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Chaudhry N, Bergey GK, Kaplan PW, Johnson EL. Life Stressors During Pregnancy in Women With Epilepsy: Results From the Pregnancy Risk Assessment Monitoring System. Neurology 2023; 100:e2424-e2431. [PMID: 37072226 PMCID: PMC10264049 DOI: 10.1212/wnl.0000000000207274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 02/23/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To compare specific life stressors and domestic abuse that pregnant women and others with epilepsy (WWE) experience compared with pregnant women and others without epilepsy (WWoE). METHODS The Pregnancy Risk Assessment Monitoring System (PRAMS) is an annual weighted survey of randomly sampled postpartum women administered by the Centers for Disease Control and Prevention. We used data from the PRAMS from 2012 to 2020 in 13 states to assess the life stressors reported by WWE compared with WWoE. We adjusted the data for maternal age, race, ethnicity, marital status, education, and socioeconomic status (SES; using income, Women, Infants, and Children program [WIC], and Medicaid use). We also examined reported abuse in WWE compared with WWoE. RESULTS This study included data from 64,951 postpartum women, representing 4,072,189 women through weighted sampling. Of these, 1,140 reported having a diagnosis of epilepsy in the 3 months before their pregnancies (representing 81,021 WWE). WWE experienced a higher number of stressors compared with WWoE. WWE were more likely to have experienced 9 of the 14 stressors asked in the PRAMS questionnaire: severe illness of a close family member, separation or divorce, homelessness, loss of a partner's job, cut in work hours or pay, arguing more than usual with their partner, serving jail time, substance abuse problem in a close contact, and death of a close contact. After adjusting for demographics (age, race, and SES), epilepsy was still associated with a higher number of stressors in pregnant women. Other factors associated with stressors were younger age, Indigenous or mixed race, non-Hispanic ethnicity, lower income, and WIC or Medicaid use. Those who were married were less likely to report stressors. WWE were also more likely to report abuse before or during their pregnancies. DISCUSSION Although managing stress is important in both epilepsy and pregnancy, WWE experience more stressors than do WWoE. After adjusting for maternal age, race, and SES, this increase in stressors persisted. Women who were younger, with lower income, on WIC or Medicaid, or not married were also more likely to experience life stressors. Alarmingly, reported abuse was also higher in WWE compared with WWoE. Attention from clinicians and support services for WWE are needed to optimize good pregnancy outcomes.
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Affiliation(s)
- Naveed Chaudhry
- From the Department of Neurology (N.C.), University of Colorado School of Medicine, Denver; and Department of Neurology (G.K.B., P.W.K., E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD.
| | - Gregory K Bergey
- From the Department of Neurology (N.C.), University of Colorado School of Medicine, Denver; and Department of Neurology (G.K.B., P.W.K., E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Peter W Kaplan
- From the Department of Neurology (N.C.), University of Colorado School of Medicine, Denver; and Department of Neurology (G.K.B., P.W.K., E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Emily L Johnson
- From the Department of Neurology (N.C.), University of Colorado School of Medicine, Denver; and Department of Neurology (G.K.B., P.W.K., E.L.J.), Johns Hopkins School of Medicine, Baltimore, MD
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Social Cognition in Temporal and Frontal Lobe Epilepsy: Systematic Review, Meta-analysis, and Clinical Recommendations. J Int Neuropsychol Soc 2023; 29:205-229. [PMID: 35249578 DOI: 10.1017/s1355617722000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Despite the importance of social cognitive functions to mental health and social adjustment, examination of these functions is absent in routine assessment of epilepsy patients. Thus, this review aims to provide a comprehensive overview of the literature on four major aspects of social cognition among temporal and frontal lobe epilepsy, which is a critical step toward designing new interventions. METHOD Papers from 1990 to 2021 were reviewed and examined for inclusion in this study. After the deduplication process, a systematic review and meta-analysis of 44 and 40 articles, respectively, involving 113 people with frontal lobe epilepsy and 1482 people with temporal lobe epilepsy were conducted. RESULTS Our results indicated that while patients with frontal or temporal lobe epilepsy have difficulties in all aspects of social cognition relative to nonclinical controls, the effect sizes were larger for theory of mind (g = .95), than for emotion recognition (g = .69) among temporal lobe epilepsy group. The frontal lobe epilepsy group exhibited significantly greater impairment in emotion recognition compared to temporal lobe. Additionally, people with right temporal lobe epilepsy (g = 1.10) performed more poorly than those with a left-sided (g = .90) seizure focus, specifically in the theory of mind domain. CONCLUSIONS These data point to a potentially important difference in the severity of deficits within the emotion recognition and theory of mind abilities depending on the laterlization of seizure side. We also suggest a guide for the assessment of impairments in social cognition that can be integrated into multidisciplinary clinical evaluation for people with epilepsy.
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Eicher M, Jokeit H. Toward social neuropsychology of epilepsy: a meta-analysis on social cognition in epilepsy phenotypes and a critical narrative review on assessment methods. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00093-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this review is to (a) characterize social cognition impairments in the domains of emotion recognition (ER) and theory of mind (ToM) in patients with epilepsy and (b) to review assessment tools with a focus on their validity and usability in clinical practice.
Methods
An electronic search for clinical studies investigating social cognition in epilepsy populations vs healthy control subjects (HC) yielded 53 studies for the meta-analysis and descriptive review.
Results
Results suggest that (1) social cognition is significantly impaired in patients with temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE) and patients with epilepsy not originating within the temporal or frontal lobes including idiopathic generalized epilepsies (eTLE/eFLE); (2) there is no significant difference between eTLE/eFLE and TLE regarding ER, while TLE and FLE patients perform worse than those with eTLE/eFLE, without significant differences between FLE and TLE regarding ToM ability. A descriptive analysis of the most commonly used assessment tools and stimulus material in this field revealed a lack of ecological validity, usability, and economic viability for everyday clinical practice.
Conclusions
Our meta-analysis shows that patients with epilepsy are at a significantly increased risk of deficits in social cognition. However, the underlying multifactorial mechanisms remain unclear. Future research should therefore specifically address the impairment of processing and methodological problems of testing.
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Eye-movement patterns during emotion recognition in focal epilepsy: an exploratory investigation. Seizure 2022; 100:95-102. [DOI: 10.1016/j.seizure.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
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Sun Y, Xu Y, Lv J, Liu Y. Self- and Situation-Focused Reappraisal are not homogeneous: Evidence from behavioral and brain networks. Neuropsychologia 2022; 173:108282. [PMID: 35660514 DOI: 10.1016/j.neuropsychologia.2022.108282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022]
Abstract
Reappraisal is an effective emotion regulation strategy which can be divided into self- and situation-focused subtypes. Previous studies have produced inconsistent findings on the moderating effects and neural mechanisms of reappraisal; thus, further research is necessary to clarify these inconsistencies. In this study, a total of 44 participants were recruited and randomly assigned to two groups. 23 participants were assigned to the self-focused group, while 21 participants were assigned to the situation-focused group. The participants' resting EEG data were collected for 6 minutes before the experiment began, followed by an emotional regulation task. During this task, participants were asked to view emotion-provoking images under four emotion regulation conditions (View, Watch, Increase, and Decrease). Late positive potential (LPP) was obtained when these emotional images were observed. LPP is an effective physiological indicator of emotion regulation, enabling this study to explore emotion regulation under different reappraisal strategies, as well as the functional connectivity and node efficiency within the brain. It was found that, in terms of the effect on emotion regulation, situation-focused reappraisal was significantly better than self-focused reappraisal at enhancing the valence of negative emotion, while self-focused reappraisal was significantly better than situation-focused reappraisal at increasing the arousal of negative emotion. In terms of neural mechanisms, multiple brain regions such as the anterior cingulate cortex, the frontal lobe, the parahippocampal gyrus, parts of the temporal lobe, and parts of the parietal lobe were involved in both reappraisal processes. In addition, there were some differences in brain regions associated with different forms of cognitive reappraisal. Self-focused reappraisal was associated with the posterior cingulate gyrus, fusiform gyrus, and lingual gyrus, and situation-focused reappraisal was associated with the parietal lobule, anterior central gyrus, and angular gyrus. In conclusion, this research demonstrates that self- and situation-focused reappraisal are not homogenous in terms of their effects and neural mechanisms and clarifies the uncertainties over their regulatory effects. Different types of reappraisal activate different brain regions when used, and the functional connectivity or node efficiency of these brain regions seems to be a suitable indicator for assessing the effects of different types of reappraisal.
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Affiliation(s)
- Yan Sun
- School of Psychology, Liaoning Normal University, Dalian, 116029, China
| | - Yuanyuan Xu
- School of Psychology, Liaoning Normal University, Dalian, 116029, China
| | - Jiaojiao Lv
- School of Psychology, Liaoning Normal University, Dalian, 116029, China; Department of Psychology, Shanxi Datong University, Datong, 037009, China
| | - Yan Liu
- School of Psychology, Liaoning Normal University, Dalian, 116029, China.
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Rainer LJ, Kronbichler M, Kuchukhidze G, Trinka E, Langthaler PB, Kronbichler L, Said-Yuerekli S, Kirschner M, Zimmermann G, Höfler J, Schmid E, Braun M. Emotional Word Processing in Patients With Juvenile Myoclonic Epilepsy. Front Neurol 2022; 13:875950. [PMID: 35720080 PMCID: PMC9201996 DOI: 10.3389/fneur.2022.875950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective According to Panksepp's hierarchical emotion model, emotion processing relies on three functionally and neuroanatomically distinct levels. These levels comprise subcortical networks (primary level), the limbic system (secondary level), and the neocortex (tertiary level) and are suggested to serve differential emotional processing. We aimed to validate and extend previous evidence of discrete and dimensional emotion processing in patient with juvenile myoclonic epilepsy (JME). Methods We recorded brain activity of patients with JME and healthy controls in response to lexical decisions to words reflecting the discrete emotion fear and the affective dimension negativity previously suggested to rely on different brain regions and to reflect different levels of processing. In all study participants, we tested verbal cognitive functions, as well as the relationship of psychiatric conditions, seizure types and duration of epilepsy and emotional word processing. Results In support of the hierarchical emotion model, we found an interaction of discrete emotion and affective dimensional processing in the right amygdala likely to reflect secondary level processing. Brain activity related to affective dimensional processing was found in the right inferior frontal gyrus and is suggested to reflect tertiary level processing. Psychiatric conditions, type of seizure nor mono- vs. polytherapy and duration of epilepsy within patients did not have any effect on the processing of emotional words. In addition, no differences in brain activity or response times between patients and controls were observed, despite neuropsychological testing revealed slightly decreased verbal intelligence, verbal fluency and reading speed in patients with JME. Significance These results were interpreted to be in line with the hierarchical emotion model and to highlight the amygdala's role in processing biologically relevant stimuli, as well as to suggest a semantic foundation of affective dimensional processing in prefrontal cortex. A lack of differences in brain activity of patients with JME and healthy controls in response to the emotional content of words could point to unaffected implicit emotion processing in patients with JME.
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Affiliation(s)
- Lucas Johannes Rainer
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT–University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Karl-Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Patrick Benjamin Langthaler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Mathematics, Paris-Lodron University, Naturwissenschaftliche Fakultaet, Salzburg, Austria
| | - Lisa Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yuerekli
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Mario Braun
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
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Szaflarski JP, Allendorfer JB, Goodman AM, Byington CG, Philip NS, Correia S, LaFrance WC. Diagnostic delay in functional seizures is associated with abnormal processing of facial emotions. Epilepsy Behav 2022; 131:108712. [PMID: 35526462 DOI: 10.1016/j.yebeh.2022.108712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In patients with functional seizures (FS), delay in diagnosis (DD) may negatively affect outcomes. Altered brain responses to emotional stimuli have been shown in adults with FS. We hypothesized that DD would be associated with differential fMRI activation in emotion processing circuits. METHODS Fifty-two adults (38 females) with video-EEG confirmed FS prospectively completed assessments related to symptoms of depression (BDI-II), anxiety (BAI), post-traumatic stress disorder (PCL-S), a measure of how their symptoms affect day-to-day life (GAF), and fMRI at 3T with emotional faces task (EFT). During fMRI, subjects indicated "male" or "female" via button press while implicitly processing happy, sad, fearful, and neutral faces. Functional magnetic resonance imaging (FMRI) response to each emotion was modeled and group analyses were performed in AFNI within pre-specified regions-of-interest involved in emotion processing. A median split (507 days) defined short- (s-DD) and long-delay diagnosis (l-DD) groups. Voxelwise regression analyses were also performed to examine linear relationship between DD and emotion processing. FMRI signal was extracted from clusters showing group differences and Spearman's correlations assessed relationships with symptom scores. RESULTS Groups did not differ in FS age of onset, sex distribution, years of education, TBI characteristics, EFT in-scanner or post-test performance, or scores on the GAF, BDI-II, BAI, and PCL-S measures. The s-DD group was younger than l-DD (mean age 32.6 vs. 40.1; p = 0.022) at the time of study participation. After correcting for age, compared to s-DD, the l-DD group showed greater fMRI activation to sad faces in the bilateral posterior cingulate cortex (PCC) and to neutral faces in the right anterior insula. Within-group linear regression revealed that with increasing DD, there was increased fMRI activation to sad faces in the PCC and to happy faces in the right anterior insula/inferior frontal gyrus (AI/IFG). There were positive correlations between PCC response to sad faces and BDI-II scores in the l-DD group (rho = 0.48, p = 0.012) and the combined sample (rho = 0.30, p = 0.029). Increased PCC activation to sad faces in those in the l-DD group was associated with worse symptoms of depression (i.e. higher BDI-II score). CONCLUSIONS Delay in FS diagnosis is associated with fMRI changes in PCC and AI/IFG. As part of the default mode network, PCC is implicated in mood control, self-referencing, and other emotion-relevant processes. In our study, PCC changes are linked to depression. Future studies should assess the effects of interventions on these abnormalities.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Caroline G Byington
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephen Correia
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
| | - W Curt LaFrance
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Morningstar M, Grannis C, Mattson WI, Nelson EE. Functional patterns of neural activation during vocal emotion recognition in youth with and without refractory epilepsy. Neuroimage Clin 2022; 34:102966. [PMID: 35182929 PMCID: PMC8859003 DOI: 10.1016/j.nicl.2022.102966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/12/2022] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
Epilepsy has been associated with deficits in the social cognitive ability to decode others' nonverbal cues to infer their emotional intent (emotion recognition). Studies have begun to identify potential neural correlates of these deficits, but have focused primarily on one type of nonverbal cue (facial expressions) to the detriment of other crucial social signals that inform the tenor of social interactions (e.g., tone of voice). Less is known about how individuals with epilepsy process these forms of social stimuli, with a particular gap in knowledge about representation of vocal cues in the developing brain. The current study compared vocal emotion recognition skills and functional patterns of neural activation to emotional voices in youth with and without refractory focal epilepsy. We made novel use of inter-subject pattern analysis to determine brain areas in which activation to emotional voices was predictive of epilepsy status. Results indicated that youth with epilepsy were comparatively less able to infer emotional intent in vocal expressions than their typically developing peers. Activation to vocal emotional expressions in regions of the mentalizing and/or default mode network (e.g., right temporo-parietal junction, right hippocampus, right medial prefrontal cortex, among others) differentiated youth with and without epilepsy. These results are consistent with emerging evidence that pediatric epilepsy is associated with altered function in neural networks subserving social cognitive abilities. Our results contribute to ongoing efforts to understand the neural markers of social cognitive deficits in pediatric epilepsy, in order to better tailor and funnel interventions to this group of youth at risk for poor social outcomes.
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Affiliation(s)
- M Morningstar
- Department of Psychology, Queen's University, Kingston, ON, Canada; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - C Grannis
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - W I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - E E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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Qi L, Zhao J, Zhao P, Zhang H, Zhong J, Pan P, Wang G, Yi Z, Xie L. Theory of mind and facial emotion recognition in adults with temporal lobe epilepsy: A meta-analysis. Front Psychiatry 2022; 13:976439. [PMID: 36276336 PMCID: PMC9582667 DOI: 10.3389/fpsyt.2022.976439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Mounting studies have investigated impairments in social cognitive domains (including theory of mind [ToM] and facial emotion recognition [FER] in adult patients with temporal lobe epilepsy (TLE). However, to date, inconsistent findings remain. METHODS A search of PubMed, Web of Science, and Embase databases was conducted until December 2021. Hedges g effect sizes were computed with a random-effects model. Meta-regressions were used to assess the potential confounding factors of between-study variability in effect sizes. RESULTS The meta-analysis included 41 studies, with a combined sample of 1,749 adult patients with TLE and 1,324 healthy controls (HCs). Relative to HCs, adult patients with TLE showed large impairments in ToM (g = -0.92) and cognitive ToM (g = -0.92), followed by medium impairments in affective ToM (g = -0.79) and FER (g = -0.77). Besides, no (statistically) significant differences were observed between the magnitude of social cognition impairment in adult with TLE who underwent and those who did not undergo epilepsy surgery. Meta-regressions exhibited that greater severity of executive functioning was associated with more severe ToM defects, and older age was associated with more severe FER defects. CONCLUSIONS Results of this meta-analysis suggest that adult patients with TLE show differential impairments in the core aspects of social cognitive domains (including ToM and FER), which may help in planning individualized treatment with appropriate cognitive and behavioral interventions.
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Affiliation(s)
- Liang Qi
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, The Second People's Hospital of Huai'an, Huaian, China
| | - Jing Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - PanWen Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - Hui Zhang
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China.,Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - GenDi Wang
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - ZhongQuan Yi
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - LiLi Xie
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
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Chaves ACS, Reis FJJ, Bandeira PM, Fernandes O, Arruda Sanchez T. Autonomic dysregulation and impairments in the recognition of facial emotional expressions in patients with chronic musculoskeletal pain. Scand J Pain 2021; 21:530-538. [PMID: 33725753 DOI: 10.1515/sjpain-2020-0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Emotions are involved in the identification of safety cues in the environment, and are also related to social interaction through recognition of emotional facial expressions. Heart rate variability (HRV) can be an indicator of the adaptive response of the autonomic nervous system to stressful conditions, including pain. This study aimed to investigate the emotional processing in a sample of patients with chronic musculoskeletal by measuring the resting-state HRV and the ability to recognize facial emotion expressions. METHODS This cross-sectional study was composed of 40 participants with chronic musculoskeletal pain and 40 asymptomatic participants. Resting HRV was measured for 10 min. The facial emotion recognition task was presented in videos and included modification from a neutral expression to faces of fear, anger, sadness, happiness, and disgust. For the facial emotion recognition task, the hit rate (%) and response time for each emotional category were measured. RESULTS The symptomatic group had a mean high frequency (HF) lower (mean = 34.14; SD = 16.95; p<0.001) than the asymptomatic group (mean = 51.11; SD = 13.01; p<0.001). The emotional facial expressions of disgust (H (1, 80)=7.82; p<0.01), anger (H (1, 80)=13.56; p<0.01), sadness (H (1, 80)=6.58; p=0.01), and happiness (H (1, 80)=12.68; p<0.01) were those for which volunteers from the symptomatic group had a lower hit rate of correct answers compared to the asymptomatic group. The response time to corrected answers showed a major group effect (F (1.77)=21.11; p<0.001) and emotional category (F (4.308)=174.21; p<0.001), without presenting any interaction between the factors (F (4.308)=0.446; p=0.775). The symptomatic group was slower to perform the task of identifying facial emotional expression (7.066 s; SD = 1.188) than the participants in the asymptomatic group (6.298 s; SD = 1.203) for all emotional categories. CONCLUSIONS Participants with chronic musculoskeletal pain presented a lower vagal activity evidenced by HRV. Participants in the symptomatic group showed lower ability to recognize faces of disgust, anger, and sadness when compared to asymptomatic participants. Considering that individuals with low resting HF-HRV have difficulties with regulating their emotions, the lower vagal activity and lower ability to recognize faces of emotional expressions observed in chronic musculoskeletal pain may suggest alterations in emotional processing. This study may shed light on changes in the emotional processing and in the autonomic nervous system in this population.
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Affiliation(s)
- Anna C S Chaves
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Felipe J J Reis
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Pamela M Bandeira
- Postgraduate Program in Medicine (Cardiology), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Orlando Fernandes
- Postgraduate Program in Radiology, Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Tiago Arruda Sanchez
- Postgraduate Program in Medicine (Cardiology), Department of Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Abstract
Human neuroimaging has had a major impact on the biological understanding of epilepsy and the relationship between pathophysiology, seizure management, and outcomes. This review highlights notable recent advancements in hardware, sequences, methods, analyses, and applications of human neuroimaging techniques utilized to assess epilepsy. These structural, functional, and metabolic assessments include magnetic resonance imaging (MRI), positron emission tomography (PET), and magnetoencephalography (MEG). Advancements that highlight non-invasive neuroimaging techniques used to study the whole brain are emphasized due to the advantages these provide in clinical and research applications. Thus, topics range across presurgical evaluations, understanding of epilepsy as a network disorder, and the interactions between epilepsy and comorbidities. New techniques and approaches are discussed which are expected to emerge into the mainstream within the next decade and impact our understanding of epilepsies. Further, an increasing breadth of investigations includes the interplay between epilepsy, mental health comorbidities, and aberrant brain networks. In the final section of this review, we focus on neuroimaging studies that assess bidirectional relationships between mental health comorbidities and epilepsy as a model for better understanding of the commonalities between both conditions.
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Affiliation(s)
- Adam M. Goodman
- Department of Neurology, UAB Epilepsy Center, University of Alabama At Birmingham, 312 Civitan International Research Center, Birmingham, AL 35294 USA
| | - Jerzy P. Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama At Birmingham, 312 Civitan International Research Center, Birmingham, AL 35294 USA
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12
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Blunted neural response to emotional faces in the fusiform and superior temporal gyrus may be marker of emotion recognition deficits in pediatric epilepsy. Epilepsy Behav 2020; 112:107432. [PMID: 32919203 PMCID: PMC7895303 DOI: 10.1016/j.yebeh.2020.107432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/17/2020] [Accepted: 08/12/2020] [Indexed: 01/13/2023]
Abstract
Individuals with epilepsy are at risk for social cognition deficits, including impairments in the ability to recognize nonverbal cues of emotion (i.e., emotion recognition [ER] skills). Such deficits are particularly pronounced in adult patients with childhood-onset seizures and are already evident in children and adolescents with epilepsy. Though these impairments have been linked to blunted neural response to emotional information in faces in adult patients, little is known about the neural correlates of ER deficits in youth with epilepsy. The current study compared ER accuracy and neural response to emotional faces during functional magnetic resonance imaging (fMRI) in youth with intractable focal epilepsy and typically developing youth. Relative to typically developing participants, individuals with epilepsy showed a) reduced accuracy in the ER task and b) blunted response to emotional faces (vs. neutral faces) in the bilateral fusiform gyri and right superior temporal gyrus (STG). Activation in these regions was correlated with performance, suggesting that aberrant response within these face-responsive regions may play a functional role in ER impairments. Reduced engagement of neural circuits relevant to processing socioemotional cues may be markers of risk for social cognitive deficits in youth with focal epilepsy.
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13
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Mirabel H, Guinet V, Voltzenlogel V, Pradier S, Hennion S. Social cognition in epilepsy: State of the art and perspectives. Rev Neurol (Paris) 2020; 176:468-479. [PMID: 32418700 DOI: 10.1016/j.neurol.2020.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The neuropsychology of epilepsy has been a major area of study for almost a century and cognitive impairments are an integral part of the new definition of epilepsy. Among such impairments, social cognition (SC) dysfunctions are of relatively recent interest. SC abilities refer to the body of knowledge and processes involved in establishing satisfying and appropriate social interactions. In particular, they allow the recognition of emotions in others, emotional experiences which are suitably adapted to social situations, and the ability to infer mental states in oneself and others. METHODS An overeview was conducted of the available data within the literature, with the objective of presenting the SC disorders associated with certain types of epilepsy and the possible risk factors already explored i.e., localisation of epileptic focus, age of onset/duration of the disease, and effects of treatments including surgery. Studies investigating the potential repercussions of these disorders on patients' daily life have also been included. RESULTS Social cognition disorders are an integral part of the cognitive disorders traditionally described in epilepsy. Indeed, a growing number of studies highlight the increased prevalence of SC disorders in various domains, and some patients appear to be more at risk than others. These disorders could be a major determining factor in the deterioration of patients' quality of life (QOL), particularly patients' support and social integration. This highlights the importance of assessing and managing these disorders in patients with epilepsy (PWE). Perspectives in the field of research and clinical practice are also evoked, such as exploring the links between disruptions in SC abilities and treatments, or developing specific tools for assessment and rehabilitation within the context of epilepsy.
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Affiliation(s)
- H Mirabel
- Neurology department, CHU de Toulouse, hôpital Pierre-Paul Riquet, Toulouse, France.
| | - V Guinet
- Department of functional neurology and epileptology, hospices civils de Lyon, Lyon, France
| | - V Voltzenlogel
- CERPPS, EA 7411, department of psychology, university of Toulouse, Toulouse, France
| | - S Pradier
- Functional explorations of the nervous system, clinical neurosciences center, university hospital center Pellegrin, Bordeaux, France
| | - S Hennion
- U1171 degenerative and vascular cognitive disorders, Inserm, epilepsy unit, reference center rare epilepsies, CHU Lille, university Lille, Lille, France
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14
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Espay AJ, Ries S, Maloney T, Vannest J, Neefus E, Dwivedi AK, Allendorfer JB, Wulsin LR, LaFrance WC, Lang AE, Szaflarski JP. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology 2019; 93:e1787-e1798. [PMID: 31586023 DOI: 10.1212/wnl.0000000000008442] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/19/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To evaluate changes in tremor severity and motor/emotion-processing circuits in response to cognitive behavioral therapy (CBT) delivered as treatment for functional tremor (FT), the most common functional movement disorder in adults. METHODS Fifteen patients with FT underwent fMRI with motor, basic-emotion, and intense-emotion tasks before and after 12 weeks of CBT. Baseline fMRI was compared to those of 25 healthy controls (HCs). The main clinical endpoint was the tremor score (sum of severity, duration, and incapacitation subscores) adapted from the Rating Scale for Psychogenic Movement Disorders (PMDRS) assessed by a blinded clinician. CBT responders were defined as those with PMDRS score reduction >75%. Anatomic and functional brain images were obtained with a 4T MRI system. Generalized linear model and region-of-interest analyses were used to evaluate before-versus-after treatment-related changes in brain activation. RESULTS CBT markedly reduced tremor severity (p < 0.01) with remission/near remission achieved in 73.3% of the cohort. Compared to HCs, in those with FT, a functionally defined fMRI region of interest in the anterior cingulate/paracingulate cortex showed increased activation at baseline and decreased activation after CBT during basic-emotion processing (p = 0.012 for CBT responders). Among CBT responders, the change in anterior cingulate/paracingulate was more significant in those with more severe baseline depression (r = 0.75, p < 0.01). CONCLUSIONS Tremor severity improved significantly after CBT. The improvement was associated with changes in the anterior cingulate/paracingulate activity, which may represent a marker of emotional dysregulation in FT and a predictor of treatment response. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that CBT significantly improves tremor severity in patients with functional tremor.
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Affiliation(s)
- Alberto J Espay
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada.
| | - Scott Ries
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Thomas Maloney
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Jennifer Vannest
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Erin Neefus
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Alok K Dwivedi
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Jane B Allendorfer
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Lawson R Wulsin
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - W Curt LaFrance
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Anthony E Lang
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Jerzy P Szaflarski
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
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15
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Ives-Deliperi VL, Jokeit H. Impaired Social Cognition in Epilepsy: A Review of What We Have Learnt From Neuroimaging Studies. Front Neurol 2019; 10:940. [PMID: 31572284 PMCID: PMC6752178 DOI: 10.3389/fneur.2019.00940] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Social cognition refers to specific mental processes that subserve social interaction. Impaired social cognition has been increasingly reported in patients with epilepsy and negatively affects overall quality of life (QOL). In this article, we will review neuroimaging studies of social cognition in people with epilepsy. Methods: An electronic search of the literature was conducted and 14 studies qualified for inclusion in the review. Results: Although the studies reviewed revealed a varied pattern of neural activations in response to emotion recognition and theory of mind tasks, consensual findings included altered pattern of signal activation in the social cognition network in patients with mesial temporal lobe epilepsy (MTLE) compared to healthy controls and significantly reduced signal activations and functional connectivity within this network in patients with right mesial temporal lobe pathology. Conclusion: This review contextualizes our current understanding of the pathophysiology of impaired social cognition in epilepsy and makes recommendations for further research.
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Affiliation(s)
| | - Hennric Jokeit
- Department of Neuropsychology, Swiss Epilepsy Centre, Zurich, Switzerland
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16
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Goodman AM, Allendorfer JB, Heyse H, Szaflarski BA, Eliassen JC, Nelson EB, Storrs JM, Szaflarski JP. Neural response to stress and perceived stress differ in patients with left temporal lobe epilepsy. Hum Brain Mapp 2019; 40:3415-3430. [PMID: 31033120 DOI: 10.1002/hbm.24606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/21/2019] [Accepted: 04/14/2019] [Indexed: 01/28/2023] Open
Abstract
Patients with epilepsy are often able to predict seizure occurrence subsequent to an acute stress experience. However, neuroimaging investigations into the neural basis of this relationship or the potential influence of perceived life stress are limited. The current study assessed the relationship between perceived stress and the neurobehavioral response to stress in patients with left temporal lobe epilepsy (LTLE) and healthy controls (HCs) using heart rate, salivary cortisol level, and functional magnetic resonance imaging and compared these effects between HCs and LTLE. Matched on perceived stress levels, groups of 36 patients with LTLE and 36 HCs completed the Montreal Imaging Stress Task, with control and stress math task conditions. Among LTLEs, 27 reported that prior (acute) stress affected their seizures (LTLES+), while nine did not (LTLES-). The results revealed that increased perceived stress was associated with seizure frequency in LTLE. Further, cortisol secretion was greater in LTLE, but did not vary with perceived stress as observed in HCs. A linear mixed-effects analysis revealed that as perceived stress increased, activation in the hippocampal complex (parahippocampal gyrus and hippocampus) decreased during stressful math in the LTLES+, increased in HCs, but did not vary in the LTLES-. Task-based functional connectivity analyses revealed LTLE differences in hippocampal functional connectivity with sensory cortex specific to stressor modalities. We argue that the current study demonstrates an inhibitory hippocampal mechanism underlying differences in resilience to stress between HCs and LTLE, as well as LTLE patients who report stress as a precipitant of seizures.
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Affiliation(s)
- Adam M Goodman
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Heidi Heyse
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Basia A Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - James C Eliassen
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Erik B Nelson
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Judd M Storrs
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
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17
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Szaflarski JP, Allendorfer JB, Nenert R, LaFrance WC, Barkan HI, DeWolfe J, Pati S, Thomas AE, Ver Hoef L. Facial emotion processing in patients with seizure disorders. Epilepsy Behav 2018; 79:193-204. [PMID: 29309953 DOI: 10.1016/j.yebeh.2017.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
Abstract
Studies of emotion processing are needed to better understand the pathophysiology of psychogenic nonepileptic seizures (PNES). We examined the differences in facial emotion processing between 12 patients with PNES, 12 patients with temporal lobe epilepsy (TLE), and 24 matched healthy controls (HCs) using fMRI with emotional faces task (EFT) (happy/sad/fearful/neutral) and resting state connectivity. Compared with TLE, patients with PNES exhibited increased fMRI response to happy, neutral, and fearful faces in visual, temporal, and/or parietal regions and decreased fMRI response to sad faces in the putamen bilaterally. Regions showing significant differences between PNES and TLE were used as functional seed regions of interest (ROIs), in addition to amygdala structural seed ROIs for resting state functional connectivity analyses. Whole brain analyses showed that compared with TLE and HCs, patients with PNES exhibited increased functional connectivity of the functional seed ROIs to several brain regions, particularly to cerebellar, visual, motor, and frontotemporal regions. Connectograms showed increased functional connections between left parahippocampal gyrus/uncus ROIs and right temporal ROIs in PNES compared with both the TLE and HC groups. Resting state functional connectivity of the left and right amygdala to various brain regions including emotion regulation and motor control circuits was increased in PNES when compared with those with TLE. This study provides preliminary evidence that patients with PNES exhibit altered facial emotion processing compared with patients with TLE and HCs and increased amygdala functional connectivity compared with TLE. These findings identify potential key differences in facial emotion processing reflective of neurophysiologic markers of neural circuitry alterations that can be used to generate further hypotheses for developing studies that examine the contributions of emotion processing to the development and maintenance of PNES.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Helen I Barkan
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer DeWolfe
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley E Thomas
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence Ver Hoef
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Chen R, Szaflarski JP. Dysfunction in emotion processing underlies functional (psychogenic) dystonia. Mov Disord 2018; 33:136-145. [PMID: 29124784 PMCID: PMC5767134 DOI: 10.1002/mds.27217] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/16/2017] [Accepted: 09/24/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to determine whether abnormalities in emotion processing underlie functional (psychogenic) dystonia, one of the most common functional movement disorders. METHODS Motor and emotion circuits were examined in 12 participants with functional dystonia, 12 with primary organic dystonia, and 25 healthy controls using functional magnetic resonance imaging at 4T and a finger-tapping task (motor task), a basic emotion-recognition task (emotional faces task), and an intense-emotion stimuli task. RESULTS There were no differences in motor task activation between groups. In the faces task, when compared with the other groups, functional dystonia patients showed areas of decreased activation in the right middle temporal gyrus and bilateral precuneus and increased activation in the right inferior frontal gyrus, bilateral occipital cortex and fusiform gyrus, and bilateral cerebellum. In the intense-emotion task, when compared with the other groups, functional dystonia patients showed decreased activation in the left insular and left motor cortices (compared to organic dystonia, they showed an additional decrease in activation in the right opercular cortex and right motor cortex) and increased activation in the left fusiform gyrus. CONCLUSIONS Functional dystonia patients exhibited stimulus-dependent altered activation in networks involved in motor preparation and execution, spatial cognition, and attentional control. These results support the presence of network dysfunction in functional dystonia. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alberto J. Espay
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
- Gardner Family Center for Parkinson’s disease and Movement Disorders, Cincinnati, Ohio
| | | | | | - Matthew M. Norris
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, Ohio
| | - James C. Eliassen
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, Ohio
| | - Erin Neefus
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Chen
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, University Health Network and the, University of Toronto, Toronto, Canada
| | - Jerzy P. Szaflarski
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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19
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Lang AE, Szaflarski JP. Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study. NEUROIMAGE-CLINICAL 2017; 17:179-187. [PMID: 29085776 PMCID: PMC5655406 DOI: 10.1016/j.nicl.2017.10.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/13/2017] [Accepted: 10/18/2017] [Indexed: 02/06/2023]
Abstract
Background Despite its high prevalence and associated disability, the neural correlates of emotion processing in patients with functional (psychogenic) tremor (FT), the most common functional movement disorder, remain poorly understood. Methods In this cross sectional functional magnetic resonance imaging (fMRI) study at 4T, 27 subjects with FT, 16 with essential tremor (ET), and 25 healthy controls (HCs) underwent a finger-tapping motor task, a basic-emotion task, and an intense-emotion task to probe motor and emotion circuitries. Anatomical and functional MRI data were processed with FSL (FMRIB Software Library) and AFNI (Analysis of Functional Neuroimages), followed by seed-to-seed connectivity analyses using anatomical regions defined from the Harvard-Oxford subcortical atlas; all analyses were corrected for multiple comparisons. Results After controlling for depression scores and correcting for multiple comparisons, the FT group showed increased activation in the right cerebellum compared to ET during the motor task; and increased activation in the paracingulate gyrus and left Heschl's gyrus compared with HC with decreased activation in the right precentral gyrus compared with ET during the basic-emotion task. No significant differences were found after adjusting for multiple comparisons during the intense-emotion task but increase in connectivity between the left amygdala and left middle frontal gyrus survived corrections in the FT subjects during this task, compared to HC. Conclusions In response to emotional stimuli, functional tremor is associated with alterations in activation and functional connectivity in networks involved in emotion processing and theory of mind. These findings may be relevant to the pathophysiology of functional movement disorders. Patients with functional tremor exhibit altered emotion processing circuitry. There is increased activation in the paracingulate gyrus after emotional stimuli. Increased connectivity between the left amygdala and middle frontal gyrus Functional disorders may be associated with disturbances in the theory of mind.
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Key Words
- AFNI, Analysis of Functional Neuroimages
- CPT-END, continuous performance task with emotional and neutral distracters
- Conversion disorder
- EPI, echo-planar imaging
- Emotion processing
- FSL, FMRIB Software Library
- FT, functional tremor
- Functional movement disorders
- Functional tremor
- HAM-A, Hamilton Anxiety Rating Scale
- HAM-D, Hamilton Depression Rating Scale
- MDEFT, modified equilibrium Fourier transform
- MINI, Mini International Neuropsychiatric Interview
- Psychogenic tremor
- fMRI
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Matthew M Norris
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - James C Eliassen
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - Erin Neefus
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anthony E Lang
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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20
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Facial emotion perception in patients with epilepsy: A systematic review with meta-analysis. Neurosci Biobehav Rev 2017; 83:212-225. [PMID: 29045812 DOI: 10.1016/j.neubiorev.2017.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 11/21/2022]
Abstract
Facial emotion perception is a fundamental social competency relying on a specialised, yet distributed, neural network. This review aimed to determine whether patients with epilepsy have facial emotion perception accuracy impairments overall, or for a subset of emotions (anger, disgust, happiness, sadness, fear, and surprise), and the relationship to epilepsy type, demographic/treatment variables, and brain organisation. Database searches used PRISMA guidelines with strict inclusion/exclusion criteria. Thirty included studies assessed patients with temporal lobe (TLE; n=709), frontocentral (FCE; n=22), and genetic generalised (GGE; n=48) epilepsy. Large deficits emerged in patients with epilepsy compared to controls (n=746; Hedges' g=0.908-1.076). Patients with TLE were significantly impaired on all emotions except surprise; patients with GGE were significantly impaired in anger, disgust, and fear perception. Meta-regression of patients with TLE revealed younger age at testing was associated with lower accuracy. This review provides evidence for marked global deficits of emotion perception in epilepsy, with differential emotion-specific impairment patterns in patients with TLE and GGE.
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Richard AE, Scheffer IE, Wilson SJ. Features of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder. Neurosci Biobehav Rev 2017; 75:203-233. [DOI: 10.1016/j.neubiorev.2016.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 12/29/2022]
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22
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McKee HR, Privitera MD. Stress as a seizure precipitant: Identification, associated factors, and treatment options. Seizure 2016; 44:21-26. [PMID: 28063791 DOI: 10.1016/j.seizure.2016.12.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022] Open
Abstract
Stress is a common and important seizure precipitant reported by epilepsy patients. Studies to date have used different methodologies to identify relationships between epilepsy and stress. Several studies have identified anxiety, depression, and childhood trauma as being more common in patients with epilepsy who report stress as a seizure precipitant compared to patients with epilepsy who did not identify stress as a seizure precipitant. In one survey study it was found that a majority of patients with stress-triggered seizures had used some type of stress reduction method on their own and, of those who tried this, an even larger majority felt that these methods improved their seizures. Additionally, small to moderate sized prospective trials, including randomized clinical trials, using general stress reduction methods have shown promise in improving outcomes in patients with epilepsy, but results on seizure frequency have been inconsistent. Based on these studies, we recommend that when clinicians encounter patients who report stress as a seizure precipitant, these patients should be screened for a treatable mood disorder. Furthermore, although seizure reduction with stress reduction methods has not been proven in a randomized controlled trial, other important endpoints like quality of life were improved. Therefore, recommending stress reduction methods to patients with epilepsy appears to be a reasonable low risk adjunctive to standard treatments. The current review highlights the need for future research to help further clarify biological mechanisms of the stress-seizure relationship and emphasizes the need for larger randomized controlled trials to help develop evidence based treatment recommendations for our epilepsy patients.
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Affiliation(s)
- Heather R McKee
- Department of Neurology, Epilepsy Division, UC Gardner Neuroscience Institute, University of Cincinnati Medical Center (0525), 260 Stetson St., Suite 2300, Cincinnati, OH 45267-0525, USA.
| | - Michael D Privitera
- Department of Neurology, Epilepsy Division, UC Gardner Neuroscience Institute, University of Cincinnati Medical Center (0525), 260 Stetson St., Suite 2300, Cincinnati, OH 45267-0525, USA.
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23
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Hennion S, Szurhaj W, Duhamel A, Lopes R, Tyvaert L, Derambure P, Delbeuck X. Characterization and prediction of the recognition of emotional faces and emotional bursts in temporal lobe epilepsy. J Clin Exp Neuropsychol 2015; 37:931-45. [DOI: 10.1080/13803395.2015.1068280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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24
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Social Cognition and Epilepsy: Understanding the Neurobiology of Empathy and Emotion. Epilepsy Curr 2015; 15:118-9. [PMID: 26316844 DOI: 10.5698/1535-7597-15.3.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Nenert R, Allendorfer JB, Szaflarski JP. A model for visual memory encoding. PLoS One 2014; 9:e107761. [PMID: 25272154 PMCID: PMC4182671 DOI: 10.1371/journal.pone.0107761] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/23/2014] [Indexed: 12/21/2022] Open
Abstract
Memory encoding engages multiple concurrent and sequential processes. While the individual processes involved in successful encoding have been examined in many studies, a sequence of events and the importance of modules associated with memory encoding has not been established. For this reason, we sought to perform a comprehensive examination of the network for memory encoding using data driven methods and to determine the directionality of the information flow in order to build a viable model of visual memory encoding. Forty healthy controls ages 19-59 performed a visual scene encoding task. FMRI data were preprocessed using SPM8 and then processed using independent component analysis (ICA) with the reliability of the identified components confirmed using ICASSO as implemented in GIFT. The directionality of the information flow was examined using Granger causality analyses (GCA). All participants performed the fMRI task well above the chance level (>90% correct on both active and control conditions) and the post-fMRI testing recall revealed correct memory encoding at 86.33 ± 5.83%. ICA identified involvement of components of five different networks in the process of memory encoding, and the GCA allowed for the directionality of the information flow to be assessed, from visual cortex via ventral stream to the attention network and then to the default mode network (DMN). Two additional networks involved in this process were the cerebellar and the auditory-insular network. This study provides evidence that successful visual memory encoding is dependent on multiple modules that are part of other networks that are only indirectly related to the main process. This model may help to identify the node(s) of the network that are affected by a specific disease processes and explain the presence of memory encoding difficulties in patients in whom focal or global network dysfunction exists.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio, United States of America
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26
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Allendorfer JB, Heyse H, Mendoza L, Nelson EB, Eliassen JC, Storrs JM, Szaflarski JP. Physiologic and cortical response to acute psychosocial stress in left temporal lobe epilepsy - a pilot cross-sectional fMRI study. Epilepsy Behav 2014; 36:115-23. [PMID: 24907497 DOI: 10.1016/j.yebeh.2014.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 11/18/2022]
Abstract
Stress is commonly reported as a seizure precipitant in individuals with poorly controlled seizures including temporal lobe epilepsy. The aim of the study was to assess the neural and physiologic correlates of psychosocial stress response during functional magnetic resonance imaging (fMRI) and their relationship with seizure occurrence in patients with left temporal lobe epilepsy (LTLE). We enrolled 23 patients with LTLE and 23 age- and sex-matched healthy controls (HCs); all underwent fMRI with control math task (CMT) and stress math task (SMT) and pre-/post-fMRI salivary cortisol analysis (acute stress reactivity calculated as % reduction from post-stress to recovery baseline; dCORT). The Beck Depression Inventory-II (BDI-II) and Perceived Stress Scale (PSS-10) were administered. T-tests of performance and cortisol variables were performed. Processing and single-subject modeling of fMRI response to CMT positive feedback and SMT negative feedback, group comparisons, and whole-brain correlation of seizure occurrence and fMRI response in patients with poorly controlled LTLE were performed. Patients with LTLE and healthy controls were similar in demographics, math performance, heart rate, and PSS-10 scores (all p>0.05). Patients with LTLE exhibited greater dCORT (p=0.048) and lower BDI-II scores (p=0.016) compared with HCs. Patients with poorly controlled LTLE showed a positive association between seizure frequency and dCORT (r=0.73, p=0.016). Functional MRI activation to feedback was similar between groups, including midfrontal, temporal, parietal, and occipital regions. Regression analyses revealed no group differences to positive feedback, but, compared with HCs, patients with LTLE showed decreased activation to negative feedback in the left cerebellum/middle occipital/fusiform gyri, left hippocampus/parahippocampus, bilateral medial frontal/cingulate/superior frontal gyri, right postcentral gyrus/inferior parietal lobule, and right insula/postcentral gyrus (p<0.05, corrected). Patients with poorly controlled LTLE showed negative association between seizure frequency and activation in the bilateral subgenual anterior cingulate (p<0.05, corrected). This study is the first to characterize the cortical and physiologic responses to acute psychosocial stress and to show a significant relationship between seizure control in LTLE and both the hypothalamic-pituitary-adrenal axis and fMRI signal reactivity to acute psychosocial stress. These findings extend our understanding of the complex interplay between stress, physiologic stress markers, and seizures/epilepsy.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
| | - Heidi Heyse
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Lucy Mendoza
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Erik B Nelson
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - James C Eliassen
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Judd M Storrs
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, OH, USA; Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA; Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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27
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Allendorfer JB, Szaflarski JP. Contributions of fMRI towards our understanding of the response to psychosocial stress in epilepsy and psychogenic nonepileptic seizures. Epilepsy Behav 2014; 35:19-25. [PMID: 24785430 DOI: 10.1016/j.yebeh.2014.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 11/26/2022]
Abstract
There are multiple definitions of stress. For this review, as a reference point, we will use the concept of acute emotional/psychosocial stress ("stress"). The presence of acute stress has been reported to have a significant effect on seizure control, with several studies showing patients with seizure disorders being able to predict with reasonable accuracy seizure occurrence within the following hours or days. However, neuroimaging investigations of the pathophysiological mechanisms underlying stress reactivity (e.g., hypothalamic-pituitary-adrenal (HPA) axis activation) in humans, in general, and in patients with seizure disorders, in particular, are scarce. The reasons for this are multiple and likely include difficulty with designing appropriate probes that test various aspects of stress response, obtaining approval for studies that induce stress in patients who are prone to having stress-induced seizures, difficulties with assessing the physiological response to stress inside the scanner (e.g., heart rate, respiratory rate, oxygenation, cortisol levels, and galvanic skin responses), participant identification, and choice of epilepsy syndrome for investigation. With the recent explosion of neuroimaging literature focusing on correlating stress of various types and levels with cortical activations in healthy and diseased populations, it is incumbent upon us to examine the available neuroimaging data in patients with seizure disorders in order to identify the existing gaps and the needs/directions for future investigations. This approach is consistent with the goals of several of the 2014 Benchmarks for Epilepsy Research for the National Institute of Neurological Disorders and Stroke and the American Epilepsy Society.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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