Face processing in adolescents with and without epilepsy

Impaired Cognitive Abilities in Siblings of Patients with Temporal Lobe Epilepsy

PURPOSE

Patients with temporal lobe epilepsy (TLE) are at high risk of cognitive impairment. In addition to persistent seizures and antiepileptic drugs (AEDs), genetic factors also play an important role in the progression of cognitive deficits in TLE patients. Defining a cognitive endophenotype for TLE can provide information on the risk of cognitive impairment in patients. This study investigated the cognitive endophenotype of TLE by comparing neuropsychological function between patients with TLE, their unaffected siblings, and healthy control subjects.

PATIENTS AND METHODS

A total of 46 patients with TLE, 26 siblings, and 33 control subjects were recruited. Cognitive function (ie, general cognition, short- and long-term memory, attention, visuospatial and executive functions, and working memory) was assessed with a battery of neuropsychological tests. Differences between groups were evaluated by analysis of covariance, with age and years of education as covariates. The Kruskal-Wallis test was used to evaluate data that did not satisfy the homogeneity of variance assumption. Pairwise comparisons were adjusted by Bonferroni correction, with a significance threshold of P<0.05.

RESULTS

Patients with TLE showed deficits in the information test (P<0.001), arithmetic test (P=0.003), digit symbol substitution test (P=0.001), block design test (BDT; P=0.005), and backward digit span test (P=0.001) and took a longer time to complete the Hayling test Part A (P=0.011) compared to controls. Left TLE patients tended to have worse executive function test scores than right TLE patients. The siblings of TLE patients showed deficits in the BDT (P=0.006, Bonferroni-corrected) relative to controls.

CONCLUSION

Patients with TLE exhibit cognitive impairment. Executive function is worse in patients with left TLE than in those with right TLE. Siblings show impaired visuospatial function relative to controls. Thus, cognitive deficits in TLE patients have a genetic component and are independent of seizures or AED use.

Cognition in epilepsy: current clinical issues of interest

PURPOSE OF REVIEW

This review provides an update and summary of recent neuropsychological findings in epilepsy focusing on three major clinical topics among the many developments in the field. We will critically outline the current state with regard to cognition in new-onset epilepsies, social cognition in epilepsy, and the long-term outcome of epilepsy surgery and the cognitive outcomes of superselective surgical procedures.

RECENT FINDINGS

Current studies indicate that neuropsychological impairments are prevalent already at the onset of epilepsy and even before, social cognition (i.e., emotion recognition and theory of mind) is impaired in different epilepsy populations, the long-term outcome of epilepsy surgery is mostly characterized by a stable or even improved cognitive status, and superselective epilepsy surgeries are associated with a promising neuropsychological outcome.

SUMMARY

The high prevalence of cognitive deficits around epilepsy onset challenges the assumption that epilepsy is the major cause of cognitive problems and calls for early neuropsychological diagnostics. Social cognition seems to be a relevant domain that is not yet routinely considered in epilepsy. The cognitive long-term outcome of epilepsy surgery is mostly positive. Stereotactic thermocoagulation and gamma knife surgery appear to be cognitively safe procedures.

Seizure-related variables are predictive of attention and memory in children with epilepsy

Children with epilepsy (CWE) are at greater risk for cognitive deficits and behavioral difficulties than are typically developing healthy children, and particular epileptic symptoms and treatments may contribute to this risk. The current study examined the relationships between four seizure-related variables and attention and memory functioning in a sample of 207 CWE (ages 6-16) using both neurocognitive and parent/teacher-report measures. Sociodemographic, medical, and neuropsychological data were collected from patients' medical charts in a retrospective fashion. Hierarchical multiple regressions were performed with sociodemographic variables (age, gender, race) entered as step one and seizure-related variables (number of anti-epileptic drugs [AEDs], EEG laterality, EEG lobe of focus, lifetime seizure duration) entered as step two. Results indicated that seizure-related variables were consistently predictive of poor cognitive performances above and beyond sociodemographic variables, although only minimally predictive of parent/teacher-reports. A longer duration of seizure burden and greater number of AEDs were robust predictors of performances on most cognitive measures. These findings indicate that CWE with long lifetime seizure durations and multiple AEDs are at risk for inefficiencies in attention and memory. Knowledge of this risk will allow treating providers greater accuracy and precision when planning medical treatment and making recommendations to families.

Impaired performance on advanced Theory of Mind tasks in children with epilepsy is related to poor communication and increased attention problems

Children with epilepsy (CWE) have social difficulties that can persist into adulthood, and this could be related to problems with understanding others' thoughts, feelings, and intentions. This study assessed children's ability to interpret and reason on mental and emotional states (Theory of Mind) and examined the relationships between task scores and reports of communication and behavior. Performance of 56 CWE (8-16years of age) with below average IQ (n=17) or an average IQ (n=39) was compared with that of 62 healthy controls with an average IQ (6-16years of age) on cognition, language, and two advanced Theory of Mind (ToM) tasks that required children to attribute mental or emotional states to eye regions and to reason on internal mental states in order to explain behavior. The CWE-below average group were significantly poorer in both ToM tasks compared with controls. The CWE - average group showed a significantly poorer ability to reason on mental states in order to explain behavior, a difference that remained after accounting for lower IQ and language deficits. Poor ToM skills were related to increased communication and attention problems in both CWE groups. There is a risk for atypical social understanding in CWE, even for children with average cognitive function.

Developmental Trajectory of Face Processing Revealed by Integrative Dynamics

Given their unique connectivity, a primary function of brain networks must be to transfer and integrate information. Therefore, the way in which information is integrated by individual nodes of the network may be an informative aspect of cognitive processing. Here we present a method inspired by telecommunications research that utilizes time–frequency fluctuations of neural activity to infer how information is integrated by individual nodes of the network. We use a queueing theoretical model to interpret empirical data in terms of information processing and integration. In particular, we demonstrate, in participants aged from 6 to 41 years, that the well-known face inversion phenomenon may be explained in terms of information integration. Our model suggests that inverted faces may be associated with shorter and more frequent neural integrative stages, indicating fractured processing and consistent with the notion that inverted faces are perceived by parts. Conversely, our model suggests that upright faces may be associated with a smaller number of sustained episodes of integration, indicating more involved processing, akin to holistic and configural processing. These differences in how upright and inverted faces are processed became more pronounced during development, indicating a gradual specialization for face perception. These effects were robustly expressed in the right fusiform gyrus (all groups), as well as right parahippocampal gyrus (children and adolescents only) and left inferior temporal cortex (adults only).

Neuromagnetic vistas into typical and atypical development of frontal lobe functions

The frontal lobes are involved in many higher-order cognitive functions such as social cognition executive functions and language and speech. These functions are complex and follow a prolonged developmental course from childhood through to early adulthood. Magnetoencephalography (MEG) is ideal for the study of development of these functions, due to its combination of temporal and spatial resolution which allows the determination of age-related changes in both neural timing and location. There are several challenges for MEG developmental studies: to design tasks appropriate to capture the neurodevelopmental trajectory of these cognitive functions, and to develop appropriate analysis strategies to capture various aspects of neuromagnetic frontal lobe activity. Here, we review our MEG research on social and executive functions, and speech in typically developing children and in two clinical groups – children with autism spectrum disorder and children born very preterm. The studies include facial emotional processing, inhibition, visual short-term memory, speech production, and resting-state networks. We present data from event-related analyses as well as on oscillations and connectivity analyses and review their contributions to understanding frontal lobe cognitive development. We also discuss the challenges of testing young children in the MEG and the development of age-appropriate technologies and paradigms.

A magnetoencephalographic study of face processing: M170, gamma-band oscillations and source localization

EEG studies suggested that the N170 ERP and Gamma-band responses to faces reflect early and later stages of a multiple-level face-perception mechanism, respectively. However, these conclusions should be considered cautiously because EEG-recorded Gamma may be contaminated by noncephalic activity such as microsaccades. Moreover, EEG studies of Gamma cannot easily reveal its intracranial sources. Here we recorded MEG rather than EEG, assessed the sources of the M170 and Gamma oscillations using beamformer, and explored the sensitivity of these neural manifestations to global, featural and configural information in faces. The M170 was larger in response to faces and face components than in response to watches. Scrambling the configuration of the inner components of the face even if presented without the face contour reduced and delayed the M170. The amplitude of MEG Gamma oscillations (30-70 Hz) was higher than baseline during an epoch between 230-570 ms from stimulus onset and was particularly sensitive to the configuration of the stimuli, regardless of their category. However, in the lower part of this frequency range (30-40 Hz) only physiognomic stimuli elevated the MEG above baseline. Both the M170 and Gamma were generated in a posterior-ventral network including the fusiform, inferior-occipital and lingual gyri, all in the right hemisphere. The generation of Gamma involved additional sources in the visual system, bilaterally. We suggest that the evoked M170 manifests a face-perception mechanism based on the global characteristics of face, whereas the induced Gamma oscillations are associated with the integration of visual input into a pre-existent coherent perceptual representation.

Empirical and theoretical aspects of generation and transfer of information in a neuromagnetic source network

Variability in source dynamics across the sources in an activated network may be indicative of how the information is processed within a network. Information-theoretic tools allow one not only to characterize local brain dynamics but also to describe interactions between distributed brain activity. This study follows such a framework and explores the relations between signal variability and asymmetry in mutual interdependencies in a data-driven pipeline of non-linear analysis of neuromagnetic sources reconstructed from human magnetoencephalographic (MEG) data collected as a reaction to a face recognition task. Asymmetry in non-linear interdependencies in the network was analyzed using transfer entropy, which quantifies predictive information transfer between the sources. Variability of the source activity was estimated using multi-scale entropy, quantifying the rate of which information is generated. The empirical results are supported by an analysis of synthetic data based on the dynamics of coupled systems with time delay in coupling. We found that the amount of information transferred from one source to another was correlated with the difference in variability between the dynamics of these two sources, with the directionality of net information transfer depending on the time scale at which the sample entropy was computed. The results based on synthetic data suggest that both time delay and strength of coupling can contribute to the relations between variability of brain signals and information transfer between them. Our findings support the previous attempts to characterize functional organization of the activated brain, based on a combination of non-linear dynamics and temporal features of brain connectivity, such as time delay.

Brain noise is task dependent and region specific

The emerging organization of anatomical and functional connections during human brain development is thought to facilitate global integration of information. Recent empirical and computational studies have shown that this enhanced capacity for information processing enables a diversified dynamic repertoire that manifests in neural activity as irregularity and noise. However, transient functional networks unfold over multiple time, scales and the embedding of a particular region depends not only on development, but also on the manner in which sensory and cognitive systems are engaged. Here we show that noise is a facet of neural activity that is also sensitive to the task context and is highly region specific. Children (6-16 yr) and adults (20-41 yr) performed a one-back face recognition task with inverted and upright faces. Neuromagnetic activity was estimated at several hundred sources in the brain by applying a beamforming technique to the magnetoencephalogram (MEG). During development, neural activity became more variable across the whole brain, with most robust increases in medial parietal regions, such as the precuneus and posterior cingulate cortex. For young children and adults, activity evoked by upright faces was more variable and noisy compared with inverted faces, and this effect was reliable only in the right fusiform gyrus. These results are consistent with the notion that upright faces engender a variety of integrative neural computations, such as the relations among facial features and their holistic constitution. This study shows that transient changes in functional integration modulated by task demand are evident in the variability of regional neural activity.

Neural responses to rigidly moving faces displaying shifts in social attention investigated with fMRI and MEG

A widely adopted neural model of face perception (Haxby, Hoffman, & Gobbini, 2000) proposes that the posterior superior temporal sulcus (STS) represents the changeable features of a face, while the face-responsive fusiform gyrus (FFA) encodes invariant aspects of facial structure. 'Changeable features' of a face can include rigid and non-rigid movements. The current study investigated neural responses to rigid, moving faces displaying shifts in social attention. Both functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) were used to investigate neural responses elicited when participants viewed video clips in which actors made a rigid shift of attention, signalled congruently from both the eyes and head. These responses were compared to those elicited by viewing static faces displaying stationary social attention information or a scrambled video displaying directional motion. Both the fMRI and MEG analyses demonstrated heightened responses along the STS to turning heads compared to static faces or scrambled movement conditions. The FFA responded to both turning heads and static faces, showing only a slight increase in response to the dynamic stimuli. These results establish the applicability of the Haxby model to the perception of rigid face motions expressing changes in social attention direction. Furthermore, the MEG beamforming analyses found an STS response in an upper frequency band (30-80 Hz) which peaked in the right anterior region. These findings, derived from two complementary neuroimaging techniques, clarify the contribution of the STS during the encoding of rigid facial action patterns of social attention, emphasising the role of anterior sulcal regions alongside previously observed posterior areas.