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Ma L, Liu G, Zhang P, Wang J, Huang W, Jiang Y, Zheng Y, Han N, Zhang Z, Zhang J. Altered Cerebro-Cerebellar Effective Connectivity in New-Onset Juvenile Myoclonic Epilepsy. Brain Sci 2022; 12:brainsci12121658. [PMID: 36552118 PMCID: PMC9775154 DOI: 10.3390/brainsci12121658] [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: 11/03/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Objective: Resting-state fMRI studies have indicated that juvenile myoclonic epilepsy (JME) could cause widespread functional connectivity disruptions between the cerebrum and cerebellum. However, the directed influences or effective connectivities (ECs) between these brain regions are poorly understood. In the current study, we aimed to evaluate the ECs between the cerebrum and cerebellum in patients with new-onset JME. (2) Methods: Thirty-four new-onset JME patients and thirty-four age-, sex-, and education-matched healthy controls (HCs) were included in this study. We compared the degree centrality (DC) between the two groups to identify intergroup differences in whole-brain functional connectivity. Then, we used a Granger causality analysis (GCA) to explore JME-caused changes in EC between cerebrum regions and cerebellum regions. Furthermore, we applied a correlation analysis to identify associations between aberrant EC and disease severity in patients with JME. (3) Results: Compared to HCs, patients with JME showed significantly increased DC in the left cerebellum posterior lobe (CePL.L), the right inferior temporal gyrus (ITG.R) and the right superior frontal gyrus (SFG.R), and decreased DC in the left inferior frontal gyrus (IFG.L) and the left superior temporal gyrus (STG.L). The patients also showed unidirectionally increased ECs from cerebellum regions to the cerebrum regions, including from the CePL.L to the right precuneus (PreCU.R), from the left cerebellum anterior lobe (CeAL.L) to the ITG.R, from the right cerebellum posterior lobe (CePL.R) to the IFG.L, and from the left inferior semi-lunar lobule of the cerebellum (CeISL.L) to the SFG.R. Additionally, the EC from the CeISL.L to the SFG.R was negatively correlated with the disease severity. (4) Conclusions: JME patients showed unidirectional EC disruptions from the cerebellum to the cerebrum, and the negative correlation between EC and disease severity provides a new perspective for understanding the cerebro-cerebellar neural circuit mechanisms in JME.
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Affiliation(s)
- Laiyang Ma
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Guangyao Liu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Pengfei Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Jun Wang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Wenjing Huang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Yanli Jiang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Yu Zheng
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Na Han
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Zhe Zhang
- School of Physics, Hangzhou Normal University, Hangzhou 311121, China
- Institute of Brain Science, Hangzhou Normal University, Hangzhou 311121, China
- Correspondence: (Z.Z.); (J.Z.); Tel.: +86-0571-28861955 (Z.Z.); +86-0931-8942090 (J.Z.)
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Correspondence: (Z.Z.); (J.Z.); Tel.: +86-0571-28861955 (Z.Z.); +86-0931-8942090 (J.Z.)
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A systematic review of resting-state and task-based fmri in juvenile myoclonic epilepsy. Brain Imaging Behav 2021; 16:1465-1494. [PMID: 34786666 DOI: 10.1007/s11682-021-00595-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Functional neuroimaging modalities have enhanced our understanding of juvenile myoclonic epilepsy (JME) underlying neural mechanisms. Due to its non-invasive, sensitive and analytical nature, functional magnetic resonance imaging (fMRI) provides valuable insights into relevant functional brain networks and their segregation and integration properties. We systematically reviewed the contribution of resting-state and task-based fMRI to the current understanding of the pathophysiology and the patterns of seizure propagation in JME Altogether, despite some discrepancies, functional findings suggest that corticothalamo-striato-cerebellar network along with default-mode network and salience network are the most affected networks in patients with JME. However, further studies are required to investigate the association between JME's main deficiencies, e.g., motor and cognitive deficiencies and fMRI findings. Moreover, simultaneous electroencephalography-fMRI (EEG-fMRI) studies indicate that alterations of these networks play a role in seizure modulation but fall short of identifying a causal relationship between altered functional properties and seizure propagation. This review highlights the complex pathophysiology of JME, which necessitates the design of more personalized diagnostic and therapeutic strategies in this group.
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Quantitative characteristics of spike-wave paroxysms in genetic generalized epilepsy. Clin Neurophysiol 2020; 131:1230-1240. [DOI: 10.1016/j.clinph.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 11/20/2022]
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Tangwiriyasakul C, Perani S, Centeno M, Yaakub SN, Abela E, Carmichael DW, Richardson MP. Dynamic brain network states in human generalized spike-wave discharges. Brain 2019; 141:2981-2994. [PMID: 30169608 PMCID: PMC6158757 DOI: 10.1093/brain/awy223] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/15/2018] [Indexed: 12/21/2022] Open
Abstract
Generalized spike-wave discharges in idiopathic generalized epilepsy are conventionally assumed to have abrupt onset and offset. However, in rodent models, discharges emerge during a dynamic evolution of brain network states, extending several seconds before and after the discharge. In human idiopathic generalized epilepsy, simultaneous EEG and functional MRI shows cortical regions may be active before discharges, and network connectivity around discharges may not be normal. Here, in human idiopathic generalized epilepsy, we investigated whether generalized spike-wave discharges emerge during a dynamic evolution of brain network states. Using EEG-functional MRI, we studied 43 patients and 34 healthy control subjects. We obtained 95 discharges from 20 patients. We compared data from patients with discharges with data from patients without discharges and healthy controls. Changes in MRI (blood oxygenation level-dependent) signal amplitude in discharge epochs were observed only at and after EEG onset, involving a sequence of parietal and frontal cortical regions then thalamus (P < 0.01, across all regions and measurement time points). Examining MRI signal phase synchrony as a measure of functional connectivity between each pair of 90 brain regions, we found significant connections (P < 0.01, across all connections and measurement time points) involving frontal, parietal and occipital cortex during discharges, and for 20 s after EEG offset. This network prominent during discharges showed significantly low synchrony (below 99% confidence interval for synchrony in this network in non-discharge epochs in patients) from 16 s to 10 s before discharges, then ramped up steeply to a significantly high level of synchrony 2 s before discharge onset. Significant connections were seen in a sensorimotor network in the minute before discharge onset. This network also showed elevated synchrony in patients without discharges compared to healthy controls (P = 0.004). During 6 s prior to discharges, additional significant connections to this sensorimotor network were observed, involving prefrontal and precuneus regions. In healthy subjects, significant connections involved a posterior cortical network. In patients with discharges, this posterior network showed significantly low synchrony during the minute prior to discharge onset. In patients without discharges, this network showed the same level of synchrony as in healthy controls. Our findings suggest persistently high sensorimotor network synchrony, coupled with transiently (at least 1 min) low posterior network synchrony, may be a state predisposing to generalized spike-wave discharge onset. Our findings also show that EEG onset and associated MRI signal amplitude change is embedded in a considerably longer period of evolving brain network states before and after discharge events.
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Affiliation(s)
- Chayanin Tangwiriyasakul
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Suejen Perani
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,Developmental Imaging and Biophysics Section, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Maria Centeno
- Developmental Imaging and Biophysics Section, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Siti Nurbaya Yaakub
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Eugenio Abela
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - David W Carmichael
- Developmental Imaging and Biophysics Section, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,King's College Hospital, London, UK
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Abnormal visual sensitivity in eyelid myoclonia with absences: Evidence from electrocortical connectivity and non-linear quantitative analysis of EEG signal. Seizure 2019; 69:118-124. [DOI: 10.1016/j.seizure.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 01/13/2023] Open
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Huguenard J. Current Controversy: Spikes, Bursts, and Synchrony in Generalized Absence Epilepsy: Unresolved Questions Regarding Thalamocortical Synchrony in Absence Epilepsy. Epilepsy Curr 2019; 19:105-111. [PMID: 30955423 PMCID: PMC6610415 DOI: 10.1177/1535759719835355] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Absence epilepsy is a disorder of thalamocortical networks. Animal models have provided detailed information regarding the core cellular, synaptic, and network features that contribute to the electroencephalogram spike and wave discharge characteristic of typical absence epilepsy. Understanding of seizure networks and dynamics is a critical step toward improving treatments, yet competing conceptual models have evolved to explain seizure initiation and propagation. Recent studies have questioned 2 key model concepts: (1) T-type Ca2+ channel-dependent burst firing in thalamic relay neurons may not be essential for seizure generation, bringing into question the proposed mechanism for the antiepileptic drug ethosuximide in reducing thalamic bursting and (2) widespread synchronized neural activity may not be a core feature of the seizures, indicating that reductions in synchrony would not be a productive therapeutic goal. In this review, I will discuss these current findings, highlight the innovative approaches that have enabled these insights, and provide a unified framework that incorporates these sometimes-conflicting ideas. Finally, I lay out future work that will be necessary to finally resolve the remaining issues.
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Affiliation(s)
- John Huguenard
- 1 Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
PURPOSE OF REVIEW Our purpose is to review evidence relating to the concept that interictal epileptiform discharges (IEDs) impair brain performance. RECENT FINDINGS Sophisticated measures of motor and cognitive performance have clarified older observations, confirming that in both animals and humans, IEDs affect aspects of performance, IED morphology, frequency, anatomical distribution, and duration matter. However, we now know that it is difficult to draw a line between IEDs and seizures, not only by electrical criteria but even by metabolic and molecular measures. IEDs impair performance acutely and probably chronically. Thus, there are good theoretical reasons for suppressing them, but no consensus has been reached on how much effort this deserves. Many antiepileptic medications effective for control of clinical seizures have little effect on IEDs. Better methods of measuring outcomes may allow selection of individual patients for whom treatment aimed at IEDs is worthwhile.
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Affiliation(s)
- Edward Faught
- Emory University, Brain Health Center 292, 12 Executive Park Drive NE, Atlanta, GA, 30306, USA.
| | - Ioannis Karakis
- Emory University, Brain Health Center 292, 12 Executive Park Drive NE, Atlanta, GA, 30306, USA
| | - Daniel L Drane
- Emory University, Brain Health Center 292, 12 Executive Park Drive NE, Atlanta, GA, 30306, USA.,University of Washington, Seattle, WA, USA
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8
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Klamer S, Ethofer T, Torner F, Sahib AK, Elshahabi A, Marquetand J, Martin P, Lerche H, Erb M, Focke NK. Unravelling the brain networks driving spike-wave discharges in genetic generalized epilepsy-common patterns and individual differences. Epilepsia Open 2018; 3:485-494. [PMID: 30525117 PMCID: PMC6276776 DOI: 10.1002/epi4.12252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/08/2022] Open
Abstract
Objective Genetic generalized epilepsies (GGEs) are characterized by generalized spike-wave discharges (GSWDs) in electroencephalography (EEG) recordings without underlying structural brain lesions. The origin of the epileptic activity remains unclear, although several studies have reported involvement of thalamus and default mode network (DMN). The aim of the current study was to investigate the networks involved in the generation and temporal evolution of GSWDs to elucidate the origin and propagation of the underlying generalized epileptic activity. Methods We examined 12 patients with GGE and GSWDs using EEG-functional magnetic resonance imaging (fMRI) and identified involved brain areas on the basis of a classical general linear model (GLM) analysis. The activation time courses of these areas were further investigated to reveal their temporal sequence of activations and deactivations. Dynamic causal modeling (DCM) was used to determine the generator of GSWDs in GGE. Results We observed activity changes in the thalamus, DMN, dorsal attention network (DAN), salience network (SN), basal ganglia, dorsolateral prefrontal cortex, and motor cortex with supplementary motor area, however, with a certain heterogeneity between patients. Investigation of the temporal sequence of activity changes showed deactivations in the DMN and DAN and activations in the SN and thalamus preceding the onset of GSWDs on EEG by several seconds. DCM analysis indicated that the DMN gates GSWDs in GGE. Significance The observed interplay between DMN, DAN, SN, and thalamus may indicate a downregulation of consciousness. The DMN seems to play a leading role as a driving force behind these changes. Overall, however, there were also clear differences in activation patterns between patients, reflecting a certain heterogeneity in this cohort of GGE patients.
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Affiliation(s)
- Silke Klamer
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany
| | - Thomas Ethofer
- Department of Biomedical Magnetic Resonance University of Tübingen Tübingen Germany.,Department of Psychiatry and Psychotherapy University of Tübingen Tübingen Germany.,Werner Reichardt Centre for Integrative Neuroscience Tübingen Germany
| | - Franziska Torner
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany
| | - Ashish Kaul Sahib
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany.,Department of Biomedical Magnetic Resonance University of Tübingen Tübingen Germany.,Werner Reichardt Centre for Integrative Neuroscience Tübingen Germany
| | - Adham Elshahabi
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany.,Werner Reichardt Centre for Integrative Neuroscience Tübingen Germany.,MEG Center University of Tübingen Tübingen Germany
| | - Justus Marquetand
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany
| | - Pascal Martin
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany
| | - Holger Lerche
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany.,Werner Reichardt Centre for Integrative Neuroscience Tübingen Germany
| | - Michael Erb
- Department of Biomedical Magnetic Resonance University of Tübingen Tübingen Germany
| | - Niels K Focke
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain Research University of Tübingen Tübingen Germany.,Werner Reichardt Centre for Integrative Neuroscience Tübingen Germany
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Unterberger I, Trinka E, Kaplan PW, Walser G, Luef G, Bauer G. Generalized nonmotor (absence) seizures-What do absence, generalized, and nonmotor mean? Epilepsia 2018; 59:523-529. [PMID: 29327337 DOI: 10.1111/epi.13996] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Clinical absences are now classified as "generalized nonmotor (absence) seizures" by the International League Against Epilepsy (ILAE). The aim of this paper is to critically review the concept of absences and to put the accompanying focal and motor symptoms into the context of the emerging pathophysiological knowledge. METHODS For this narrative review we performed an extensive literature search on the term "absence," and analyzed the plethora of symptoms observed in clinical absences. RESULTS Arising from the localization and the involved cortical networks, motor symptoms may include bilateral mild eyelid fluttering and mild myoclonic jerks of extremities. These motor symptoms may also occur unilaterally, analogous to a focal motor seizure with Jacksonian march. Furthermore, electroencephalography (EEG) abnormalities may exhibit initial frontal focal spikes and consistent asymmetries. Electroclinical characteristics support the cortical focus theory of absence seizures. Simultaneous EEG/functional magnetic resonance imaging (fMRI) measurements document cortical deactivation and thalamic activation. Cortical deactivation is related to slow waves and disturbances of consciousness of varying degrees. Motor symptoms correspond to the spike component of the 3/s spike-and-wave-discharges. Thalamic activation can be interpreted as a response to overcome cortical deactivation. Furthermore, arousal reaction during drowsiness or sleep triggers spikes in an abnormally excitable cortex. An initial disturbance in arousal mechanisms ("dyshormia") might be responsible for the start of this abnormal sequence. SIGNIFICANCE The classification as "generalized nonfocal and nonmotor (absence) seizure" does not covey the complex semiology of a patient's clinical events.
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Affiliation(s)
- Iris Unterberger
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Gerald Walser
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Gerhard Luef
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Gerhard Bauer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Kim JH. Grey and White Matter Alterations in Juvenile Myoclonic Epilepsy: A Comprehensive Review. J Epilepsy Res 2017; 7:77-88. [PMID: 29344465 PMCID: PMC5767493 DOI: 10.14581/jer.17013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/30/2017] [Indexed: 12/28/2022] Open
Abstract
Juvenile myoclonic epilepsy (JME) has been classified as a syndrome of idiopathic generalized epilepsy and is characterized by a strong genetic basis, age-specific onset of seizures, specific types of seizures, generalized spike-wave discharges on electroencephalography, and a lack of focal abnormality on magnetic resonance imaging (MRI). Recently, a wide range of advanced neuroimaging techniques have been utilized to elucidate the neuroanatomical substrates and pathophysiological mechanisms underlying JME. Specifically, a number of quantitative MRI studies have reported focal or regional abnormalities of the subcortical and cortical grey matter, particularly the thalamus and frontal cortex, in JME patients. In addition, diffusion tensor imaging studies have pointed to disrupted microstructural integrity of the corpus callosum and multiple frontal white matter tracts as well as thalamofrontal dysconnectivity in JME patients. Converging evidence from neuroimaging studies strongly suggests that JME is a predominantly thalamofrontal network epilepsy, challenging the traditional concept of JME as a generalized epilepsy. There is also limited evidence indicating extrafrontal and extrathalamic involvement in JME. This systematic review outlines the main findings from currently available MRI studies focusing on grey and white matter alterations, and discusses their contributions to the etiology and pathophysiology of JME. The clinical utility, advantages, and drawbacks of each imaging modality are briefly described as well.
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Affiliation(s)
- Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Kim JH, Kim JB, Suh SI, Kim DW. Subcortical grey matter changes in juvenile myoclonic epilepsy. NEUROIMAGE-CLINICAL 2017; 17:397-404. [PMID: 29159052 PMCID: PMC5683808 DOI: 10.1016/j.nicl.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022]
Abstract
Recent neuroimaging studies have provided converging evidence of structural and functional abnormalities of the thalamus in patients with juvenile myoclonic epilepsy (JME). There has also been limited evidence indicating involvement of the subcortical grey matter structures other than thalamus in JME, but with inconsistent findings across the studies. In the present study, we combined volumetric MRI and diffusion tensor imaging analyses to investigate macrostructural and microstructural alterations of the subcortical grey matter in 64 JME patients compared to 58 matched control subjects. Raw volume, fractional anisotropy (FA), and mean diffusivity (MD) of 6 subcortical grey matter structures (amygdala, hippocampus, caudate, pallidum, putamen, thalamus) were measured in both hemispheres. Between-group (controls versus patients) comparisons of normalized volume, FA, and MD, as well as within-group (patients) correlation analyses between structural changes and clinical variables were carried out. Compared to controls, JME patients exhibited significant volume reductions in left pallidum and bilateral putamen and thalamus. Duration of epilepsy negatively correlated with bilateral putamen volumes. Patients and controls did not differ in FA values of all structures. Compared to controls, JME patients showed significant MD increases in left pallidum and bilateral hippocampus, putamen, and thalamus. Significant positive correlations were found between duration of epilepsy and MD values of bilateral hippocampus and thalamus. We have provided evidence that macrostructural and microstructural abnormalities may not only be confined to the thalamus but also affect basal ganglia and hippocampus in JME. Our findings could further support the pathophysiological hypothesis of striato-thalamo-frontal network abnormality underlying JME, and may implicate disease progression. Reduced volumes of left pallidum and bilateral putamen and thalamus in JME patients Negative correlation between disease duration and putamen volumes Increased MD of left pallidum and bilateral hippocampus, putamen, and thalamus in JME patients Positive correlation between disease duration and MD of bilateral hippocampus and thalamus Structural changes may not only be confined to the thalamus but also affect basal ganglia and hippocampus in JME.
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Affiliation(s)
- Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Jung Bin Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
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12
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Guo JN, Kim R, Chen Y, Negishi M, Jhun S, Weiss S, Ryu JH, Bai X, Xiao W, Feeney E, Rodriguez-Fernandez J, Mistry H, Crunelli V, Crowley MJ, Mayes LC, Constable RT, Blumenfeld H. Impaired consciousness in patients with absence seizures investigated by functional MRI, EEG, and behavioural measures: a cross-sectional study. Lancet Neurol 2017; 15:1336-1345. [PMID: 27839650 PMCID: PMC5504428 DOI: 10.1016/s1474-4422(16)30295-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022]
Abstract
Background Absence seizures are brief episodes of impaired consciousness characterized by staring and behavioral arrest. The neural underpinnings of impaired consciousness and of the variable severity of behavioral impairment observed from one absence seizure to the next are not well understood. We therefore compared fMRI and EEG changes in absence seizures with impaired task performance to seizures in which performance was spared. Methods Patients were recruited from 59 pediatric neurology practices including hospitals and neurology outpatient offices throughout the United States. We performed simultaneous electroencephalography (EEG), fMRI, and behavioral testing in children and adolescents aged 6 to 19 years with typical absence epilepsy. fMRI and EEG were analyzed using data-driven approaches without prior assumptions about signal time courses or spatial distributions. The main outcomes were fMRI and EEG amplitudes in seizures with impaired versus spared behavioral responses analysed by t-test. We also examined the timing of fMRI and EEG changes in seizures with impaired behavioral responses compared to seizures with spared responses. Findings 93 patients were enrolled between September 1, 2005 and January 1, 2013, and we captured a total of 1032 seizures in 39 patients. fMRI changes during seizures occurred sequentially in three functional brain networks previously well-validated in studies of normal subjects. Seizures associated with more impaired behavior showed higher fMRI amplitude in all three networks compared to seizures with spared performance. In the default-mode network fMRI, amplitude was 0·57 ± 0·26% for seizures with impaired and 0·40 ± 0·16% for seizures with spared behavioral responses (mean difference 017%; 95% CI: 0·11 to 0·23%; p < 0.0001). In the task-positive network, fMRI amplitude was 0·53 ± 0·29% for impaired and 0·39 ± 0·15% for spared seizures (mean difference 0·14%; 95% CI: 008 to 0·21%; p < 0.0001). In the sensorimotor-thalamic network, fMRI amplitude was 0·41 ± 0·25% for impaired and 0·34 ± 014% for spared seizures (mean difference 0 07%; 95% CI: 001 to 0·13%; p = 0.02). Seizures with impaired behavior also showed greater EEG power in widespread brain regions compared to seizures with spared behavior. Mean fractional EEG power in the frontal leads was 50·4 ± 15·2 for seizures with impaired and 24·8 ± 6·5 for seizures with spared behavior (mean difference 25·6; 95% CI: 210 to 30·3); middle leads 35·4 ± 6·5 for impaired, 13 3 ± 34 for spared seizures (mean difference 22·1; 95% CI: 20.0 to 24·1); posterior leads 41·6 ± 5·3 for impaired, 24·6 ± 86 for spared seizures (mean difference 170; 95% CI: 14·4 to 19·7); p < 00001 for all comparisons. Average seizure duration was longer for seizures with impaired behavior at 79 ± 66 s, compared to 3·8 ± 3.0 s for seizures with spared behavior (mean difference 4.1 s; 95% CI 3.0 to 5.3 s, p < 00001). However, larger amplitude fMRI and EEG signals occurred at the outset or even preceding seizures with impairment. Interpretation Impaired consciousness in absence seizures is related to the intensity of physiological changes in established networks affecting widespread regions of the brain. Increased EEG and fMRI amplitude occurs at the onset of seizures associated with behavioral impairment. These findings suggest that a vulnerable state may exist at the initiation of some seizures leading to greater physiological changes and altered consciousness.
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Affiliation(s)
- Jennifer N Guo
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Robert Kim
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Yu Chen
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Michiro Negishi
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Stephen Jhun
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Weiss
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Jun Hwan Ryu
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Xiaoxiao Bai
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Wendy Xiao
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Erin Feeney
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Hetal Mistry
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Michael J Crowley
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Linda C Mayes
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - R Todd Constable
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
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13
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Vaudano AE, Olivotto S, Ruggieri A, Gessaroli G, De Giorgis V, Parmeggiani A, Veggiotti P, Meletti S. Brain correlates of spike and wave discharges in GLUT1 deficiency syndrome. NEUROIMAGE-CLINICAL 2016; 13:446-454. [PMID: 28116237 PMCID: PMC5233795 DOI: 10.1016/j.nicl.2016.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/04/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022]
Abstract
Purpose To provide imaging biomarkers of generalized spike-and-wave discharges (GSWD) in patients with GLUT1 deficiency syndrome (GLUT1DS). Methods Eighteen GLUT1DS patients with pathogenetic mutation in SLC2A1 gene were studied by means of Video-EEG simultaneously recorded with functional MRI (VideoEEG-fMRI). A control group of sex and age-matched patients affected by Genetic Generalized Epilepsy (GGE) with GSWD were investigated with the same protocol. Within and between groups comparison was performed as appropriated. For GLUT1DS, correlations analyses between the contrast of interest and the main clinical measurements were provided. Results EEG during fMRI revealed interictal GSWD in 10 GLUT1DS patients. Group-level analysis showed BOLD signal increases at the premotor cortex and putamen. With respect to GGE, GLUT1DS patients demonstrated increased neuronal activity in the putamen, precuneus, cingulate cortex, SMA and paracentral lobule. Whole-brain correlation analyses disclosed a linear relationship between the GSWD-related BOLD changes and the levels of glycorrhachia at diagnosis over the sensory-motor cortex and superior parietal lobuli. Conclusion The BOLD dynamics related to GSWD in GLUT1DS are substantially different from typical GGE showing the former an increased activity in the premotor-striatal network and a decrease in the thalamus. The revealed hemodynamic maps might represent imaging biomarkers of GLUT1DS, being potentially useful for a precocious diagnosis of this genetic disorder. First report describing the epilepsy-related hemodynamic patterns in GLUT1DS. The revealed BOLD maps can represent GLUT1DS imaging biomarkers. The premotor-striatal network generates the GSWD in GLUT1DS. The glycorrhachia at diagnosis influences the epilepsy-related BOLD maps.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; N.O.C.S.A.E. Hospital, AUSL Modena, 41100 Modena, Italy
| | - Sara Olivotto
- Brain and Behavior Department, University of Pavia, Pavia, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Antonia Parmeggiani
- Child Neurology and Psychiatry Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Pierangelo Veggiotti
- Brain and Behavior Department, University of Pavia, Pavia, Italy; Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; N.O.C.S.A.E. Hospital, AUSL Modena, 41100 Modena, Italy
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14
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Benuzzi F, Ballotta D, Mirandola L, Ruggieri A, Vaudano AE, Zucchelli M, Ferrari E, Nichelli PF, Meletti S. An EEG-fMRI Study on the Termination of Generalized Spike-And-Wave Discharges in Absence Epilepsy. PLoS One 2015; 10:e0130943. [PMID: 26154563 PMCID: PMC4496065 DOI: 10.1371/journal.pone.0130943] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/27/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Different studies have investigated by means of EEG-fMRI coregistration the brain networks related to generalized spike-and-wave discharges (GSWD) in patients with idiopathic generalized epilepsy (IGE). These studies revealed a widespread GSWD-related neural network that involves the thalamus and regions of the default mode network. In this study we investigated which brain regions are critically involved in the termination of absence seizures (AS) in a group of IGE patients. Methods Eighteen patients (6 male; mean age 25 years) with AS were included in the EEG-fMRI study. Functional data were acquired at 3T with continuous simultaneous video-EEG recording. Event-related analysis was performed with SPM8 software, using the following regressors: (1) GSWD onset and duration; (2) GSWD offset. Data were analyzed at single-subject and at group level with a second level random effect analysis. Results A mean of 17 events for patient was recorded (mean duration of 4.2 sec). Group-level analysis related to GSWD onset respect to rest confirmed previous findings revealing thalamic activation and a precuneus/posterior cingulate deactivation. At GSWD termination we observed a decrease in BOLD signal over the bilateral dorsolateral frontal cortex respect to the baseline (and respect to GSWD onset). The contrast GSWD offset versus onset showed a BOLD signal increase over the precuneus-posterior cingulate region bilaterally. Parametric correlations between electro-clinical variables and BOLD signal at GSWD offset did not reveal significant effects. Conclusion The role of the decreased neural activity of lateral prefrontal cortex at GSWD termination deserve future investigations to ascertain if it has a role in promoting the discharge offset, as well as in the determination of the cognitive deficits often present in patients with AS. The increased BOLD signal at precuneal/posterior cingulate cortex might reflect the recovery of neural activity in regions that are “suspended” during spike and waves activity, as previously hypothesized.
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Affiliation(s)
- Francesca Benuzzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniela Ballotta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Mirandola
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, NOCSAE Hospital-ASL, Modena, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, NOCSAE Hospital-ASL, Modena, Italy
| | | | | | - Paolo Frigio Nichelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, NOCSAE Hospital-ASL, Modena, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, NOCSAE Hospital-ASL, Modena, Italy
- * E-mail:
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15
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van Graan LA, Lemieux L, Chaudhary UJ. Methods and utility of EEG-fMRI in epilepsy. Quant Imaging Med Surg 2015; 5:300-12. [PMID: 25853087 DOI: 10.3978/j.issn.2223-4292.2015.02.04] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/22/2015] [Indexed: 12/13/2022]
Abstract
Brain activity data in general and more specifically in epilepsy can be represented as a matrix that includes measures of electrophysiology, anatomy and behaviour. Each of these sub-matrices has a complex interaction depending upon the brain state i.e., rest, cognition, seizures and interictal periods. This interaction presents significant challenges for interpretation but also potential for developing further insights into individual event types. Successful treatments in epilepsy hinge on unravelling these complexities, and also on the sensitivity and specificity of methods that characterize the nature and localization of underlying physiological and pathological networks. Limitations of pharmacological and surgical treatments call for refinement and elaboration of methods to improve our capability to localise the generators of seizure activity and our understanding of the neurobiology of epilepsy. Simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI), by potentially circumventing some of the limitations of EEG in terms of sensitivity, can allow the mapping of haemodynamic networks over the entire brain related to specific spontaneous and triggered epileptic events in humans, and thereby provide new localising information. In this work we review the published literature, and discuss the methods and utility of EEG-fMRI in localising the generators of epileptic activity. We draw on our experience and that of other groups, to summarise the spectrum of information provided by an increasing number of EEG-fMRI case-series, case studies and group studies in patients with epilepsy, for its potential role to elucidate epileptic generators and networks. We conclude that EEG-fMRI provides a multidimensional view that contributes valuable clinical information to localize the epileptic focus with potential important implications for the surgical treatment of some patients with drug-resistant epilepsy, and insights into the resting state and cognitive network dynamics.
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Affiliation(s)
- Louis André van Graan
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK ; 2 MRI Unit, Epilepsy Society, Chalfont St. Peter SL9 0RJ, UK
| | - Louis Lemieux
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK ; 2 MRI Unit, Epilepsy Society, Chalfont St. Peter SL9 0RJ, UK
| | - Umair Javaid Chaudhary
- 1 Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK ; 2 MRI Unit, Epilepsy Society, Chalfont St. Peter SL9 0RJ, UK
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16
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Liu B, Li Z, Xie P. Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging. Neural Regen Res 2015; 9:2095-101. [PMID: 25657727 PMCID: PMC4316475 DOI: 10.4103/1673-5374.147937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 01/13/2023] Open
Abstract
Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic resonance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treatment only. The intervention group received vertebral artery orifice angioplasty and stenting + identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.
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Affiliation(s)
- Bo Liu
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China
| | - Zhiwei Li
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China ; Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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17
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An D, Dubeau F, Gotman J. BOLD responses related to focal spikes and widespread bilateral synchronous discharges generated in the frontal lobe. Epilepsia 2015; 56:366-74. [PMID: 25599979 DOI: 10.1111/epi.12909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate whether specific frontal regions have a tendency to generate widespread bilateral synchronous discharges (WBSDs) and others focal spikes and to determine the regions most involved when WBSDs occur; to assess the relationships between the extent of electroencephalography (EEG) discharges and the extent of metabolic changes measured by EEG/functional magnetic resonance imaging (fMRI). METHODS Thirty-seven patients with interictal epileptic discharges (IEDs) with frontocentral predominance underwent EEG/fMRI. Patients were divided into a Focal (20 patients) group with focal frontal spikes and a WBSD group (17 patients). Maps of hemodynamic responses related to IEDs were compared between the two groups. RESULTS The mean number ± SD of IEDs in the Focal group was 137.5 ± 38.1 and in the WBSD group, 73.5 ± 16.6 (p = 0.07). The volume of hemodynamic responses in the WBSD group was significantly larger than in the Focal group (mean, 243.3 ± 41.1 versus 114.8 ± 27.4 cm(3), p = 0.01). Maximum hemodynamic responses occurred in both groups in the following regions: dorsolateral prefrontal, mesial prefrontal, cingulate, and supplementary motor cortices. Maxima in premotor and motor cortex, frontal operculum, frontopolar, and orbitofrontal regions were found only in the Focal group, and maxima in thalamus and caudate only occurred in the WBSD group. Thalamic responses were significantly more common in the WBSD group (14/17) than in the Focal group (7/20), p = 0.004. Deactivation in the default mode network was significantly more common in the WBSD group (14/17) than in the Focal group (10/20), p = 0.04. SIGNIFICANCE The spatial distribution and extent of blood oxygen level-dependent (BOLD) responses correlate well with electrophysiologic changes. Focal frontal spikes and WBSDs are not region specific in the frontal lobe, and the same frontal region can generate focal and generalized discharges. This suggests that widespread discharges reflect widespread epileptogenicity rather than a focal discharge located in a region favorable to spreading. The thalamus plays an important role in bilateral synchronization.
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Affiliation(s)
- Dongmei An
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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18
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Zhou SY, Tong L, Song F, Hong XJ, Sun HF, Chang H, Xing HJ, Li ZY, Dong CB. Selective medial temporal volume reduction in the hippocampus of patients with idiopathic generalized tonic-clonic seizures. Epilepsy Res 2014; 110:39-48. [PMID: 25616454 DOI: 10.1016/j.eplepsyres.2014.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/12/2014] [Accepted: 11/16/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Different subtypes of idiopathic generalized epilepsy may indicate different mechanisms and outcomes, suggesting that it is necessary to use a 'pure sample' of a single subtype. METHODS A volumetric study, in conjunction with cognition assessments, was performed in a pure sample of patients with idiopathic generalized tonic-clonic seizures (IGE-GTCS; 15 males and 15 females) matched with normal control subjects (15 males and 17 females). The volumetric measurements were focused on the hippocampus and its surrounding structures, including the amygdala, the parahippocampal gyrus, the entorhinal cortex and the perirhinal cortex. The Wechsler Adult Intelligence Scale-Revised in China was administered to assess cognitive status. RESULTS A volume reduction was found only in the hippocampus, with a more severe effect on the left side than the right side. The total number and frequency of seizures had significant negative correlations with multiple cognitive measures. Furthermore, the hippocampal volume reduction was significantly correlated with some aspects of cognitive impairment. CONCLUSION These findings suggest that compared with the other medial temporal structures, the hippocampus may be more vulnerable to the neuropathology of IGE-GTCS. The observation that cognitive deterioration was correlated with an increased frequency and total number of seizures highlights the critical importance of preventing seizures from recurrence.
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Affiliation(s)
- Shi-Yu Zhou
- Department of Psychology, Dalian Medical University, Dalian, China.
| | - Lin Tong
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, No. 222 of ZhongShan Road, 116011 Dalian, China; Department of Neurology, Yantai Municipal Hospital, Yantai, China.
| | - Fan Song
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, No. 222 of ZhongShan Road, 116011 Dalian, China.
| | - Xiao-Jun Hong
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, No. 222 of ZhongShan Road, 116011 Dalian, China.
| | - Hui-Fang Sun
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, No. 222 of ZhongShan Road, 116011 Dalian, China.
| | - Hong Chang
- Department of Neurology, The Third People's Hospital of Dalian, Dalian, China.
| | - Hui-Juan Xing
- Department of Neurology, The Third People's Hospital of Dalian, Dalian, China.
| | - Zhi-Yong Li
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Chun-Bo Dong
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, No. 222 of ZhongShan Road, 116011 Dalian, China.
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Vaudano AE, Ruggieri A, Tondelli M, Avanzini P, Benuzzi F, Gessaroli G, Cantalupo G, Mastrangelo M, Vignoli A, Bonaventura CD, Canevini MP, Bernardina BD, Nichelli PF, Meletti S. The visual system in eyelid myoclonia with absences. Ann Neurol 2014; 76:412-27. [DOI: 10.1002/ana.24236] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 07/15/2014] [Accepted: 07/21/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Manuela Tondelli
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Pietro Avanzini
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
- Department of Neuroscience; University of Parma; Parma
| | - Francesca Benuzzi
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Giuliana Gessaroli
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Gaetano Cantalupo
- Department of Life and Reproduction Sciences; University of Verona; Verona
| | | | - Aglaia Vignoli
- Department of Health Sciences, Epilepsy Center, San Paolo Hospital; University of Milan; Milan
| | - Carlo Di Bonaventura
- Department of Neurological Sciences; University of Rome “La Sapienza,”; Rome Italy
| | - Maria Paola Canevini
- Department of Health Sciences, Epilepsy Center, San Paolo Hospital; University of Milan; Milan
| | | | - Paolo Frigio Nichelli
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Science; University of Modena and Reggio Emilia; Nuovo Ospedale Civile S. Agostino Estense (NOCSAE) Hospital, AUSL Modena, NOCSE Hospital Modena
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