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Struck AF, Garcia-Ramos C, Nair VA, Prabhakaran V, Dabbs K, Conant LL, Binder JR, Loring D, Meyerand M, Hermann BP. The relevance of Spearman's g for epilepsy. Brain Commun 2024; 6:fcae176. [PMID: 38883806 PMCID: PMC11179110 DOI: 10.1093/braincomms/fcae176] [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: 11/02/2023] [Revised: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
Whilst the concept of a general mental factor known as 'g' has been of longstanding interest, for unknown reasons, it has never been interrogated in epilepsy despite the 100+ year empirical history of the neuropsychology of epilepsy. This investigation seeks to identify g within a comprehensive neuropsychological data set and compare participants with temporal lobe epilepsy to controls, characterize the discriminatory power of g compared with domain-specific cognitive metrics, explore the association of g with clinical epilepsy and sociodemographic variables and identify the structural and network properties associated with g in epilepsy. Participants included 110 temporal lobe epilepsy patients and 79 healthy controls between the ages of 19 and 60. Participants underwent neuropsychological assessment, clinical interview and structural and functional imaging. Cognitive data were subjected to factor analysis to identify g and compare the group of patients with control participants. The relative power of g compared with domain-specific tests was interrogated, clinical and sociodemographic variables were examined for their relationship with g, and structural and functional images were assessed using traditional regional volumetrics, cortical surface features and network analytics. Findings indicate (i) significantly (P < 0.005) lower g in patients compared with controls; (ii) g is at least as powerful as individual cognitive domain-specific metrics and other analytic approaches to discriminating patients from control participants; (iii) lower g was associated with earlier age of onset and medication use, greater number of antiseizure medications and longer epilepsy duration (Ps < 0.04); and lower parental and personal education and greater neighbourhood deprivation (Ps < 0.012); and (iv) amongst patients, lower g was linked to decreased total intracranial volume (P = 0.019), age and intracranial volume adjusted total tissue volume (P = 0.019) and age and intracranial volume adjusted total corpus callosum volume (P = 0.012)-particularly posterior, mid-posterior and anterior (Ps < 0.022) regions. Cortical vertex analyses showed lower g to be associated specifically with decreased gyrification in bilateral medial orbitofrontal regions. Network analysis of resting-state data with focus on the participation coefficient showed g to be associated with the superior parietal network. Spearman's g is reduced in patients, has considerable discriminatory power compared with domain-specific metrics and is linked to a multiplex of factors related to brain (size, connectivity and frontoparietal networks), environment (familial and personal education and neighbourhood disadvantage) and disease (epilepsy onset, treatment and duration). Greater attention to contemporary models of human cognition is warranted in order to advance the neuropsychology of epilepsy.
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Affiliation(s)
- Aaron F Struck
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
| | - Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Veena A Nair
- Department of Radiology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - David Loring
- Department of Neurology and Pediatrics, Emory University, Atlanta, GA 30322, USA
| | - Mary Meyerand
- Department of Medical Physics, Wisconsin-Madison, Madison, WI 53726, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
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Tran EB, Vonk JMJ, Casaletto K, Zhang D, Christin R, Marathe S, Gorno-Tempini ML, Chang EF, Kleen JK. Development and validation of a nonverbal consensus-based semantic memory paradigm in patients with epilepsy. J Int Neuropsychol Soc 2024:1-9. [PMID: 38616725 DOI: 10.1017/s1355617724000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Brain areas implicated in semantic memory can be damaged in patients with epilepsy (PWE). However, it is challenging to delineate semantic processing deficits from acoustic, linguistic, and other verbal aspects in current neuropsychological assessments. We developed a new Visual-based Semantic Association Task (ViSAT) to evaluate nonverbal semantic processing in PWE. METHOD The ViSAT was adapted from similar predecessors (Pyramids & Palm Trees test, PPT; Camels & Cactus Test, CCT) comprised of 100 unique trials using real-life color pictures that avoid demographic, cultural, and other potential confounds. We obtained performance data from 23 PWE participants and 24 control participants (Control), along with crowdsourced normative data from 54 Amazon Mechanical Turk (Mturk) workers. RESULTS ViSAT reached a consensus >90% in 91.3% of trials compared to 83.6% in PPT and 82.9% in CCT. A deep learning model demonstrated that visual features of the stimulus images (color, shape; i.e., non-semantic) did not influence top answer choices (p = 0.577). The PWE group had lower accuracy than the Control group (p = 0.019). PWE had longer response times than the Control group in general and this was augmented for the semantic processing (trial answer) stage (both p < 0.001). CONCLUSIONS This study demonstrated performance impairments in PWE that may reflect dysfunction of nonverbal semantic memory circuits, such as seizure onset zones overlapping with key semantic regions (e.g., anterior temporal lobe). The ViSAT paradigm avoids confounds, is repeatable/longitudinal, captures behavioral data, and is open-source, thus we propose it as a strong alternative for clinical and research assessment of nonverbal semantic memory.
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Affiliation(s)
- Edwina B Tran
- Department of Neurology, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Jet M J Vonk
- Department of Neurology, University of California, San Francisco, CA, USA
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Kaitlin Casaletto
- Department of Neurology, University of California, San Francisco, CA, USA
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Da Zhang
- Department of Neurology, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Raphael Christin
- Department of Neurology, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Siddharth Marathe
- Department of Neurology, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, University of California, San Francisco, CA, USA
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Edward F Chang
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jonathan K Kleen
- Department of Neurology, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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Meng X, Deng K, Huang B, Lin X, Wu Y, Tao W, Lin C, Yang Y, Chen F. Classification of temporal lobe epilepsy based on neuropsychological tests and exploration of its underlying neurobiology. Front Hum Neurosci 2023; 17:1100683. [PMID: 37397855 PMCID: PMC10307531 DOI: 10.3389/fnhum.2023.1100683] [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: 11/17/2022] [Accepted: 05/09/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To assist improving long-term postoperative seizure-free rate, we aimed to use machine learning algorithms based on neuropsychological data to differentiate temporal lobe epilepsy (TLE) from extratemporal lobe epilepsy (extraTLE), as well as explore the relationship between magnetic resonance imaging (MRI) and neuropsychological tests. Methods Twenty-three patients with TLE and 23 patients with extraTLE underwent neuropsychological tests and MRI scans before surgery. The least absolute shrinkage and selection operator were firstly employed for feature selection, and a machine learning approach with neuropsychological tests was employed to classify TLE using leave-one-out cross-validation. A generalized linear model was used to analyze the relationship between brain alterations and neuropsychological tests. Results We found that logistic regression with the selected neuropsychological tests generated classification accuracies of 87.0%, with an area under the receiver operating characteristic curve (AUC) of 0.89. Three neuropsychological tests were acquired as significant neuropsychological signatures for the diagnosis of TLE. We also found that the Right-Left Orientation Test difference was related to the superior temporal and the banks of the superior temporal sulcus (bankssts). The Conditional Association Learning Test (CALT) was associated with the cortical thickness difference in the lateral orbitofrontal area between the two groups, and the Component Verbal Fluency Test was associated with the cortical thickness difference in the lateral occipital cortex between the two groups. Conclusion These results showed that machine learning-based classification with the selected neuropsychological data can successfully classify TLE with high accuracy compared to previous studies, which could provide kind of warning sign for surgery candidate of TLE patients. In addition, understanding the mechanism of cognitive behavior by neuroimaging information could assist doctors in the presurgical evaluation of TLE.
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Affiliation(s)
- Xianghong Meng
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, China
| | - Kan Deng
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- MSC Clinical and Technical Solutions, Philips Healthcare, Guangzhou, China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xiaoyi Lin
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yingtong Wu
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Wei Tao
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, China
| | - Chuxuan Lin
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yang Yang
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Fuyong Chen
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, China
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Tai XY, Torzillo E, Lyall DM, Manohar S, Husain M, Sen A. Association of Dementia Risk With Focal Epilepsy and Modifiable Cardiovascular Risk Factors. JAMA Neurol 2023; 80:445-454. [PMID: 36972059 PMCID: PMC10043806 DOI: 10.1001/jamaneurol.2023.0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
Importance Epilepsy has been associated with cognitive impairment and potentially dementia in older individuals. However, the extent to which epilepsy may increase dementia risk, how this compares with other neurological conditions, and how modifiable cardiovascular risk factors may affect this risk remain unclear. Objective To compare the differential risks of subsequent dementia for focal epilepsy compared with stroke and migraine as well as healthy controls, stratified by cardiovascular risk. Design, Setting, and Participants This cross-sectional study is based on data from the UK Biobank, a population-based cohort of more than 500 000 participants aged 38 to 72 years who underwent physiological measurements and cognitive testing and provided biological samples at 1 of 22 centers across the United Kingdom. Participants were eligible for this study if they were without dementia at baseline and had clinical data pertaining to a history of focal epilepsy, stroke, or migraine. The baseline assessment was performed from 2006 to 2010, and participants were followed up until 2021. Exposures Mutually exclusive groups of participants with epilepsy, stroke, and migraine at baseline assessment and controls (who had none of these conditions). Individuals were divided into low, moderate, or high cardiovascular risk groups based on factors that included waist to hip ratio, history of hypertension, hypercholesterolemia, diabetes, and smoking pack-years. Main Outcomes and Measures Incident all-cause dementia; measures of executive function; and brain total hippocampal, gray matter, and white matter hyperintensity volumes. Results Of 495 149 participants (225 481 [45.5%] men; mean [SD] age, 57.5 [8.1] years), 3864 had a diagnosis of focal epilepsy only, 6397 had a history of stroke only, and 14 518 had migraine only. Executive function was comparable between participants with epilepsy and stroke and worse than the control and migraine group. Focal epilepsy was associated with a higher risk of developing dementia (hazard ratio [HR], 4.02; 95% CI, 3.45 to 4.68; P < .001), compared with stroke (HR, 2.56; 95% CI, 2.28 to 2.87; P < .001), or migraine (HR, 1.02; 95% CI, 0.85 to 1.21; P = .94). Participants with focal epilepsy and high cardiovascular risk were more than 13 times more likely to develop dementia (HR, 13.66; 95% CI, 10.61 to 17.60; P < .001) compared with controls with low cardiovascular risk. The imaging subsample included 42 353 participants. Focal epilepsy was associated with lower hippocampal volume (mean difference, -0.17; 95% CI, -0.02 to -0.32; t = -2.18; P = .03) and lower total gray matter volume (mean difference, -0.33; 95% CI, -0.18 to -0.48; t = -4.29; P < .001) compared with controls. There was no significant difference in white matter hyperintensity volume (mean difference, 0.10; 95% CI, -0.07 to 0.26; t = 1.14; P = .26). Conclusions and Relevance In this study, focal epilepsy was associated with a significant risk of developing dementia, to a greater extent than stroke, which was magnified substantially in individuals with high cardiovascular risk. Further findings suggest that targeting modifiable cardiovascular risk factors may be an effective intervention to reduce dementia risk in individuals with epilepsy.
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Affiliation(s)
- Xin You Tai
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Emma Torzillo
- Epilepsy Department, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Donald M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sanjay Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
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Ferrario R, Giovagnoli AR. Processing speed in temporal lobe epilepsy. A scoping review. Epilepsy Behav 2023; 142:109169. [PMID: 36963317 DOI: 10.1016/j.yebeh.2023.109169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Impaired processing speed (PS) can affect patients with temporal lobe epilepsy (TLE). However, it is usually considered a nonspecific clinical feature and is not measured, but this raises lexical and methodological problems. This review aims to evaluate the existing terminology and assessment methods of PS in patients with TLE. METHODS A scoping review was conducted based on the extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The electronic literature search was conducted on Medline-PubMed, American Psychological Association-PsycINFO, Elton Bryson Stephens Company, and Google Scholar, using the keywords "temporal lobe epilepsy" and "speed" or "slowing" plus "processing," "cognitive," "psychomotor," or "mental." Peer-reviewed articles published before December 2022 were analyzed if they were in English, including patients older than 14 years and at least one neuropsychological measure, reported original research focused on PS and had the selected keywords in the title, keywords, and abstract. RESULTS Seven articles published between December 2004 and September 2021 were selected. The terms "processing speed," "psychomotor speed," and "information processing speed," based on similar theoretical constructs, were the most frequently used. Assessment methods included non-computerized or paper-and-pencil tests (WAIS-III Digit Symbol and Symbol Search subtests, Purdue Pegboard and Grooved Pegboard Tests, Trail Making Test and Stroop Color-Word Test) and computerized tests (Sternberg Memory Scanning Test, Pattern Comparison Processing Speed, Computerized Visual Searching). In some studies, impairment was associated with white and gray matter damage in the brain, independent of clinical and treatment variables. CONCLUSION Clinical research on TLE has focused inconsistently on PS. Different evaluation terms and methods have been used while referring to similar theoretical constructs. These findings highlight a gap between the clinical importance of PS and its assessment. Studies are needed to share terms and tools among clinical centers and clarify the position of PS in the TLE phenotype.
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Affiliation(s)
- Rosalba Ferrario
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy
| | - Anna Rita Giovagnoli
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy.
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Helmstaedter C, Sadat-Hossieny Z, Kanner AM, Meador KJ. Cognitive disorders in epilepsy II: Clinical targets, indications and selection of test instruments. Seizure 2020; 83:223-231. [PMID: 33172763 DOI: 10.1016/j.seizure.2020.09.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022] Open
Abstract
This is the second of two narrative reviews on cognitive disorders in epilepsy (companion manuscript: Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations). Its focus is on the clinical targets, indications, and the selection of neuropsychological test instruments. Cognitive assessment has become an essential tool for the diagnosis and outcome control in the clinical management of epilepsy. The diagnostics of basic and higher brain functions can provide valuable information on lateralized and localized brain dysfunctions associated with epilepsy, its underlying pathologies and treatment. In addition to the detection or verification of deficits, neuropsychology reveals the patient's cognitive strengths and, thus, information about the patient reserve capacities for functional restitution and compensation. Neuropsychology is an integral part of diagnostic evaluations mainly in the context of epilepsy surgery to avoid new or additional damage to preexisting neurocognitive impairments. In addition and increasingly, neuropsychology is being used as a tool for monitoring of the disease and its underlying pathologies, and it is suited for the quality and outcome control of pharmacological or other non-invasive medical intervention. This narrative review summarizes the present state of neuropsychological assessments in epilepsy, reveals diagnostic gaps, and shows the great need for education, homogenization, translation and standardization of instruments.
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Affiliation(s)
- C Helmstaedter
- University Clinic Bonn, Department of Epileptology, Germany.
| | - Z Sadat-Hossieny
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
| | - A M Kanner
- University of Miami Health System, Uhealth Neurology, 1150 NW 14th St #609, Miami, FL 33136, USA
| | - K J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
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Sen A, Jette N, Husain M, Sander JW. Epilepsy in older people. Lancet 2020; 395:735-748. [PMID: 32113502 DOI: 10.1016/s0140-6736(19)33064-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular risk factors might be an important strategy to reduce the probability of developing epilepsy.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Masud Husain
- Department of Psychology, University of Oxford, Oxford UK
| | - Josemir W Sander
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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Simmatis LER, Jin AY, Keiski M, Lomax LB, Scott SH, Winston GP. Assessing various sensorimotor and cognitive functions in people with epilepsy is feasible with robotics. Epilepsy Behav 2020; 103:106859. [PMID: 31918991 DOI: 10.1016/j.yebeh.2019.106859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Epilepsy is a common neurological disorder characterized by recurrent seizures, along with comorbid cognitive and psychosocial impairment. Current gold standards of assessment can quantify cognitive and motor performance, but may not capture all subtleties of behavior. Here, we study the feasibility of assessing various upper limb sensorimotor and cognition functions in people with epilepsy using the Kinarm robotic assessment system. We quantify performance across multiple behavioral domains and additionally consider the possible effects of epilepsy subtype and medication. METHODS We recruited individuals with a variety of epilepsy subtypes. Participants performed 8 behavioral tasks that tested motor, cognitive, and sensory domains. We collected data on the same tasks from a group of control participants that had no known neurological impairments. We quantified performance using Task Scores, which provide a composite measure of overall performance on a given task and are adjusted for age, sex, and handedness. RESULTS We collected data from 46 individuals with epilepsy and 92 control participants. The assessment was well-tolerated, with no adverse events recorded. Cognitive tasks testing spatial working memory, executive function, and motor response inhibition were the most frequently impaired in the epilepsy cohort, with 33/46 (72%) being outside the normal range on at least one of these tasks. Additionally, 29/46 (63%) were impaired on at least one task testing primarily motor skill, and 14/46 (30%) were impaired on a proprioceptive sensory task. People with either focal epilepsy or generalized epilepsy performed significantly worse on both motor and cognitive tasks than control participants after correcting for multiple comparisons. There were no statistical differences between generalized and focal epilepsy groups on Task Scores. Finally, individuals taking topiramate trended toward having worse performance on a spatial working memory task than other individuals with epilepsy who were not taking topiramate. CONCLUSIONS Kinarm robotic assessment is feasible in individuals with epilepsy and is well-tolerated. Our robotic paradigm can detect impairments in various sensorimotor and cognitive functions across the population with epilepsy. Future studies will explore the role of epilepsy subtype and medications.
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Affiliation(s)
- Leif E R Simmatis
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Albert Y Jin
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada
| | - Michelle Keiski
- Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada
| | - Lysa B Lomax
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Biomedical and Molecular Sciences, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Gavin P Winston
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada.
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9
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Englot DJ, Morgan VL, Chang C. Impaired vigilance networks in temporal lobe epilepsy: Mechanisms and clinical implications. Epilepsia 2020; 61:189-202. [PMID: 31901182 DOI: 10.1111/epi.16423] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Abstract
Mesial temporal lobe epilepsy (mTLE) is a neurological disorder in which patients suffer from frequent consciousness-impairing seizures, broad neurocognitive deficits, and diminished quality of life. Although seizures in mTLE originate focally in the hippocampus or amygdala, mTLE patients demonstrate cognitive deficits that extend beyond temporal lobe function-such as decline in executive function, cognitive processing speed, and attention-as well as diffuse decreases in neocortical metabolism and functional connectivity. Given prior observations that mTLE patients exhibit impairments in vigilance, and that seizures may disrupt the activity and long-range connectivity of subcortical brain structures involved in vigilance regulation, we propose that subcortical activating networks underlying vigilance play a critical role in mediating the widespread neural and cognitive effects of focal mTLE. Here, we review evidence for impaired vigilance in mTLE, examine clinical implications and potential network underpinnings, and suggest neuroimaging strategies for determining the relationship between vigilance, brain connectivity, and neurocognition in patients and healthy controls.
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Affiliation(s)
- Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Victoria L Morgan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Catie Chang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
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Manabe Y, Komatsu T, Seki S, Sugawara T. Dietary astaxanthin can accumulate in the brain of rats. Biosci Biotechnol Biochem 2018; 82:1433-1436. [DOI: 10.1080/09168451.2018.1459467] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ABSTRACT
We evaluated the distribution of astaxanthin in rat brains after a single dose administration and after feeding 0.1% astaxanthin diet for 5 days. Astaxanthin was detected in the hippocampus and cerebral cortex 4 and 8 h after a single dose. Astaxanthin concentration in rat brains was higher after consumption of astaxanthin diet for 5 days than after a single dose.
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Affiliation(s)
- Yuki Manabe
- Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | | | - Shinobu Seki
- Pharmaceutical and Healthcare Research Laboratories, Research and Development Management Headquarters, FUJIFILM Corporation, Kanagawa, Japan
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Sen A, Capelli V, Husain M. Cognition and dementia in older patients with epilepsy. Brain 2018; 141:1592-1608. [PMID: 29506031 PMCID: PMC5972564 DOI: 10.1093/brain/awy022] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/12/2022] Open
Abstract
With advances in healthcare and an ageing population, the number of older adults with epilepsy is set to rise substantially across the world. In developed countries the highest incidence of epilepsy is already in people over 65 and, as life expectancy increases, individuals who developed epilepsy at a young age are also living longer. Recent findings show that older persons with epilepsy are more likely to suffer from cognitive dysfunction and that there might be an important bidirectional relationship between epilepsy and dementia. Thus some people with epilepsy may be at a higher risk of developing dementia, while individuals with some forms of dementia, particularly Alzheimer's disease and vascular dementia, are at significantly higher risk of developing epilepsy. Consistent with this emerging view, epidemiological findings reveal that people with epilepsy and individuals with Alzheimer's disease share common risk factors. Recent studies in Alzheimer's disease and late-onset epilepsy also suggest common pathological links mediated by underlying vascular changes and/or tau pathology. Meanwhile electrophysiological and neuroimaging investigations in epilepsy, Alzheimer's disease, and vascular dementia have focused interest on network level dysfunction, which might be important in mediating cognitive dysfunction across all three of these conditions. In this review we consider whether seizures promote dementia, whether dementia causes seizures, or if common underlying pathophysiological mechanisms cause both. We examine the evidence that cognitive impairment is associated with epilepsy in older people (aged over 65) and the prognosis for patients with epilepsy developing dementia, with a specific emphasis on common mechanisms that might underlie the cognitive deficits observed in epilepsy and Alzheimer's disease. Our analyses suggest that there is considerable intersection between epilepsy, Alzheimer's disease and cerebrovascular disease raising the possibility that better understanding of shared mechanisms in these conditions might help to ameliorate not just seizures, but also epileptogenesis and cognitive dysfunction.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Valentina Capelli
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Masud Husain
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
- Department of Experimental Psychology, University of Oxford, UK
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Mapping the neuropsychological profile of temporal lobe epilepsy using cognitive network topology and graph theory. Epilepsy Behav 2016; 63:9-16. [PMID: 27532489 PMCID: PMC5048539 DOI: 10.1016/j.yebeh.2016.07.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 07/01/2016] [Accepted: 07/24/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Normal cognitive function is defined by harmonious interaction among multiple neuropsychological domains. Epilepsy has a disruptive effect on cognition, but how diverse cognitive abilities differentially interact with one another compared with healthy controls (HC) is unclear. This study used graph theory to analyze the community structure of cognitive networks in adults with temporal lobe epilepsy (TLE) compared with that in HC. METHODS Neuropsychological assessment was performed in 100 patients with TLE and 82 HC. For each group, an adjacency matrix was constructed representing pair-wise correlation coefficients between raw scores obtained in each possible test combination. For each cognitive network, each node corresponded to a cognitive test; each link corresponded to the correlation coefficient between tests. Global network structure, community structure, and node-wise graph theory properties were qualitatively assessed. RESULTS The community structure in patients with TLE was composed of fewer, larger, more mixed modules, characterizing three main modules representing close relationships between the following: 1) aspects of executive function (EF), verbal and visual memory, 2) speed and fluency, and 3) speed, EF, perception, language, intelligence, and nonverbal memory. Conversely, controls exhibited a relative division between cognitive functions, segregating into more numerous, smaller modules consisting of the following: 1) verbal memory, 2) language, perception, and intelligence, 3) speed and fluency, and 4) visual memory and EF. Overall node-wise clustering coefficient and efficiency were increased in TLE. SIGNIFICANCE Adults with TLE demonstrate a less clear and poorly structured segregation between multiple cognitive domains. This panorama suggests a higher degree of interdependency across multiple cognitive domains in TLE, possibly indicating compensatory mechanisms to overcome functional impairments.
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