1
|
Syed M, Miao J, Sathe A, Kang K, Manmatharayan A, Kogan M, Matias CM, Sharan A, Alizadeh M. Profiles of resting state functional connectivity in temporal lobe epilepsy associated with post-laser interstitial thermal therapy seizure outcomes and semiologies. FRONTIERS IN NEUROIMAGING 2023; 2:1201682. [PMID: 38025313 PMCID: PMC10665565 DOI: 10.3389/fnimg.2023.1201682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
Introduction It is now understood that in focal epilepsy, impacted neural regions are not limited to the epileptogenic zone. As such, further investigation into the underlying functional connectivity (FC) patterns in those enduring Temporal Lobe Epilepsy (TLE) with Mesial Temporal Sclerosis (MTS) is imperative to understanding the intricacies of the disease. Methods The rsfMRIs of 17 healthy participants, 10 left-sided TLE-MTS patients with a pre-operative history of focal impaired awareness seizures (FIA), and 13 left-sided TLE-MTS patients with a pre-operative history of focal aware seizures (FA) were compared to determine the existence of distinct FC patterns with respect to seizure types. Similarly, the rsfMRIs of the above-mentioned healthy participants, 16 left-sided TLE-MTS individuals who were seizure-free (SF) 12 months postoperatively, and 16 left-sided TLE-MTS persons without seizure freedom (nSF) were interrogated. The ROI-to-ROI connectivity analysis included a total of 175 regions of interest (ROIs) and accounted for both age and duration of epileptic activity. Significant correlations were determined via two-sample t-tests and Bonferroni correction (α = 0.05). Results Comparisons of FA and FIA groups depicted significant correlations between the contralateral anterior cingulate gyrus, subgenual region, and the contralateral cerebellum, lobule III (p-value = 2.26e-4, mean z-score = -0.05 ± 0.28, T = -4.23). Comparisons of SF with nSF depicted two significantly paired-ROIs; the contralateral amygdala and the contralateral precuneus (p-value = 2.9e-5, mean z-score = -0.12 ± 0.19, T = 4.98), as well as the contralateral locus coeruleus and the ipsilateral intralaminar nucleus (p-value= 1.37e-4, mean z-score = 0.06 ± 0.17, T = -4.41). Significance FC analysis proves to be a lucrative modality for exploring unique signatures with respect to seizure types and postoperative outcomes. By furthering our understanding of the differences between epileptic phenotypes, we can achieve improvement in future treatment modalities not limited to targeting advancements.
Collapse
Affiliation(s)
- Mashaal Syed
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jingya Miao
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
| | - Anish Sathe
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kichang Kang
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
| | - Arichena Manmatharayan
- Department of Neurology, Detroit Medical Center, University Health Center, Detroit, MI, United States
| | - Michael Kogan
- Department of Neurological Surgery, University of New Mexico, Albuquerque, NM, United States
| | - Caio M. Matias
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashwini Sharan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mahdi Alizadeh
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
- Thomas Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| |
Collapse
|
2
|
Hwang G, Dabbs K, Conant L, Nair VA, Mathis J, Almane DN, Nencka A, Birn R, Humphries C, Raghavan M, DeYoe EA, Struck AF, Maganti R, Binder JR, Meyerand E, Prabhakaran V, Hermann B. Cognitive slowing and its underlying neurobiology in temporal lobe epilepsy. Cortex 2019; 117:41-52. [PMID: 30927560 DOI: 10.1016/j.cortex.2019.02.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/06/2018] [Accepted: 02/23/2019] [Indexed: 11/17/2022]
Abstract
Cognitive slowing is a known but comparatively under-investigated neuropsychological complication of the epilepsies in relation to other known cognitive comorbidities such as memory, executive function and language. Here we focus on a novel metric of processing speed, characterize its relative salience compared to other cognitive difficulties in epilepsy, and explore its underlying neurobiological correlates. Research participants included 55 patients with temporal lobe epilepsy (TLE) and 58 healthy controls from the Epilepsy Connectome Project (ECP) who were administered a battery of tests yielding 14 neuropsychological measures, including selected tests from the NIH Toolbox-Cognitive Battery, and underwent 3T MRI and resting state fMRI. TLE patients exhibited a pattern of generalized cognitive impairment with very few lateralized abnormalities. Using the neuropsychological measures, machine learning (Support Vector Machine binary classification model) classified the TLE and control groups with 74% accuracy with processing speed (NIH Toolbox Pattern Comparison Processing Speed Test) the best predictor. In TLE, slower processing speed was associated predominantly with decreased local gyrification in regions including the rostral and caudal middle frontal gyrus, inferior precentral cortex, insula, inferior parietal cortex (angular and supramarginal gyri), lateral occipital cortex, rostral anterior cingulate, and medial orbital frontal regions, as well as three small regions of the temporal lobe. Slower processing speed was also associated with decreased connectivity between the primary visual cortices in both hemispheres and the left supplementary motor area, as well as between the right parieto-occipital sulcus and right middle insular area. Overall, slowed processing speed is an important cognitive comorbidity of TLE associated with altered brain structure and connectivity.
Collapse
Affiliation(s)
- Gyujoon Hwang
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin Dabbs
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lisa Conant
- Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Veena A Nair
- Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jed Mathis
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dace N Almane
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew Nencka
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rasmus Birn
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Manoj Raghavan
- Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Edgar A DeYoe
- Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aaron F Struck
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Rama Maganti
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Elizabeth Meyerand
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Radiology, University of Wisconsin-Madison, Madison, WI, USA; Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Vivek Prabhakaran
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Radiology, University of Wisconsin-Madison, Madison, WI, USA; Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Bruce Hermann
- Neurology, University of Wisconsin-Madison, Madison, WI, USA.
| |
Collapse
|
3
|
Capizzano AA, Kawasaki H, Sainju RK, Kirby P, Kim J, Moritani T. Amygdala enlargement in mesial temporal lobe epilepsy: an alternative imaging presentation of limbic epilepsy. Neuroradiology 2018; 61:119-127. [PMID: 30353210 DOI: 10.1007/s00234-018-2109-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess imaging, clinical, and pathological features of mesial temporal lobe epilepsy (mTLE) patients with amygdala enlargement (AE) in comparison with those with mesial temporal sclerosis (MTS). METHODS Clinical, imaging, and pathologic features were retrospectively reviewed in 40 mTLE patients with postoperative follow-up (10 with AE and 30 with MTS). The volumes and signal intensity of the amygdala and hippocampus were assessed in 10 AE, 10 age- and sex-matched MTS patients, and 12 controls (HC). RESULTS AE patients had a lower rate of concordant FDG PET (p < 0.05) and required more frequently intracerebral electrodes compared to MTS patients (p < 0.05). AE had larger ipsilateral amygdala (p < 0.0001) and hippocampus volumes (p < 0.0001) compared to MTS and to HC, with no significant differences for other brain structures. Normalized FLAIR signal was higher in the ipsilateral than contralateral amygdala in both AE and MTS (p < 0.001 and p < 0.05, respectively) and higher in the ipsilateral amygdala compared to HC (p < 0.05). In MTS, ADC in the ipsilateral amygdala (867 mm2/s) was higher compared to the contralateral one (804.8 × 10-6 mm2/s, p < 0.01), compared to HC (773 × 10-6 mm2/s, p < 0.01) and compared to the ipsilateral amygdala in AE (813.7 × 10-6 mm2/s, p < 0.05). AE patients had dysplasia (50%) or astrocytic gliosis (50%) of the amygdala extending to the hippocampus and temporal isocortex, and only 2/10 cases had pathologic findings of MTS. CONCLUSION AE patients have distinct imaging and pathologic features compared to MTS, and require more extensive preoperative workup. Recognition of AE may improve preoperative assessment in TLE surgical candidates.
Collapse
Affiliation(s)
- Aristides A Capizzano
- Department of Radiology, Division of Neuroradiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Hiroto Kawasaki
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Rup K Sainju
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - Patricia Kirby
- Department of Pathology, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - John Kim
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, 200 Hawkins Dr., Ann Arbor, MI, 48109, USA
| | - Toshio Moritani
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, 200 Hawkins Dr., Ann Arbor, MI, 48109, USA
| |
Collapse
|
4
|
Alves M, Beamer E, Engel T. The Metabotropic Purinergic P2Y Receptor Family as Novel Drug Target in Epilepsy. Front Pharmacol 2018; 9:193. [PMID: 29563872 PMCID: PMC5851315 DOI: 10.3389/fphar.2018.00193] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Abstract
Epilepsy encompasses a heterogeneous group of neurological syndromes which are characterized by recurrent seizures affecting over 60 million people worldwide. Current anti-epileptic drugs (AEDs) are mainly designed to target ion channels and/or GABA or glutamate receptors. Despite recent advances in drug development, however, pharmacoresistance in epilepsy remains as high as 30%, suggesting the need for the development of new AEDs with a non-classical mechanism of action. Neuroinflammation is increasingly recognized as one of the key players in seizure generation and in the maintenance of the epileptic phenotype. Consequently, targeting signaling molecules involved in inflammatory processes may represent new avenues to improve treatment in epilepsy. Nucleotides such as adenosine-5′-triphosphate (ATP) and uridine-5′-triphosphate (UTP) are released in the brain into the extracellular space during pathological conditions such as increased neuronal firing or cell death. Once released, these nucleotides bind to and activate specific purinergic receptors termed P2 receptors where they mediate the release of gliotransmitters and drive neuronal hyperexcitation and neuroinflammatory processes. This includes the fast acting ionotropic P2X channels and slower-acting G-protein-coupled P2Y receptors. While the expression and function of P2X receptors has been well-established in experimental models of epilepsy, emerging evidence is now also suggesting a prominent role for the P2Y receptor subfamily in seizure generation and the maintenance of epilepsy. In this review we discuss data supporting a role for the P2Y receptor family in epilepsy and the most recent finding demonstrating their involvement during seizure-induced pathology and in epilepsy.
Collapse
Affiliation(s)
- Mariana Alves
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Edward Beamer
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tobias Engel
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
5
|
Cota VR, Drabowski BMB, de Oliveira JC, Moraes MFD. The epileptic amygdala: Toward the development of a neural prosthesis by temporally coded electrical stimulation. J Neurosci Res 2017; 94:463-85. [PMID: 27091311 DOI: 10.1002/jnr.23741] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
Abstract
Many patients with epilepsy do not obtain proper control of their seizures through conventional treatment. We review aspects of the pathophysiology underlying epileptic phenomena, with a special interest in the role of the amygdala, stressing the importance of hypersynchronism in both ictogenesis and epileptogenesis. We then review experimental studies on electrical stimulation of mesiotemporal epileptogenic areas, the amygdala included, as a means to treat medically refractory epilepsy. Regular high-frequency stimulation (HFS) commonly has anticonvulsant effects and sparse antiepileptogenic properties. On the other hand, HFS is related to acute and long-term increases in excitability related to direct neuronal activation, long-term potentiation, and kindling, raising concerns regarding its safety and jeopardizing in-depth understanding of its mechanisms. In turn, the safer regular low-frequency stimulation (LFS) has a robust antiepileptogenic effect, but its pro- or anticonvulsant effect seems to vary at random among studies. As an alternative, studies by our group on the development and investigation of temporally unstructured electrical stimulation applied to the amygdala have shown that nonperiodic stimulation (NPS), which is a nonstandard form of LFS, is capable of suppressing both acute and chronic spontaneous seizures. We hypothesize two noncompetitive mechanisms for the therapeutic role of amygdala in NPS, 1) a direct desynchronization of epileptic circuitry in the forebrain and brainstem and 2) an indirect desynchronization/inhibition through nucleus accumbens activation. We conclude by reintroducing the idea that hypersynchronism, rather than hyperexcitability, may be the key for epileptic phenomena and epilepsy treatment.
Collapse
Affiliation(s)
- Vinícius Rosa Cota
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Bruna Marcela Bacellar Drabowski
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Jasiara Carla de Oliveira
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Márcio Flávio Dutra Moraes
- Núcleo de Neurociências, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
6
|
Yankam Njiwa J, Gray K, Costes N, Mauguiere F, Ryvlin P, Hammers A. Advanced [(18)F]FDG and [(11)C]flumazenil PET analysis for individual outcome prediction after temporal lobe epilepsy surgery for hippocampal sclerosis. NEUROIMAGE-CLINICAL 2014; 7:122-31. [PMID: 25610774 PMCID: PMC4299974 DOI: 10.1016/j.nicl.2014.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/10/2014] [Accepted: 11/15/2014] [Indexed: 11/20/2022]
Abstract
Purpose We have previously shown that an imaging marker, increased periventricular [11C]flumazenil ([11C]FMZ) binding, is associated with failure to become seizure free (SF) after surgery for temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS). Here, we investigated whether increased preoperative periventricular white matter (WM) signal can be detected on clinical [18F]FDG-PET images. We then explored the potential of periventricular FDG WM increases, as well as whole-brain [11C]FMZ and [18F]FDG images analysed with random forest classifiers, for predicting surgery outcome. Methods Sixteen patients with MRI-defined HS had preoperative [18F]FDG and [11C]FMZ-PET. Fifty controls had [18F]FDG-PET (30), [11C]FMZ-PET (41), or both (21). Periventricular WM signal was analysed using Statistical Parametric Mapping (SPM8), and whole-brain image classification was performed using random forests implemented in R (http://www.r-project.org). Surgery outcome was predicted at the group and individual levels. Results At the group level, non-seizure free (NSF) versus SF patients had periventricular increases with both tracers. Against controls, NSF patients showed more prominent periventricular [11C]FMZ and [18F]FDG signal increases than SF patients. All differences were more marked for [11C]FMZ. For individuals, periventricular WM signal increases were seen at optimized thresholds in 5/8 NSF patients for both tracers. For SF patients, 1/8 showed periventricular signal increases for [11C]FMZ, and 4/8 for [18F]FDG. Hence, [18F]FDG had relatively poor sensitivity and specificity. Random forest classification accurately identified 7/8 SF and 7/8 NSF patients using [11C]FMZ images, but only 4/8 SF and 6/8 NSF patients with [18F]FDG. Conclusion This study extends the association between periventricular WM increases and NSF outcome to clinical [18F]FDG-PET, but only at the group level. Whole-brain random forest classification increases [11C]FMZ-PET's performance for predicting surgery outcome.
Collapse
Affiliation(s)
- J. Yankam Njiwa
- Neurodis Foundation, Lyon, France
- Correspondence to: Cermep. — Imagerie du vivant, 59 Boulevard Pinel, Lyon/Bron 69677, France. Tel: +33 4 72 68 86 34.
| | - K.R. Gray
- Department Of Computing, Biomedical Image Analysis Group, Imperial College London, UK
| | - N. Costes
- Cermep-Imagerie du vivant, Lyon, France
| | - F. Mauguiere
- Université Lyon 1, Inserm, CNRS, Centre De Recherche en Neuroscience de Lyon, France
- Service de Neurologie Fonctionnelle et d'Epileptologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
- Université De Lyon, Université Claude Bernard, Lyon, France
| | - P. Ryvlin
- Université Lyon 1, Inserm, CNRS, Centre De Recherche en Neuroscience de Lyon, France
- Service de Neurologie Fonctionnelle et d'Epileptologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | | |
Collapse
|