Radiology West China Hospital Sichuan University Chengdu Sichuan China
| | - Qiyong Gong
- Huaxi MR Research Center Department of Radiology West China Hospital Sichuan University Chengdu Sichuan China
| | - Dong Zhou
- Department of Neurology West China Hospital Sichuan University Chengdu Sichuan China
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Jafari-Khouzani K, Elisevich K, Wasade VS, Soltanian-Zadeh H. Contribution of Quantitative Amygdalar MR FLAIR Signal Analysis for Lateralization of Mesial Temporal Lobe Epilepsy. J Neuroimaging 2018; 28:666-675. [PMID: 30066349 DOI: 10.1111/jon.12549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE This study evaluates the contribution of an automated amygdalar fluid-attenuated inversion recovery (FLAIR) signal analysis for the lateralization of mesial temporal lobe epilepsy (mTLE). METHODS Sixty-nine patients (27 M, 42 F) who had undergone surgery and achieved an Engel class Ia postoperative outcome were identified as a pure cohort of mTLE cases. Forty-six nonepileptic subjects comprised the control group. The amygdala was segmented in T1-weighted images using an atlas-based segmentation. The right/left ratios of amygdalar FLAIR mean and standard deviation were calculated for each subject. A linear classifier (ie, discriminator line) was designed for lateralization using the FLAIR features and a boundary domain, within which lateralization was assumed to be less definitive, was established using the same features from control subjects. Hippocampal FLAIR and volume analysis was performed for comparison. RESULTS With the boundary domain in place, lateralization accuracy was found to be 70% with hippocampal FLAIR and 67% with hippocampal volume. Taking amygdalar analysis into account, 22% of cases that were found to have uncertain lateralization by hippocampal FLAIR analysis were confidently lateralized by amygdalar FLAIR. No misclassified case was found outside the amygdalar FLAIR boundary domain. CONCLUSIONS Amygdalar FLAIR analysis provides an additional metric by which to establish mTLE in those cases where hippocampal FLAIR and volume analysis have failed to provide lateralizing information.
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Affiliation(s)
- Kourosh Jafari-Khouzani
- iCAD, Incorpoated, Nashua, NH.,Medical Image Analysis Laboratory, Henry Ford Health System, Detroit, MI
| | - Kost Elisevich
- Department of Clinical Neurosciences (Division of Neurosurgery), Spectrum Health System, Grand Rapids, MI.,Division of Neurosurgery, College of Human Medicine, Michigan State University, Grand Rapids, MI
| | | | - Hamid Soltanian-Zadeh
- Medical Image Analysis Laboratory, Henry Ford Health System, Detroit, MI.,Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
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Nanni M, Martínez-Soto J, Gonzalez-Santos L, Barrios FA. Neural correlates of the natural observation of an emotionally loaded video. PLoS One 2018; 13:e0198731. [PMID: 29883494 PMCID: PMC5993250 DOI: 10.1371/journal.pone.0198731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/24/2018] [Indexed: 01/24/2023] Open
Abstract
Studies based on a paradigm of free or natural viewing have revealed characteristics that allow us to know how the brain processes stimuli within a natural environment. This method has been little used to study brain function. With a connectivity approach, we examine the processing of emotions using an exploratory method to analyze functional magnetic resonance imaging (fMRI) data. This research describes our approach to modeling stress paradigms suitable for neuroimaging environments. We showed a short film (4.54 minutes) with high negative emotional valence and high arousal content to 24 healthy male subjects (36.42 years old; SD = 12.14) during fMRI. Independent component analysis (ICA) was used to identify networks based on spatial statistical independence. Through this analysis we identified the sensorimotor system and its influence on the dorsal attention and default-mode networks, which in turn have reciprocal activity and modulate networks described as emotional.
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Affiliation(s)
- Melanni Nanni
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Querétaro, México
| | - Joel Martínez-Soto
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Querétaro, México
- Department of Psychology, Universidad de Guanajuato, León, Guanajuato, México
| | | | - Fernando A. Barrios
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Querétaro, México
- * E-mail:
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Shah MN, Mitra A, Goyal MS, Snyder AZ, Zhang J, Shimony JS, Limbrick DD, Raichle ME, Smyth MD. Resting state signal latency predicts laterality in pediatric medically refractory temporal lobe epilepsy. Childs Nerv Syst 2018; 34:901-910. [PMID: 29511809 PMCID: PMC5897166 DOI: 10.1007/s00381-018-3770-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Temporal lobe epilepsy (TLE) affects resting state brain networks in adults. This study aims to correlate resting state functional MRI (rsMRI) signal latency in pediatric TLE patients with their laterality. METHODS From 2006 to 2016, 26 surgical TLE patients (12 left, 14 right) with a mean age of 10.7 years (range 0.9-18) were prospectively studied. Preoperative rsMRI was obtained in patients with concordant lateralizing structural MRI, EEG, and PET studies. Standard preprocessing techniques and seed-based rsMRI analyses were performed. Additionally, the latency in rsMRI signal between each 6 mm voxel sampled was examined, compared to the global mean signal, and projected onto standard atlas space for individuals and the cohort. RESULTS All but one of the 26 patients improved seizure frequency postoperatively with a mean follow-up of 2.9 years (range 0-7.7), with 21 patients seizure-free. When grouped for epileptogenic laterality, the latency map qualitatively demonstrated that the right TLE patients had a relatively early signal pattern, whereas the left TLE patients had a relatively late signal pattern compared to the global mean signal in the right temporal lobe. Quantitatively, the two groups had significantly different signal latency clusters in the bilateral temporal lobes (p < 0.001). CONCLUSION There are functional MR signal latency changes in medical refractory pediatric TLE patients. Qualitatively, signal latency in the right temporal lobe precedes the mean signal in right TLE patients and is delayed in left TLE patients. With larger confirmatory studies, preoperative rsMRI latency analysis may offer an inexpensive, noninvasive adjunct modality to lateralize pediatric TLE.
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Affiliation(s)
- Manish N Shah
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, 6431 Fannin St, MSB 5.144, Houston, TX, 77030, USA.
| | - Anish Mitra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Manu S Goyal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jing Zhang
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, 6431 Fannin St, MSB 5.144, Houston, TX, 77030, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Marcus E Raichle
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Matthew D Smyth
- Department of Neurological Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, 63110, USA
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19
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The roles of surgery and technology in understanding focal epilepsy and its comorbidities. Lancet Neurol 2018; 17:373-382. [DOI: 10.1016/s1474-4422(18)30031-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 01/21/2023]
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20
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Mesial temporal lobe epilepsy diminishes functional connectivity during emotion perception. Epilepsy Res 2017; 134:33-40. [DOI: 10.1016/j.eplepsyres.2017.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/04/2017] [Accepted: 05/05/2017] [Indexed: 12/12/2022]
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21
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Left or right? Lateralizing temporal lobe epilepsy by dynamic amygdala fMRI. Epilepsy Behav 2017; 70:118-124. [PMID: 28427018 DOI: 10.1016/j.yebeh.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In this case series, the findings of 85 functional MRI studies employing a dynamic fearful face paradigm are reported. Previous findings have shown the paradigm to generate bilateral amygdala activations in healthy subjects and unilateral activations in patients with MTLE, in the contralateral hemisphere to seizure origin. Such findings suggest ipsilateral limbic pathology and offer collateral evidence in lateralizing MTLE. METHODS The series includes 60 patients with TLE, 12 patients with extra-temporal lobe epilepsy, and 13 healthy controls. Functional MRI studies using a 1.5T scanner were conducted over a three-year period at a single epilepsy center and individual results were compared with EEG findings. RESULTS In the cohort of unilateral TLE patients, lateralized activations of the amygdala were concordant with EEG findings in 76% of patients (77% lTLE, 74% rTLE). The differences in the mean lateralized indices of the lTLE, rTLE, and healthy control groups were all statistically significant. Lateralized amygdala activations were concordant with EEG findings in only 31% of the 12 patients with extra-temporal lobe epilepsy and bilateral amygdala activations were generated in all but one of the healthy control subjects. SIGNIFICANCE This case series further endorses the utility of the dynamic fearful face functional MRI paradigm using the widely available 1.5T as an adjunctive investigation to lateralize TLE.
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Richard AE, Scheffer IE, Wilson SJ. Features of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder. Neurosci Biobehav Rev 2017; 75:203-233. [DOI: 10.1016/j.neubiorev.2016.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 12/29/2022]
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Hennion S, Delbeuck X, Koelkebeck K, Brion M, Tyvaert L, Plomhause L, Derambure P, Lopes R, Szurhaj W. A functional magnetic resonance imaging investigation of theory of mind impairments in patients with temporal lobe epilepsy. Neuropsychologia 2016; 93:271-279. [DOI: 10.1016/j.neuropsychologia.2016.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Neural Modulation in Aversive Emotion Processing: An Independent Component Analysis Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:2816567. [PMID: 27579051 PMCID: PMC4992784 DOI: 10.1155/2016/2816567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/14/2016] [Indexed: 01/20/2023]
Abstract
Emotional processing has an important role in social interaction. We report the findings about the Independent Component Analysis carried out on a fMRI set obtained with a paradigm of face emotional processing. The results showed that an independent component, mainly cerebellar-medial-frontal, had a positive modulation associated with fear processing. Also, another independent component, mainly parahippocampal-prefrontal, showed a negative modulation that could be associated with implicit reappraisal of emotional stimuli. Independent Component Analysis could serve as a method to understand complex cognitive processes and their underlying neural dynamics.
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Turner BO, Marinsek N, Ryhal E, Miller MB. Hemispheric lateralization in reasoning. Ann N Y Acad Sci 2015; 1359:47-64. [PMID: 26426534 DOI: 10.1111/nyas.12940] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
A growing body of evidence suggests that reasoning in humans relies on a number of related processes whose neural loci are largely lateralized to one hemisphere or the other. A recent review of this evidence concluded that the patterns of lateralization observed are organized according to two complementary tendencies. The left hemisphere attempts to reduce uncertainty by drawing inferences or creating explanations, even at the cost of ignoring conflicting evidence or generating implausible explanations. Conversely, the right hemisphere aims to reduce conflict by rejecting or refining explanations that are no longer tenable in the face of new evidence. In healthy adults, the hemispheres work together to achieve a balance between certainty and consistency, and a wealth of neuropsychological research supports the notion that upsetting this balance results in various failures in reasoning, including delusions. However, support for this model from the neuroimaging literature is mixed. Here, we examine the evidence for this framework from multiple research domains, including an activation likelihood estimation analysis of functional magnetic resonance imaging studies of reasoning. Our results suggest a need to either revise this model as it applies to healthy adults or to develop better tools for assessing lateralization in these individuals.
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Affiliation(s)
- Benjamin O Turner
- Department of Psychological & Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Nicole Marinsek
- Dynamical Neuroscience, University of California Santa Barbara, Santa Barbara, California
| | - Emily Ryhal
- Department of Psychological & Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Michael B Miller
- Department of Psychological & Brain Sciences, University of California Santa Barbara, Santa Barbara, California
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Right mesial temporal lobe epilepsy impairs empathy-related brain responses to dynamic fearful faces. J Neurol 2015; 262:729-41. [PMID: 25572160 DOI: 10.1007/s00415-014-7622-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 12/30/2022]
Abstract
Unilateral mesial temporal lobe epilepsy (MTLE) has been associated with reduced amygdala responsiveness to fearful faces. However, the effect of unilateral MTLE on empathy-related brain responses in extra-amygdalar regions has not been investigated. Using functional magnetic resonance imaging, we measured empathy-related brain responses to dynamic fearful faces in 34 patients with unilateral MTLE (18 right sided), in an epilepsy (extra-MTLE; n = 16) and in a healthy control group (n = 30). The primary finding was that right MTLE (RMTLE) was associated with decreased activity predominantly in the right amygdala and also in bilateral periaqueductal gray (PAG) but normal activity in the right anterior insula. The results of the extra-MTLE group demonstrate that these reduced amygdala and PAG responses go beyond the attenuation caused by antiepileptic and antidepressant medication. These findings clearly indicate that RMTLE affects the function of mesial temporal and midbrain structures that mediate basic interoceptive input necessary for the emotional awareness of empathic experiences of fear. Together with the decreased empathic concern found in the RMTLE group, this study provides neurobehavioral evidence that patients with RMTLE are at increased risk for reduced empathy towards others' internal states and sheds new light on the nature of social-cognitive impairments frequently accompanying MTLE.
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Pittau F, Mégevand P, Sheybani L, Abela E, Grouiller F, Spinelli L, Michel CM, Seeck M, Vulliemoz S. Mapping epileptic activity: sources or networks for the clinicians? Front Neurol 2014; 5:218. [PMID: 25414692 PMCID: PMC4220689 DOI: 10.3389/fneur.2014.00218] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/08/2014] [Indexed: 01/03/2023] Open
Abstract
Epileptic seizures of focal origin are classically considered to arise from a focal epileptogenic zone and then spread to other brain regions. This is a key concept for semiological electro-clinical correlations, localization of relevant structural lesions, and selection of patients for epilepsy surgery. Recent development in neuro-imaging and electro-physiology and combinations, thereof, have been validated as contributory tools for focus localization. In parallel, these techniques have revealed that widespread networks of brain regions, rather than a single epileptogenic region, are implicated in focal epileptic activity. Sophisticated multimodal imaging and analysis strategies of brain connectivity patterns have been developed to characterize the spatio-temporal relationships within these networks by combining the strength of both techniques to optimize spatial and temporal resolution with whole-brain coverage and directional connectivity. In this paper, we review the potential clinical contribution of these functional mapping techniques as well as invasive electrophysiology in human beings and animal models for characterizing network connectivity.
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Affiliation(s)
- Francesca Pittau
- EEG and Epilepsy Unit, Neurology Department, University Hospitals and Faculty of Medicine of Geneva , Geneva , Switzerland
| | - Pierre Mégevand
- Laboratory for Multimodal Human Brain Mapping, Hofstra North Shore LIJ School of Medicine , Manhasset, NY , USA
| | - Laurent Sheybani
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva , Geneva , Switzerland
| | - Eugenio Abela
- Support Center of Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital , Bern , Switzerland
| | - Frédéric Grouiller
- Radiology Department, University Hospitals and Faculty of Medicine of Geneva , Geneva , Switzerland
| | - Laurent Spinelli
- EEG and Epilepsy Unit, Neurology Department, University Hospitals and Faculty of Medicine of Geneva , Geneva , Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva , Geneva , Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Neurology Department, University Hospitals and Faculty of Medicine of Geneva , Geneva , Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Neurology Department, University Hospitals and Faculty of Medicine of Geneva , Geneva , Switzerland
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Labudda K, Mertens M, Steinkroeger C, Bien CG, Woermann FG. Lesion side matters - an fMRI study on the association between neural correlates of watching dynamic fearful faces and their evaluation in patients with temporal lobe epilepsy. Epilepsy Behav 2014; 31:321-8. [PMID: 24210457 DOI: 10.1016/j.yebeh.2013.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/27/2022]
Abstract
Most studies assessing facial affect recognition in patients with TLE reported emotional disturbances in patients with TLE. Results from the few fMRI studies assessing neural correlates of affective face processing in patients with TLE are divergent. Some, but not all, found asymmetrical mesiotemporal activations, i.e., stronger activations within the hemisphere contralateral to seizure onset. Little is known about the association between neural correlates of affect processing and subjective evaluation of the stimuli presented. Therefore, we investigated the neural correlates of processing dynamic fearful faces in 37 patients with mesial temporal lobe epilepsy (TLE; 18 with left-sided TLE (lTLE), 19 with right-sided TLE (rTLE)) and 20 healthy subjects. We additionally assessed individual ratings of the fear intensity and arousal perception of the fMRI stimuli and correlated these data with the activations induced by the fearful face paradigm and activation lateralization within the mesiotemporal structures (in terms of individual lateralization indices, LIs). In healthy subjects, whole-brain analysis showed bilateral activations within a widespread network of mesial and lateral temporal, occipital, and frontal areas. The patient groups activated different parts of this network. In patients with lTLE, we found predominantly right-sided activations within the mesial and lateral temporal cortices and the superior frontal gyrus. In patients with rTLE, we observed bilateral activations in the posterior regions of the lateral temporal lobe and within the occipital cortex. Mesiotemporal region-of-interest analysis showed bilateral symmetric activations associated with watching fearful faces in healthy subjects. According to the region of interest and LI analyses, in the patients with lTLE, mesiotemporal activations were lateralized to the right hemisphere. In the patients with rTLE, we found left-sided mesiotemporal activations. In patients with lTLE, fear ratings were comparable to those of healthy subjects and were correlated with relatively stronger activations in the right compared to the left amygdala. Patients with rTLE showed significantly reduced fear ratings compared to healthy subjects, and we did not find associations with amygdala lateralization. Although we found stronger activations within the contralateral mesial temporal lobe in the majority of all patients, our results suggest that only in the event of left-sided mesiotemporal damage is the right mesial temporal lobe able to preserve intact facial fear recognition. In the event of right-sided mesiotemporal damage, fear recognition is disturbed. This underlines the hypothesis that the right amygdala is biologically predisposed to processing fear, and its function cannot be fully compensated in the event of right-sided mesiotemporal damage.
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Affiliation(s)
- Kirsten Labudda
- Mara Hospital, Bethel Epilepsy Center, Maraweg 21, 33617 Bielefeld, Germany
| | - Markus Mertens
- Mara Hospital, Bethel Epilepsy Center, Maraweg 21, 33617 Bielefeld, Germany
| | | | - Christian G Bien
- Mara Hospital, Bethel Epilepsy Center, Maraweg 21, 33617 Bielefeld, Germany
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Kemmotsu N, Kucukboyaci NE, Cheng CE, Girard HM, Tecoma ES, Iragui VJ, McDonald CR. Alterations in functional connectivity between the hippocampus and prefrontal cortex as a correlate of depressive symptoms in temporal lobe epilepsy. Epilepsy Behav 2013; 29:552-9. [PMID: 24176688 PMCID: PMC3876964 DOI: 10.1016/j.yebeh.2013.09.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/05/2013] [Accepted: 09/29/2013] [Indexed: 11/18/2022]
Abstract
Depression is a common comorbidity in temporal lobe epilepsy (TLE) that is thought to have a neurobiological basis. This study investigated the functional connectivity (FC) of medial temporal networks in depression symptomatology of TLE and the relative contribution of structural versus FC measures. Volumetric MRI and functional connectivity MRI (fcMRI) were performed on nineteen patients with TLE and 20 controls. The hippocampi and amygdalae were selected as seeds, and five prefrontal and five cingulate regions of interest (ROIs) were selected as targets. Low-frequency blood-oxygen-level-dependent signals were isolated from fcMRI data, and ROIs with synchronous signal fluctuations with the seeds were identified. Depressive symptoms were measured by the Beck Depression Inventory-II. The patients with TLE showed greater ipsilateral hippocampal atrophy (HA) and reduced FC between the ipsilateral hippocampus and the ventral posterior cingulate cortex (vPCC). Neither HA nor hippocampal-vPCC FC asymmetry was a robust contributor to depressive symptoms. Rather, hippocampal-anterior prefrontal FC was a stronger contributor to depressive symptoms in left TLE (LTLE). Conversely, right amygdala FC was correlated with depressive symptoms in both patient groups, with a positive and negative correlation in LTLE and right TLE (RTLE), respectively. Frontolimbic network dysfunction is a strong contributor to levels of depressive symptoms in TLE and a better contributor than HA in LTLE. In addition, the right amygdala may play a role in depression symptomatology regardless of the side of the epileptogenic focus. These findings may inform the treatment of depressive symptoms in TLE and inspire future research to help guide surgical planning.
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Affiliation(s)
- Nobuko Kemmotsu
- University of California San Diego Multimodal Imaging Laboratory, 8950 Villa La Jolla Dr., Suite C101, La Jolla, CA 92037, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
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Cataldi M, Avoli M, de Villers-Sidani E. Resting state networks in temporal lobe epilepsy. Epilepsia 2013; 54:2048-59. [PMID: 24117098 DOI: 10.1111/epi.12400] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 12/17/2022]
Abstract
Temporal lobe epilepsy (TLE) is typically described as a neurologic disorder affecting a cerebral network comprising the hippocampus proper and several anatomically related extrahippocampal regions. A new level of complexity was recently added to the study of this disorder by the evidence that TLE also appears to chronically alter the activity of several brain-wide neural networks involved in the control of higher order brain functions and not traditionally linked to epilepsy. Recently developed brain imaging techniques such as functional magnetic resonance imaging (fMRI) analysis of resting state connectivity, have greatly contributed to these observations by allowing the precise characterization of several brain networks with distinct functional signatures in the resting brain, and therefore also known as "resting state networks." These significant advances in imaging represent an opportunity to investigate the still elusive origins of the disabling cognitive and psychiatric manifestations of TLE, and could have important implications for its pathophysiology and, perhaps, its therapy. Herein we review recent studies in this field by focusing on resting state networks that have been implicated in the pathophysiology of psychiatric disorders and cognitive impairment in patients with epilepsy: the default mode network, the attention network, and the reward/emotion network.
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Affiliation(s)
- Mauro Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Naples, Italy
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Doucet GE, Skidmore C, Sharan AD, Sperling MR, Tracy JI. Functional connectivity abnormalities vary by amygdala subdivision and are associated with psychiatric symptoms in unilateral temporal epilepsy. Brain Cogn 2013; 83:171-82. [PMID: 24036129 DOI: 10.1016/j.bandc.2013.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/11/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
The amygdala has been described as a structure affected by mesial temporal lobe epilepsy (MTLE). Indeed, it is suggested that amygdala abnormalities are related to the co-morbid depression and anxiety reported in MTLE. In this context, we investigated the relation between functional connectivity (FC) emerging from this structure in fMRI and depression and anxiety levels reported in MTLE patients. We focused on resting-state BOLD activity and evaluated whether FC differences emerge from each of three amygdala subdivisions (laterobasal, centromedial and superficial) in left and right MTLE groups, compared with healthy controls. Results revealed significant differences between patient groups and controls. Specifically, the left MTLE group showed abnormal FC for the left-sided seeds only. Furthermore, regardless of the seed, we observed more reliable differences between the right MTLE group and controls. Further analysis of these results revealed correlations between these impaired connectivities and psychiatric symptoms in both MTLE groups. Opposite relations, however, were highlighted: the more depressed or anxious the right MTLE patients, the closer their FC values approached controls; whereas the less anxious the left MTLE patients, the closer their FC values were normative. These results highlight how MTLE alter FC emerging from the limbic system. Overall, our data demonstrate that right TLE has a more maladaptive impact on emotion-related networks, in ways specific to the amygdala region, and the emotion symptom involved, than left TLE.
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Affiliation(s)
- Gaëlle E Doucet
- Department of Neurology, Thomas Jefferson University, United States; Department of Neurosurgery, Thomas Jefferson University, United States
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Abstract
Children with epilepsy are at risk for behavioral and cognitive comorbidities. Potential etiologies can be assessed in part by neuroimaging. Functional magnetic resonance imaging (MRI) has a major role in presurgical evaluation and prediction of postoperative outcome by mapping of language and memory. Structural MRI and functional MRI have shown changes in children and adolescents with attention deficit hyperactivity disorder and disruptive behavior, common comorbidities in children with epilepsy. Neuroimaging has the potential for significantly increasing understanding of the basis of cognitive and behavioral problems in children with epilepsy.
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