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Benzait A, Krenz V, Wegrzyn M, Doll A, Woermann F, Labudda K, Bien CG, Kissler J. Hemodynamic correlates of emotion regulation in frontal lobe epilepsy patients and healthy participants. Hum Brain Mapp 2023; 44:1456-1475. [PMID: 36366744 PMCID: PMC9921231 DOI: 10.1002/hbm.26133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
The ability to regulate emotions is indispensable for maintaining psychological health. It heavily relies on frontal lobe functions which are disrupted in frontal lobe epilepsy. Accordingly, emotional dysregulation and use of maladaptive emotion regulation strategies have been reported in frontal lobe epilepsy patients. Therefore, it is of clinical and scientific interest to investigate emotion regulation in frontal lobe epilepsy. We studied neural correlates of upregulating and downregulating emotions toward aversive pictures through reappraisal in 18 frontal lobe epilepsy patients and 17 healthy controls using functional magnetic resonance imaging. Patients tended to report more difficulties with impulse control than controls. On the neural level, patients had diminished activity during upregulation in distributed left-sided regions, including ventrolateral and dorsomedial prefrontal cortex, angular gyrus and anterior temporal gyrus. Patients also showed less activity than controls in the left precuneus for upregulation compared to downregulation. Unlike controls, they displayed no task-related activity changes in the left amygdala, whereas the right amygdala showed task-related modulations in both groups. Upregulation-related activity changes in the left inferior frontal gyrus, insula, orbitofrontal cortex, anterior and posterior cingulate cortex, and precuneus were correlated with questionnaire data on habitual emotion regulation. Our results show that structural or functional impairments in the frontal lobes disrupt neural mechanisms underlying emotion regulation through reappraisal throughout the brain, including posterior regions involved in semantic control. Findings on the amygdala as a major target of emotion regulation are in line with the view that specifically the left amygdala is connected with semantic processing networks.
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Affiliation(s)
- Anissa Benzait
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Valentina Krenz
- Department of Psychology, University of Hamburg, Hamburg, Germany
| | - Martin Wegrzyn
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Anna Doll
- Department of Psychology, Bielefeld University, Bielefeld, Germany.,Department of Epileptology (Mara Hospital), Medical School, Bielefeld University, Bielefeld, Germany
| | - Friedrich Woermann
- Department of Epileptology (Mara Hospital), Medical School, Bielefeld University, Bielefeld, Germany
| | - Kirsten Labudda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Mara Hospital), Medical School, Bielefeld University, Bielefeld, Germany
| | - Johanna Kissler
- Department of Psychology, Bielefeld University, Bielefeld, Germany.,Center of Excellence Cognitive Interaction Technology (CITEC), Bielefeld University, Bielefeld, Germany
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Xu H, Zhu H, Luo L, Zhang R. Altered gray matter volume in MRI-negative focal to bilateral tonic-clonic seizures. Acta Neurol Belg 2021; 121:1525-1533. [PMID: 32449136 DOI: 10.1007/s13760-020-01383-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
To investigate cortical changes in MRI-negative patients with focal to bilateral tonic-clonic seizures (FBTCS). High-resolution three-dimensional T1-weighted MRI were collected with a GE 3.0-T MRI scanner from 26 patients with FBTCS and 21 healthy volunteers at Nanjing Brain Hospital. Voxel-based morphometry was performed on T1-weighted MRI of all subjects. A two-sample t test was performed to compare the GMV of two groups. Age and gender were taken as covariables, so that brain regions with significant differences, as compared by two-sample t test, between the two group were obtained. These regions were extracted as the regions of interest (ROIs) used for correlation analysis between ROIs and clinical variables. There is no significant difference in GMF between two groups. In FBTCS, regions with decreased GMV are bilateral thalamus, bilateral orbitofrontal cortex, left medical cingulate gyrus, and right supplementary motor area. GMV is increased within the bilateral para-hippocampal regions (voxel-wise FDR-corrected, P < 0.05). The GMVs are significantly negatively correlated with disease duration in the left thalamus and the left para-hippocampal region (P < 0.05). Seizures may lead to the loss of neurons and the decrease of GMV in FBTCS. The increase of GMV in some regions might be due to inflammatory responses in the early stages of epileptic seizures.
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Affiliation(s)
- Honghao Xu
- Department of Functional Neurosurgery, The Brain Hospital Affiliated to Nanjing Medical University, Nanjing, 210029, China
| | - Haitao Zhu
- Department of Functional Neurosurgery, The Brain Hospital Affiliated to Nanjing Medical University, Nanjing, 210029, China
| | - Lei Luo
- Department of Functional Neurosurgery, The Brain Hospital Affiliated to Nanjing Medical University, Nanjing, 210029, China
| | - Rui Zhang
- Department of Functional Neurosurgery, The Brain Hospital Affiliated to Nanjing Medical University, Nanjing, 210029, China.
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Cognitive deficits and rehabilitation mechanisms in mild traumatic brain injury patients revealed by EEG connectivity markers. Clin Neurophysiol 2021; 132:554-567. [PMID: 33453686 DOI: 10.1016/j.clinph.2020.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/13/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the multiple specific biomarkers and cognitive compensatory mechanisms of mild traumatic brain injury (mTBI) patients at recovery stage. METHODS The experiment was performed in two sections. In Section I, using event-related potential, event-related oscillation and spatial phase-synchronization, we explored neural dynamics in 24 volunteered healthy controls (HC) and 38 patients at least 6 months post-mTBI (19 with epidural hematoma, EDH; 19 with subdural hematoma, SDH) during a Go/NoGo task. In Section II, according to the neuropsychological scales, patients were divided into sub-groups to assess these electroencephalography (EEG) indicators in identifying different rehabilitation outcomes of mTBI. RESULTS In Section I, mean amplitudes of NoGo-P3 and P3d were decreased in mTBI patients relative to HC, and NoGo-theta power in the non-injured hemisphere was decreased in SDH patients only. In Section II, patients with chronic neuropsychological defects exhibited more serious impairments of intra-hemispheric connectivity, whereas inter-hemispheric centro-parietal and frontal connectivity were enhanced in response to lesions. CONCLUSIONS EEG distinguished mTBI patients from healthy controls, and estimated different rehabilitation outcomes of mTBI. The centro-parietal and frontal connectivity are the main compensatory mechanism for the recovery of mTBI patients. SIGNIFICANCE EEG measurements and network connectivity can track recovery process and mechanism of mTBI.
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Moguilner S, García AM, Mikulan E, Del Carmen García M, Vaucheret E, Amarillo Y, Bekinschtein TA, Ibáñez A. An unaware agenda: interictal consciousness impairments in epileptic patients. Neurosci Conscious 2017; 2017:niw024. [PMID: 30042834 PMCID: PMC6007167 DOI: 10.1093/nc/niw024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/16/2016] [Accepted: 12/21/2016] [Indexed: 01/07/2023] Open
Abstract
Consciousness impairments have been described as a cornerstone of epilepsy. Generalized seizures are usually characterized by a complete loss of consciousness, whereas focal seizures have more variable degrees of responsiveness. In addition to these impairments that occur during ictal episodes, alterations of consciousness have also been repeatedly observed between seizures (i.e. during interictal periods). In this opinion article, we review evidence supporting the novel hypothesis that epilepsy produces consciousness impairments which remain present interictally. Then, we discuss therapies aimed to reduce seizure frequency, which may modulate consciousness between epileptic seizures. We conclude with a consideration of relevant pathophysiological mechanisms. In particular, the thalamocortical network seems to be involved in both seizure generation and interictal consciousness impairments, which could inaugurate a promising translational agenda for epilepsy studies.
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Affiliation(s)
- Sebastian Moguilner
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,Fundación Escuela de Medicina Nuclear (FUESMEN) and Comisión Nacional de Energía Atómica (CNEA), Buenos Aires, Argentina.,Instituto Balseiro and Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Cuyo (UNCuyo), Mendoza, Argentina
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Elementary and Special Education (FEEyE), National University of Cuyo (UNCuyo), Mendoza, Argentina
| | - Ezequiel Mikulan
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Maria Del Carmen García
- Programa de Cirugía de Epilepsia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Esteban Vaucheret
- Servicio de Neurologia Infantil del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Yimy Amarillo
- Consejo Nacional de Investigaciones Científicas y Técnicas, Física Estadística e Interdisciplinaria, Centro Atómico Bariloche, San Carlos de Bariloche, Rio Negro, Argentina
| | | | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia
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Slinger G, Sinke MRT, Braun KPJ, Otte WM. White matter abnormalities at a regional and voxel level in focal and generalized epilepsy: A systematic review and meta-analysis. NEUROIMAGE-CLINICAL 2016; 12:902-909. [PMID: 27882296 PMCID: PMC5114611 DOI: 10.1016/j.nicl.2016.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 12/24/2022]
Abstract
Objective Since the introduction of diffusion tensor imaging, white matter abnormalities in epilepsy have been studied extensively. However, the affected areas reported, the extent of abnormalities and the association with relevant clinical parameters are highly variable. We aimed to obtain a more consistent estimate of white matter abnormalities and their association with clinical parameters in different epilepsy types. Methods We systematically searched for differences in white matter fractional anisotropy and mean diffusivity, at regional and voxel level, between people with epilepsy and healthy controls. Meta-analyses were used to quantify the directionality and extent of these differences. Correlations between white matter differences and age of epilepsy onset, duration of epilepsy and sex were assessed with meta-regressions. Results Forty-two studies, with 1027 people with epilepsy and 1122 controls, were included with regional data. Sixteen voxel-based studies were also included. People with temporal or frontal lobe epilepsy had significantly decreased fractional anisotropy (Δ –0.021, 95% confidence interval –0.026 to –0.016) and increased mean diffusivity (Δ0.026 × 10–3 mm2/s, 0.012 to 0.039) in the commissural, association and projection white matter fibers. White matter was much less affected in generalized epilepsy. White matter changes in people with focal epilepsy correlated with age at onset, epilepsy duration and sex. Significance This study provides a better estimation of white matter changes in different epilepsies. Effects are particularly found in people with focal epilepsy. Correlations with the duration of focal epilepsy support the hypothesis that these changes are, at least partly, a consequence of seizures and may warrant early surgery. Future studies need to guarantee adequate group sizes, as white matter differences in epilepsy are small. White matter FA and MD are more affected in focal than in generalized epilepsy. Epilepsy subtypes show distinct patterns of affected white matter regions. White matter integrity is altered both ipsi- and contralaterally in focal epilepsy. White matter changes in focal epilepsy seem to be a consequence of seizures.
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Affiliation(s)
- Geertruida Slinger
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, The Netherlands
| | - Michel R T Sinke
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Willem M Otte
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, The Netherlands; Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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Braakman HMH, Vaessen MJ, Jansen JFA, Debeij-van Hall MHJA, de Louw A, Hofman PAM, Vles JSH, Aldenkamp AP, Backes WH. Pediatric frontal lobe epilepsy: white matter abnormalities and cognitive impairment. Acta Neurol Scand 2014; 129:252-62. [PMID: 24112290 DOI: 10.1111/ane.12183] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cognitive impairment is frequent in children with frontal lobe epilepsy (FLE). Its etiology remains unknown. With diffusion tensor imaging, we have studied cerebral white matter properties and associations with cognitive functioning in children with FLE and healthy controls. METHODS Thirty children aged 8-13 years with FLE of unknown cause and 39 healthy age-matched controls underwent neuropsychological assessment, structural and diffusion-weighted brain MRI. Patients were grouped as cognitively impaired or unimpaired, and their white matter diffusion properties were compared with the controls. RESULTS Children with FLE had reduced apparent diffusion coefficients in various posteriorly located tract bundles, a reduced fractional anisotropy (FA) of the white matter tract between the right frontal and right occipital lobe, and smaller volumes of several collections of interlobar bundle tracts, compared with controls. The cognitively impaired patient group demonstrated significant increases in FA of the white matter of both occipital lobes, a reduced FA of white matter tract bundles between the right frontal and both left occipital lobe and subcortical white matter area, and smaller volumes of two collections of tract bundles connecting the frontal lobe with the temporal and parietal lobes, compared with controls. CONCLUSIONS Children with FLE had white matter abnormalities mainly in posterior brain regions, not confined to the area of the seizure focus. Cognitively impaired children with FLE showed the most pronounced white matter abnormalities. These possibly reflect disturbed maturation and might be part of the etiology of the cognitive impairment.
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Affiliation(s)
- H. M. H. Braakman
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - M. J. Vaessen
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - J. F. A. Jansen
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | | | - A. de Louw
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - P. A. M. Hofman
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - J. S. H. Vles
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - A. P. Aldenkamp
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - W. H. Backes
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
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Braakman HMH, van der Kruijs SJM, Vaessen MJ, Jansen JFA, Debeij-van Hall MHJA, Vles JSH, Aldenkamp AP, Backes WH, Hofman PAM. Microstructural and functional MRI studies of cognitive impairment in epilepsy. Epilepsia 2012; 53:1690-9. [PMID: 22889330 DOI: 10.1111/j.1528-1167.2012.03624.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cognitive impairment is the most common comorbidity in children with epilepsy, but its pathophysiology and predisposing conditions remain unknown. Clinical epilepsy characteristics are not conclusive in determining cognitive outcome. Because many children with epilepsy do not have macrostructural magnetic resonance imaging (MRI) abnormalities, the underlying substrate for cognitive impairment may be found at the microstructural or functional level. In the last two decades, new MRI techniques have been developed that have the potential to visualize microstructural or functional abnormalities associated with cognitive impairment. These include volumetric MRI, voxel-based morphometry (VBM), diffusion tensor imaging (DTI), MR spectroscopy (MRS), and functional MRI (fMRI). All of these techniques have shed new light on various aspects associated with, or underlying, cognitive impairment, although their use in epilepsy has been limited and focused mostly on adults. Therefore, in this review, the use of all these different MRI techniques to unravel cognitive impairment in epilepsy is discussed both in adults and children with epilepsy. Volumetric MRI and VBM have revealed significant volume losses in the area of the seizure focus as well as in distant areas. DTI adds evidence of loss of integrity of connections from the seizure focus to distant areas as well as between distant areas. MRS and fMRI have shown impaired function both in the area of the seizure focus as well as in distant structures. For this review we have compiled and compared findings from the various techniques to conclude that cognitive impairment in epilepsy results from a network disorder in which the (micro)structures as well as the functionality can be disturbed.
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Affiliation(s)
- Hilde M H Braakman
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Fahoum F, Lopes R, Pittau F, Dubeau F, Gotman J. Widespread epileptic networks in focal epilepsies: EEG-fMRI study. Epilepsia 2012; 53:1618-27. [PMID: 22691174 DOI: 10.1111/j.1528-1167.2012.03533.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the extent of brain involvement during focal epileptic activity, we studied patterns of cortical and subcortical metabolic changes coinciding with interictal epileptic discharges (IEDs) using group analysis of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) scans in patients with focal epilepsy. METHODS We selected patients with temporal lobe epilepsy (TLE, n = 32), frontal lobe epilepsy (FLE, n = 14), and posterior quadrant epilepsy (PQE, n = 20) from our 3 Tesla EEG-fMRI database. We applied group analysis upon the blood oxygen-level dependent (BOLD) response associated with focal IEDs. KEY FINDINGS Patients with TLE and FLE showed activations and deactivations, whereas in PQE only deactivations occurred. In TLE and FLE, the largest activation was in the mid-cingulate gyri bilaterally. In FLE, activations were also found in the ipsilateral frontal operculum, thalamus, and internal capsule, and in the contralateral cerebellum, whereas in TLE, we found additional activations in the ipsilateral mesial and neocortical temporal regions, insula, and cerebellar cortex. All three groups showed deactivations in default mode network regions, the most widespread being in the TLE group, and less in PQE and FLE. SIGNIFICANCE These results indicate that different epileptic syndromes result in unique and widespread networks related to focal IEDs. Default mode regions are deactivated in response to focal discharges in all three groups with syndrome specific pattern. We conclude that focal IEDs are associated with specific networks of widespread metabolic changes that may cause more substantial disturbance to brain function than might be appreciated from the focal nature of the scalp EEG discharges.
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Affiliation(s)
- Firas Fahoum
- Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
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