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Talami F, Lemieux L, Avanzini P, Ballerini A, Cantalupo G, Laufs H, Meletti S, Vaudano AE. The influence of wakefulness fluctuations on brain networks involved in centrotemporal spike occurrence. Clin Neurophysiol 2024; 164:47-56. [PMID: 38848666 DOI: 10.1016/j.clinph.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/18/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Drowsiness has been implicated in the modulation of centro-temporal spikes (CTS) in Self-limited epilepsy with Centro-Temporal Spikes (SeLECTS). Here, we explore this relationship and whether fluctuations in wakefulness influence the brain networks involved in CTS generation. METHODS Functional MRI (fMRI) and electroencephalography (EEG) was simultaneously acquired in 25 SeLECTS. A multispectral EEG index quantified drowsiness ('EWI': EEG Wakefulness Index). EEG (Pearson Correlation, Cross Correlation, Trend Estimation, Granger Causality) and fMRI (PPI: psychophysiological interactions) analytic approaches were adopted to explore respectively: (a) the relationship between EWI and changes in CTS frequency and (b) the functional connectivity of the networks involved in CTS generation and wakefulness oscillations. EEG analyses were repeated on a sample of routine EEG from the same patient's cohort. RESULTS No correlation was found between EWI fluctuations and CTS density during the EEG-fMRI recordings, while they showed an anticorrelated trend when drowsiness was followed by proper sleep in routine EEG traces. According to PPI findings, EWI fluctuations modulate the connectivity between the brain networks engaged by CTS and the left frontal operculum. CONCLUSIONS While CTS frequency per se seems unrelated to drowsiness, wakefulness oscillations modulate the connectivity between CTS generators and key regions of the language circuitry, a cognitive function often impaired in SeLECTS. SIGNIFICANCE This work advances our understanding of (a) interaction between CTS occurrence and vigilance fluctuations and (b) possible mechanisms responsible for language disruption in SeLECTS.
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Affiliation(s)
- Francesca Talami
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy; Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Louis Lemieux
- Department of Clinical and Experimental and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, United Kingdom
| | - Pietro Avanzini
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
| | - Alice Ballerini
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gaetano Cantalupo
- Innovation Biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy; Child Neuropsychiatry Unit and Center for Research on Epilepsies in Pediatric age (CREP), University Hospital of Verona (full member of the European Reference Network EpiCARE), Verona, Italy
| | - Helmut Laufs
- University Medical Center Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Germany
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurophysiology Unit and Epilepsy Centre, Neuroscience Department, AOU Modena, Italy.
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurophysiology Unit and Epilepsy Centre, Neuroscience Department, AOU Modena, Italy.
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Fu Y, Zhang J, Cao Y, Ye L, Zheng R, Li Q, Shen B, Shi Y, Cao J, Fang J. Recognition memory deficits detected through eye-tracking in well-controlled children with self-limited epilepsy with centrotemporal spikes. Epilepsia 2024; 65:1128-1140. [PMID: 38299621 DOI: 10.1111/epi.17902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Children with self-limited epilepsy characterized by centrotemporal spikes (SeLECTS) exhibit cognitive deficits in memory during the active phase, but there is currently a lack of studies and techniques to assess their memory development after well-controlled seizures. In this study, we employed eye-tracking techniques to investigate visual memory and its association with clinical factors and global intellectual ability, aiming to identify potential risk factors by examining encoding and recognition processes. METHODS A total of 26 recruited patients diagnosed with SeLECTS who had been seizure-free for at least 2 years, along with 24 control subjects, underwent Wechsler cognitive assessment and an eye-movement-based memory task while video-electroencephalographic (EEG) data were recorded. Fixation and pupil data related to eye movements were utilized to detect distinct memory processes and subsequently to compare the cognitive performance of patients exhibiting different regression patterns on EEG. RESULTS The findings revealed persistent impairments in visual memory among children with SeLECTS after being well controlled, primarily observed in the recognition stage rather than the encoding phase. Furthermore, the age at onset, frequency of seizures, and interictal epileptiform discharges exhibited significant correlations with eye movement data. SIGNIFICANCE Children with SeLECTS exhibit persistent recognition memory impairment after being well controlled for the disease. Controlling the frequency of seizures and reducing prolonged epileptiform activity may improve memory cognitive development. The application of the eye-tracking technique may provide novel insights into exploring memory cognition as well as underlying mechanisms associated with pediatric epilepsy.
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Affiliation(s)
- Yanlu Fu
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jingxin Zhang
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yina Cao
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Linmei Ye
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Runze Zheng
- Artificial Intelligence Institute, Hangzhou Dianzi University School of Automation, Hangzhou, Zhejiang, China
| | - Qiwei Li
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Beibei Shen
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yi Shi
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jiuwen Cao
- Artificial Intelligence Institute, Hangzhou Dianzi University School of Automation, Hangzhou, Zhejiang, China
| | - Jiajia Fang
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
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Zinchenko VP, Dolgacheva LP, Tuleukhanov ST. Calcium-permeable AMPA and kainate receptors of GABAergic neurons. Biophys Rev 2024; 16:165-171. [PMID: 38737208 PMCID: PMC11078900 DOI: 10.1007/s12551-024-01184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/16/2024] [Indexed: 05/14/2024] Open
Abstract
This Commentary presents a brief discussion of the action of glutamate calcium permeable receptors present with neurons on the release of the neurotransmitter gamma-aminobutyric acid (GABA). In particular, Glutamate sensitive Kainic Acid Receptors (KARs) and α-Amino-3-hydroxy-5-Methyl-4-isoxazole Propionic Acid Receptor (AMPARs) are Na+ channels that typically cause neuronal cells to depolarize and release GABA. Some of these receptors are also permeable to Ca2+ and are hence involved in the calcium-dependent release of GABA neurotransmitters. Calcium-permeable kainate and AMPA receptors (CP-KARs and CP-AMPARs) are predominantly located in GABAergic neurons in the mature brain and their primary role is to regulate GABA release. AMPARs which do not contain the GluA2 subunit are mainly localized in the postsynaptic membrane. CP-KAR receptors are located mainly in the presynapse. GABAergic neurons expressing CP-KARs and CP-AMPARs respond to excitation earlier and faster, suppressing hyperexcitation of other neurons by the advanced GABA release due to an early rapid [Ca2+]i increase. CP-AMPARs have demonstrated a more pronounced impact on plasticity compared to NMDARs because of their capacity to elevate intracellular Ca2+ levels independently of voltage. GABAergic neurons that express CP-AMPARs contribute to the disinhibition of glutamatergic neurons by suppressing GABAergic neurons that express CP-KARs. Hence, the presence of glutamate CP-KARs and CP-AMPARs is crucial in governing hyperexcitation and synaptic plasticity in GABAergic neurons.
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Affiliation(s)
- V. P. Zinchenko
- Federal Research Center “Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences”, Institute of Cell Biophysics of the Russian Academy of Sciences, Institutskaya 3, Pushchino, Russia 142290
| | - L. P. Dolgacheva
- Federal Research Center “Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences”, Institute of Cell Biophysics of the Russian Academy of Sciences, Institutskaya 3, Pushchino, Russia 142290
| | - S. T. Tuleukhanov
- Al-Farabi Kazakh National University, 050040 Al-Farabi Avenue 71, Almaty, Republic of Kazakhstan
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Neumann H, Daseking M, Thiels C, Köhler C, Lücke T. Cognitive development in children with new-onset Rolandic epilepsy and Rolandic discharges without seizures: Focusing on intelligence, visual perception, working memory and the role of parents' education. Epilepsy Behav 2024; 152:109596. [PMID: 38350362 DOI: 10.1016/j.yebeh.2023.109596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE Our aim was to assess intelligence, visual perception and working memory in children with new-onset Rolandic epilepsy (RE) and children with Rolandic discharges without seizures (RD). METHODS The participants in the study were 12 children with RE and 26 children with RD aged 4 to 10 years (all without medication and shortly after diagnosis) and 31 healthy controls. Their cognitive performance was assessed using the German versions of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), the Wechsler Intelligence Scale for Children (WISC-IV), the Developmental Test of Visual Perception-2 (DTVP-2), the Developmental Test of Visual Perception-Adolescent and Adult (DTVP-A) (each according to age) and the Word Order, Hand Movements and Spatial Memory subtests of the German version of the Kaufman Assessment Battery for Children (K-ABC). RESULTS The comparison of the entire group of children with RE/RD and the control group conducted in the first step of our analysis revealed a weaker performance of the children with RE/RD in all cognitive domains. Significant deficits, however, were found exclusively in the RD group. Compared to the controls, they performed significantly weaker regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.002; processing speed: p = 0.005), visual perception (general visual perception: p = 0.005; visual-motor integration: p = 0.002) and working memory (WISC working memory: p = 0.002 and K-ABC Word Order (p = 0.010) and Hand Movements (p = 0.001) subtests. Also, the children without seizures scored significantly lower than those with seizures on the WISC Working Memory Index (p = 0.010) and on the K-ABC Word Order (p = 0.021) and Hand Movements (p = 0.027) subtests. Further analysis of our data demonstrated the particular importance of the family context for child development. Significant cognitive deficits were found only in children with RD from parents with lower educational levels. This group consistently scored lower compared to the control group regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.012; processing speed: p = 0.034), visual perception (general visual perception: p = 0.018; visual-motor integration: p = 0.010) and auditory working memory (WISC working memory: p = 0.014). Furthermore, compared to the children with RE, they performed significantly weaker on verbal IQ (p = 0.020), auditory working memory consistently (WISC working memory: p = 0.027; K-ABC: Word Order: p = 0.046) as well as in one of the K-ABC spatial working memory subtests (Hand Movements: p = 0.029). Although we did not find significant deficits in children with new-onset RE compared to healthy controls, the performance of this group tended to be weaker more often. No statistically significant associations were observed between selected clinical markers (focus types: centrotemporal/other foci/laterality of foci and spread of Rolandic discharges) and cognitive test results. Except for spatial working memory, we also found no evidence that the age of our patients at the time of study participation was of significant importance to their cognitive performance. CONCLUSIONS Our study provides some evidence that children with Rolandic discharges, with and without seizures, may be at higher risk of cognitive impairment. In addition to medical care, we emphasise early differentiated psychosocial diagnostics to provide these children and their families with targeted support if developmental problems are present.
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Affiliation(s)
- Helmut Neumann
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany.
| | - Monika Daseking
- Department of Educational Psychology, Helmut Schmidt University/University of the Armed Forces Hamburg, Hamburg, Germany
| | - Charlotte Thiels
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Cornelia Köhler
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
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Dontaine P, Rouge C, Urbain C, Galer S, Raffoul R, Nonclercq A, Van Dyck D, Baijot S, Aeby A. How the Spreading and Intensity of Interictal Epileptic Activity Are Associated with Visuo-Spatial Skills in Children with Self-Limited Focal Epilepsy with Centro-Temporal Spikes. Brain Sci 2023; 13:1566. [PMID: 38002525 PMCID: PMC10669985 DOI: 10.3390/brainsci13111566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This paper investigates brain-behaviour associations between interictal epileptic discharges and cognitive performance in a population of children with self-limited focal epilepsy with centro-temporal spikes (SeLECTS). Sixteen patients with SeLECTS underwent an extensive neuropsychological assessment, including verbal short-term and episodic memory, non-verbal short-term memory, attentional abilities and executive function. Two quantitative EEG indices were analysed, i.e., the Spike Wave Index (SWI) and the Spike Wave Frequency (SWF), and one qualitative EEG index, i.e., the EEG score, was used to evaluate the spreading of focal SW to other parts of the brain. We investigated associations between EEG indices and neuropsychological performance with non-parametric Spearman correlation analyses, including correction for multiple comparisons. The results showed a significant negative correlation between (i) the awake EEG score and the Block Tapping Test, a visuo-spatial short-term memory task, and (ii) the sleep SWI and the Tower of London, a visuo-spatial planning task (pcorr < 0.05). These findings suggest that, in addition to the usual quantitative EEG indices, the EEG analysis should include the qualitative EEG score evaluating the spreading of focal SW to other parts of the brain and that neuropsychological assessment should include visuo-spatial skills.
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Affiliation(s)
- Pauline Dontaine
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Coralie Rouge
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Charline Urbain
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Sophie Galer
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Romain Raffoul
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Antoine Nonclercq
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Dorine Van Dyck
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Simon Baijot
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Alec Aeby
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
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Steinruecke M, Gillespie C, Ahmed N, Bandyopadhyay S, Duklas D, Ghahfarokhi MH, Henshall DE, Khan M, de Koning R, Madden J, Marston JSN, Mohamed RAA, Nischal SA, Norton EJ, Parameswaran G, Vasilica AM, Wei JOY, Williams CE, Williams F, Agrawal S, Grigoratos DN, Israni A, Kumar R, McCrea N, Patel J, Petropoulos MC, Singh J. Care and three-year outcomes of children with Benign Epilepsy with Centro-Temporal Spikes in England. Epilepsy Behav 2023; 148:109465. [PMID: 37844441 DOI: 10.1016/j.yebeh.2023.109465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Benign Epilepsy with Centro-Temporal Spikes (BECTS) is a pediatric epilepsy with typically good seizure control. Although BECTS may increase patients' risk of developing neurological comorbidities, their clinical care and short-term outcomes are poorly quantified. METHODS We retrospectively assessed adherence to National Institute for Health and Care Excellence (NICE) guidelines relating to specialist referral, electroencephalogram (EEG) conduct and annual review in the care of patients with BECTS, and measured their seizure, neurodevelopmental and learning outcomes at three years post-diagnosis. RESULTS Across ten centers in England, we identified 124 patients (74 male) diagnosed with BECTS between 2015 and 2017. Patients had a mean age at diagnosis of 8.0 (95% CI = 7.6-8.4) years. 24/95 (25%) patients were seen by a specialist within two weeks of presentation; 59/100 (59%) received an EEG within two weeks of request; and 59/114 (52%) were reviewed annually. At three years post-diagnosis, 32/114 (28%) experienced ongoing seizures; 26/114 (23%) had reported poor school progress; 15/114 (13%) were diagnosed with a neurodevelopmental disorder (six autism spectrum disorder, six attention-deficit/hyperactivity disorder); and 10/114 (8.8%) were diagnosed with a learning difficulty (three processing deficit, three dyslexia). Center-level random effects models estimated neurodevelopmental diagnoses in 9% (95% CI: 2-16%) of patients and learning difficulty diagnoses in 7% (95% CI: 2-12%). CONCLUSIONS In this multicenter work, we found variable adherence to NICE guidelines in the care of patients with BECTS and identified a notable level of neurological comorbidity. Patients with BECTS may benefit from enhanced cognitive and behavioral assessment and monitoring.
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Affiliation(s)
- Moritz Steinruecke
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, UK; University of Cambridge School of Clinical Medicine, UK.
| | - Conor Gillespie
- School of Medicine, University of Liverpool, UK; Department of Clinical Neurosciences, University of Cambridge, UK
| | - Najma Ahmed
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Soham Bandyopadhyay
- Clinical Neurosciences, School of Clinical and Experimental Sciences, University of Southampton, UK; Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, UK; Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, UK
| | | | | | - David E Henshall
- Deanery of Clinical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, UK
| | - Mehdi Khan
- UCL Medical School, Faculty of Medical Sciences, University College London, UK
| | | | - James Madden
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | | | | | | | - Emma Jane Norton
- University Division of Anaesthesia, University of Cambridge, UK; Faculty of Medicine, University of Southampton, UK
| | | | | | - John Ong Ying Wei
- College of Medical and Dental Sciences, University of Birmingham, UK
| | - Chloe Ec Williams
- School of Medicine, University of Liverpool, UK; Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, UK
| | | | - Shakti Agrawal
- Paediatric Neurology, Birmingham Women's and Children's NHS Foundation Trust, UK
| | | | - Anil Israni
- Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, UK; Faculty of Medicine, Parul University, India
| | - Ram Kumar
- Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, UK
| | - Nadine McCrea
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jayesh Patel
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Maria-Christina Petropoulos
- UCL Medical School, Faculty of Medical Sciences, University College London, UK; University College Hospital, University College London Hospitals NHS Foundation Trust, UK
| | - Jaspal Singh
- University Hospital Southampton NHS Foundation Trust, UK
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Yin Y, Wang F, Ma Y, Yang J, Li R, Li Y, Wang J, Liu H. Structural and functional changes in drug-naïve benign childhood epilepsy with centrotemporal spikes and their associated gene expression profiles. Cereb Cortex 2023; 33:5774-5782. [PMID: 36444721 PMCID: PMC10183734 DOI: 10.1093/cercor/bhac458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/30/2022] Open
Abstract
Benign epilepsy with centrotemporal spikes (BECTS) is a common pediatric epilepsy syndrome that has been widely reported to show abnormal brain structure and function. However, the genetic mechanisms underlying structural and functional changes remain largely unknown. Based on the structural and resting-state functional magnetic resonance imaging data of 22 drug-naïve children with BECTS and 33 healthy controls, we conducted voxel-based morphology (VBM) and fractional amplitude of low-frequency fluctuation (fALFF) analyses to compare cortical morphology and spontaneous brain activity between the 2 groups. In combination with the Allen Human Brain Atlas, transcriptome-neuroimaging spatial correlation analyses were applied to explore gene expression profiles associated with gray matter volume (GMV) and fALFF changes in BECTS. VBM analysis demonstrated significantly increased GMV in the right brainstem and right middle cingulate gyrus in BECTS. Moreover, children with BECTS exhibited significantly increased fALFF in left temporal pole, while decreased fALFF in right thalamus and left precuneus. These brain structural and functional alterations were closely related to behavioral and cognitive deficits, and the fALFF-linked gene expression profiles were enriched in voltage-gated ion channel and synaptic activity as well as neuron projection. Our findings suggest that brain morphological and functional abnormalities in children with BECTS involve complex polygenic genetic mechanisms.
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Affiliation(s)
- Yu Yin
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563003, China
| | - Fuqin Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563003, China
| | - Yingzi Ma
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, China
- Yunnan Key Laboratory of Primate Biomedical Research, Kunming 650500, Yunnan, China
| | - Jia Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, China
- Yunnan Key Laboratory of Primate Biomedical Research, Kunming 650500, Yunnan, China
| | - Rui Li
- School of Electrical Engineering and Electronic Information, Xihua University, Chengdu 610039, China
| | - Yuanyuan Li
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 625014, China
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, China
- Yunnan Key Laboratory of Primate Biomedical Research, Kunming 650500, Yunnan, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563003, China
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Specchio N, Wirrell EC, Scheffer IE, Nabbout R, Riney K, Samia P, Guerreiro M, Gwer S, Zuberi SM, Wilmshurst JM, Yozawitz E, Pressler R, Hirsch E, Wiebe S, Cross HJ, Perucca E, Moshé SL, Tinuper P, Auvin S. International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: Position paper by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1398-1442. [PMID: 35503717 DOI: 10.1111/epi.17241] [Citation(s) in RCA: 270] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
The 2017 International League Against Epilepsy classification has defined a three-tier system with epilepsy syndrome identification at the third level. Although a syndrome cannot be determined in all children with epilepsy, identification of a specific syndrome provides guidance on management and prognosis. In this paper, we describe the childhood onset epilepsy syndromes, most of which have both mandatory seizure type(s) and interictal electroencephalographic (EEG) features. Based on the 2017 Classification of Seizures and Epilepsies, some syndrome names have been updated using terms directly describing the seizure semiology. Epilepsy syndromes beginning in childhood have been divided into three categories: (1) self-limited focal epilepsies, comprising four syndromes: self-limited epilepsy with centrotemporal spikes, self-limited epilepsy with autonomic seizures, childhood occipital visual epilepsy, and photosensitive occipital lobe epilepsy; (2) generalized epilepsies, comprising three syndromes: childhood absence epilepsy, epilepsy with myoclonic absence, and epilepsy with eyelid myoclonia; and (3) developmental and/or epileptic encephalopathies, comprising five syndromes: epilepsy with myoclonic-atonic seizures, Lennox-Gastaut syndrome, developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep, hemiconvulsion-hemiplegia-epilepsy syndrome, and febrile infection-related epilepsy syndrome. We define each, highlighting the mandatory seizure(s), EEG features, phenotypic variations, and findings from key investigations.
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Affiliation(s)
- Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, Full Member of EpiCARE, Rome, Italy
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Necker-Sick Children Hospital, Public Hospital Network of Paris, member of EpiCARE, Imagine Institute, National Institute of Health and Medical Research, Mixed Unit of Research 1163, University of Paris, Paris, France
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - Pauline Samia
- Department of Pediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | | | - Sam Gwer
- School of Medicine, Kenyatta University, and Afya Research Africa, Nairobi, Kenya
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children and Institute of Health & Wellbeing, member of EpiCARE, University of Glasgow, Glasgow, UK
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R. Korey Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Ronit Pressler
- Programme of Developmental Neurosciences, University College London National Institute for Health Research Biomedical Research Centre Great Ormond Street Institute of Child Health, Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, UK
| | - Edouard Hirsch
- Neurology Epilepsy Units "Francis Rohmer", INSERM 1258, FMTS, Strasbourg University, Strasbourg, France
| | - Sam Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Helen J Cross
- Programme of Developmental Neurosciences, University College London National Institute for Health Research Biomedical Research Centre Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, and Young Epilepsy Lingfield, London, UK
| | - Emilio Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences, Scientific Institute for Research and Health Care, Bologna, Italy
| | - Stéphane Auvin
- Robert Debré Hospital, Public Hospital Network of Paris, NeuroDiderot, National Institute of Health and Medical Research, Department Medico-Universitaire Innovation Robert-Debré, Pediatric Neurology, University of Paris, Paris, France
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9
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Baggio M, Toffoli L, Da Rold M, Duma GM, Mento G, Morao V, Danieli A, Bonanni P. Neuropsychological and behavioral profiles of self-limited epileptic syndromes of childhood: a cross-syndrome comparison. Child Neuropsychol 2022; 28:878-902. [PMID: 35086426 DOI: 10.1080/09297049.2022.2028754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood epilepsy with centro-temporal spikes (CECTS), Childhood absence epilepsy (CAE) and Panayiotopoulos syndrome (PS) are some of the most common pediatric epileptic syndromes. Despite the relatively benign (self-limited) course of epilepsy, current evidence suggests that these conditions are associated with an increased risk of neuropsychological and behavioral comorbidities. This study provides a cross-epileptic syndromes' comparison reporting on the cognitive and behavioral profile of a cohort of 32 children with CECTS (n = 14), CAE (n = 10) and PS (n = 8), aged 6 to 15 years old. Frequent, although often subclinical cognitive difficulties involving attention, executive functions and academic abilities were found in children with CECTS and CAE, and to a lesser extent in PS. Internalizing symptoms (particularly anxiety) were more common in the PS group compared to CECTS and CAE based on parental reports. Correlational analysis revealed a significant correlation between phonemic fluency and seizure-free interval at the time of evaluation, suggesting a beneficial effect of epilepsy remission on this executive function measure in all the three groups. These results add to existing literature providing further detail on neuropsychological and behavioral peculiarities of children with CECTS, CAE, and PS. Moreover, the need for neuropsychological assessment as part of the standard childhood epilepsy evaluation is stressed. The results are discussed in the context of the current literature, highlighting areas of consensus and controversies related to the clinical management of these epileptic syndromes as well as directions for future research.
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Affiliation(s)
- Martina Baggio
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Lisa Toffoli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Martina Da Rold
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Gian Marco Duma
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Giovanni Mento
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Padova Neuroscience Center (PNC), University of Padova, Italy
| | - Veronica Morao
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
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10
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Cursio I, Ronzano N, Asunis M, Dettori M, Cossu S, Murru S, Cau M, Incani F, Mei D, Bianchini C, Scioni M, Pruna D. A peculiar family with recurrent self-limited epileptic syndrome and associated developmental disorders in six girls. Epilepsy Behav Rep 2022; 19:100546. [PMID: 35637976 PMCID: PMC9142554 DOI: 10.1016/j.ebr.2022.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022] Open
Abstract
Self-Limited Epilepsies may evolve to Developmental and/or Epileptic Encephalopathy. Family cases may present with recurrent phenotype and complex genetic background. Genetic testing could not provide useful elements for early aetiological diagnosis. This electroclinical phenotype had remarkable impact on development. It’s important an early identification of genetic risk factors of family cases.
We describe a complex family with two couples (two sisters who married two brothers) with consistent social and neuropsychiatric problems, originally from Sardinia. Each couple had three daughters, which shared electroclinical epileptic syndrome and developmental disorders. All patients suffered from mild to moderate intellectual disability, speech difficulties and behavioural disorders. Four out of six patients had epilepsy onset between 3 and 4 years of age. The epileptic history almost reflected the typical clinical course of a self-Limited Focal Epilepsy of Childhood. However, our patients don’t have the complete features characteristic of one of the four specific self-Limited Focal Epilepsies of Childhood; a progressive evolution into a Developmental and/or Epileptic Encephalopathy with spike-wave activation in sleep was observed in the two older sister of the first family, which developed more severe developmental disorder too. In the other epileptic patients, improvement of EEG pattern was not coincident with an improvement of the developmental disorders. Brain MRI, performed in three patients, showed normal findings. Genetic analysis carried out so far (SNP-array, study of Runs of homozygosity, FMR1 triplet-repeat primer-PCR assay, Next Generation Sequencing based gene panel for epilepsy and neurodevelopmental disorders and Exome Sequencing), did not provide useful elements for an aetiological diagnosis.
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11
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Hermann BP, Struck AF, Busch RM, Reyes A, Kaestner E, McDonald CR. Neurobehavioural comorbidities of epilepsy: towards a network-based precision taxonomy. Nat Rev Neurol 2021; 17:731-746. [PMID: 34552218 PMCID: PMC8900353 DOI: 10.1038/s41582-021-00555-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this 'lesion model' has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.
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Affiliation(s)
- Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,
| | - Aaron F. Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Robyn M. Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anny Reyes
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Erik Kaestner
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R. McDonald
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
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12
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Zanaboni MP, Varesio C, Pasca L, Foti A, Totaro M, Celario M, Provenzi L, De Giorgis V. Systematic review of executive functions in children with self-limited epilepsy with centrotemporal spikes. Epilepsy Behav 2021; 123:108254. [PMID: 34428616 DOI: 10.1016/j.yebeh.2021.108254] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
Self-limited Epilepsy with Centrotemporal Spikes (ECTS) is a self-limiting childhood epilepsy with an overall good prognosis. The neurocognitive profile of ECTS shows various degrees of neuropsychological impairment, with speech impairment and executive dysfunction being the most prominent. This review aimed to clarify the executive function (EF) profile of children with ECTS and the clinical variables' impact on these abilities. We conducted a systematic review of the relevant literature for articles published up to January 2021. Demographic and clinical characteristics were abstracted from the original records. EF tasks used in the studies were classified according to Diamond's model, which identified four components: working memory, inhibitory control, cognitive flexibility, and higher order EFs. Twenty-three studies were included. Among the included records, 14 studies examined working memory, 15 inhibitory control, 15 flexibility, 4 higher order EFs, and 2 general EFs. Results confirmed the presence of a specific impairment in two abilities: inhibitory control and cognitive flexibility. This review confirms the need to assess each EF both in verbal and visual-spatial tasks. The early detection of children with ECTS at risk of developing neuropsychological impairment could activate interventions and prevent worse school achievement, social functioning, and a poor quality of life. Systematic review registration: PROSPERO: CRD42021245959.
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Affiliation(s)
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Annalisa Foti
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Martina Totaro
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Celario
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
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13
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Xu Y, Xu Q, Zhang Q, Stufflebeam SM, Yang F, He Y, Hu Z, Weng Y, Xiao J, Lu G, Zhang Z. Influence of epileptogenic region on brain structural changes in Rolandic epilepsy. Brain Imaging Behav 2021; 16:424-434. [PMID: 34420145 DOI: 10.1007/s11682-021-00517-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
To investigate the influence of epileptogenic cortex (Rolandic areas) with executive functions in Rolandic epilepsy using structural covariance analysis of structural magnetic resonance imaging (MRI). Structural MRI data of drug-naive patients with Rolandic epilepsy (n = 70) and typically developing children as healthy controls (n = 83) were analyzed using voxel-based morphometry. Gray matter volumes in the patients were compared with those of healthy controls, and were further correlated with epilepsy duration and cognitive score of executive function, respectively. By applying Granger causal analysis to the sequenced morphometric data according to disease progression information, causal network of structural covariance was constructed to assess the causal influence of structural changes from Rolandic cortices to the regions engaging executive function in the patients. Compared with healthy controls, epilepsy patients showed increased gray matter volume in the Rolandic regions, and also the regions engaging in executive function. Covariance network analyses showed that along with disease progression, the Rolandic regions imposed positive causal influence on the regions engaging in executive function. In the patients with Rolandic epilepsy, epileptogenic regions have causal influence on the structural changes in the regions of executive function, implicating damaging effects of Rolandic epilepsy on human brain.
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Affiliation(s)
- Yin Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, 210002, China.,Institute of Neurology, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Qirui Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, 210002, China.,Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Steven M Stufflebeam
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Suite 2301, Charlestown, MA, 02129, USA
| | - Fang Yang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Yan He
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng Hu
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yifei Weng
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Junhao Xiao
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, 210002, China. .,Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China. .,State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, 210093, China.
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, 210002, China. .,Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China. .,State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, 210093, China. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Suite 2301, Charlestown, MA, 02129, USA.
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14
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Executive Functions and Attention in Childhood Epilepsies: A Neuropsychological Hallmark of Dysfunction? J Int Neuropsychol Soc 2021; 27:673-685. [PMID: 33183389 DOI: 10.1017/s1355617720001125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with epilepsy are at risk for several lifetime problems, in which neuropsychological impairments may represent an impacting factor. We evaluated the neuropsychological functions in children suffering from three main epilepsy categories. Further, we analyzed the longitudinal evolution of the neuropsychological profile over time. METHODS Patients undergoing neuropsychological evaluation at our Department from 2012 to 2018 were identified retrospectively. We selected patients aged 6-16 years and with at least two evaluations. Three epilepsy categories were considered: focal/structural, focal self-limited, and idiopathic generalized. Each evaluation included the same structured assessment of main neuropsychological domains. The effect of the epilepsy category, illness duration, seizure status, and medication was computed in multilevel models. RESULTS We identified 103 patients (focal self-limited = 27; focal/structural = 51; and idiopathic generalized = 25), for 233 evaluations. The majority of deficits were reported in attention and executive functions (>30% of patients); the results were dichotomized to obtain global indexes. Multilevel models showed a trend toward statistical significance of category of epilepsy on the global executive index and of illness duration on global attention index. Illness duration predicted the scores of executive and attention tasks, while category and medication predicted executive task performance. Focal/structural epilepsies mostly affected the executive domain, with deficits persisting over time. By contrast, an ameliorative effect of illness duration for attention was documented in all epilepsies. CONCLUSIONS This study offers lacking information about the evolution of deficits in time, the role of epilepsy category, and possible psychological implications for high-order cognitive skills, central in several social and academic problems.
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15
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Ramos IDSS, Coelho CVG, Ribeiro F, Lopes AF. Executive functioning in children with self-limited epilepsy with centrotemporal spikes: a systematic review and meta-analysis. Child Neuropsychol 2021; 28:30-60. [PMID: 34251988 DOI: 10.1080/09297049.2021.1945019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Self-limited epilepsy with centrotemporal spikes (ECTS) is one of the most frequent focal epilepsies amongst children. Because remission usually occurs before 16 years old and patients present infrequent clinical manifestation, ECTS was considered benign for a long time. Despite the reports on cognitive deficits associated with ECTS in the last years, knowledge about the condition's specific executive function domains (inhibitory control, working memory, cognitive flexibility, verbal fluency, and higher-order executive functions) is still lacking. The following systematic review was conducted according to PRISMA guidelines. The PubMed and Scopus databases and gray literature were searched according to the following eligibility criteria: (1) original articles published in peer-review journals; (2) studies that present assessment of children with ECTS; and (3) studies with an available assessment of the executive function of the participants. A total of 43 studies (1179 patients and 1086 healthy controls) met the inclusion criteria. Data from 19 studies were extracted, and meta-analysis methods were used to compare results in the three main executive function domains and verbal fluency. The study quality was measured through the Newcastle-Ottawa Scale (NOS) and the evidence quality with the GRADEpro tool. Results and conclusions: The present systematic review is the first to gather information about executive functioning in children with ECTS. According to the meta-analyses, children with ECTS show weaker performances when compared with a control group in inhibitory control, cognitive flexibility, and verbal fluency. However, because the quality of evidence was classified as very low, caution is needed when interpreting the strength of the results.
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Affiliation(s)
- Inês Duarte Sá Seixas Ramos
- Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Carolina Vanessa Gomes Coelho
- Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal.,CIERL-UMa - Research Centre for Regional and Local Studies, Funchal, Ilha da Madeira, Portugal
| | - Filipa Ribeiro
- Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Ana Filipa Lopes
- Centro de Desenvolvimento da Criança Torrado da Silva do Hospital Garcia de Orta, Almada, Portugal.,Neuropsychological Assessment and Ageing Processes (NAAP-CINEICC-FPCE) da Universidade de Coimbra, Coimbra, Portugal
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16
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Georgopoulou V, Spruyt K, Garganis K, Kosmidis MH. Altered Sleep-Related Consolidation and Neurocognitive Comorbidity in CECTS. Front Hum Neurosci 2021; 15:563807. [PMID: 34163335 PMCID: PMC8215163 DOI: 10.3389/fnhum.2021.563807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Our aim is to use neurophysiological sleep-related consolidation (SRC) phenomena to identify putative pathophysiological mechanisms in CECTS linked to diffuse neurocognitive deficits. We argue that there are numerous studies on the association between seizure aspects and neurocognitive functioning but not as many on interictal variables and neurocognitive deficits. We suggest two additional foci. First, the interictal presentation in CECTS and second, neuronal oscillations involved in SRC processes. Existing data on mechanisms through which interictal epileptiform spikes (IES) impact upon SRC indicate that they have the potential to: (a) perturb cross-regional coupling of neuronal oscillations, (b) mimic consolidation processes, (c) alter the precision of the spatiotemporal coupling of oscillations, and (d) variably impact upon SRC performance. Sleep spindles merit systematic study in CECTS in order to clarify: (a) the state of the slow oscillations (SOs) with which they coordinate, (b) the precision of slow oscillation-spindle coupling, and (c) whether their developmental trajectories differ from those of healthy children. We subsequently review studies on the associations between IES load during NREM sleep and SRC performance in childhood epilepsy. We then use sleep consolidation neurophysiological processes and their interplay with IES to help clarify the diffuse neurocognitive deficits that have been empirically documented in CECTS. We claim that studying SRC in CECTS will help to clarify pathophysiological mechanisms toward diverse neurocognitive deficits. Future developments could include close links between the fields of epilepsy and sleep, as well as new therapeutic neurostimulation targets. At the clinical level, children diagnosed with CECTS could benefit from close monitoring with respect to epilepsy, sleep and neurocognitive functions.
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Affiliation(s)
- Victoria Georgopoulou
- 2nd Centre for Educational and Counseling Support of Eastern Thessaloniki, Ministry of Education, Thessaloniki, Greece.,Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Karen Spruyt
- INSERM, Claude Bernard University, School of Medicine, Lyon, France
| | | | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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17
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Bailey K, McAdam-Wong D, Im-Bolter N. Language measurement in childhood epilepsy: A review. BRAIN AND LANGUAGE 2021; 217:104940. [PMID: 33819772 DOI: 10.1016/j.bandl.2021.104940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
The psychosocial well-being of children and adolescents with epilepsy is affected by comorbid language deficits. Little is known about the focus of current research in language and epilepsy. A systematic review of research was conducted to identify gaps in knowledge regarding language and epilepsy. In total, 83 published articles were eligible for inclusion. More studies included samples presenting with focal seizures (k = 39) compared to generalized seizures (k = 10), few included measures of morphology (k = 4). Most studies (k = 66) included samples of participants across a wide age range. Our review indicated t-hat future research should include a greater focus on participants with more diversity in epilepsy etiology (e.g., symptomatic epilepsy), and seizure type (e.g., generalized seizures), assessment of additional areas of language (e.g., morphology), increased focus on early childhood, focused examination of specific developmental stages, and greater use of comparison groups with an alternate epilepsy diagnosis.
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Affiliation(s)
- Katharine Bailey
- Department of Psychology, Queen's University, Kingston, ON, Canada; Department of Psychology, Trent University, Peterborough, ON, Canada.
| | | | - Nancie Im-Bolter
- Department of Psychology, Trent University, Peterborough, ON, Canada
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18
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ELAhwal SA, El-Heneedy YAE, Bahnasy WS, Amer RAR, Rashed KH. The interictal activities load and cognitive performance of children with typical absence epilepsy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The description of childhood absence epilepsy (CAE) a benign self-limited generalized epilepsy has become a matter of debate. The objectives of this work were to evaluate the existence of psychiatric and cognitive impairments among patients with typical CAE and to correlate their possible relation to seizure frequency, duration of epilepsy, IISL, and valproate therapy.
Methods
The study was conducted on 19 typical CAE patients receiving valproate therapy, 11 newly diagnosed CAE patients not receiving AEDs, and 30 healthy control subjects (HCS). Participants were subjected to medical history taking, EEG monitoring, child behavior checklist (CBCL), Stanford Binet Intelligence Scale 5th edition, and computerized psychometric tests that assess cognitive domains and executive functions.
Results
The study revealed a high rate of cognitive and psychiatric dysfunctions in CAE patients. 53.3% of patients had psychiatric problems versus 16.6% in HCS. Attention deficit hyperactive disorder (ADHD) (26.6%), anxiety (16.6%), and depression (6.6%) were the most common psychiatric disorders in the patient group. Withdrawn/depressed symptoms, thought problems, social problems, and attention problems in CAE patients were significantly increased compared to HCS. At the same time, CAE patients perform worse in cognitive scales than HCS with comparable intelligent quotient (IQ) scores.
Conclusion
Cognitive and psychiatric impairments in typical CAE patients appear multifactorial in origin with epilepsy-related factors including the duration of epilepsy and interictal spike load (IISL).
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Poole BJ, Phillips NL, Stewart E, Harris IM, Lah S. Working Memory in Pediatric Epilepsy: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2021; 31:569-609. [PMID: 33818735 DOI: 10.1007/s11065-021-09491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/21/2021] [Indexed: 10/21/2022]
Abstract
Working memory is a multicomponent system that is supported by overlapping specialized networks in the brain. Baddeley's working memory model includes four components: the phonological loop, visuo-spatial sketchpad, the central executive, and episodic buffer. The aim of this review was to establish the gravity and pattern of working memory deficits in pediatric epilepsy. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided electronic searches. Sixty-five studies were included in the review. Meta-analyses revealed significant impairments across each working memory component: phonological loop (g = 0.739), visuo-spatial sketchpad (g = 0.521), and central executive (g = 0.560) in children with epilepsy compared to controls. The episodic buffer was not examined. The pattern of impairments, however, differed according to the site and side of seizure focus. This suggests that working memory components are differentially vulnerable to the location of seizure focus in the developing brain.
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Affiliation(s)
- Belinda J Poole
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia
| | - Natalie L Phillips
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia
| | - Elizabeth Stewart
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia
| | - Irina M Harris
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, NSW, 2006, Australia. .,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, NSW, 2109, Australia.
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20
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Duma GM, Danieli A, Morao V, Da Rold M, Baggio M, Toffoli L, Zanatta A, Vettorel A, Bonanni P, Mento G. Implicit cognitive flexibility in self-limited focal epilepsy of childhood: An HD-EEG study. Epilepsy Behav 2021; 116:107747. [PMID: 33493810 DOI: 10.1016/j.yebeh.2020.107747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
Self-limited focal epilepsy of childhood (SFEC) is often related to mild impairments in several neuropsychological domains, including cognitive flexibility, which is generally considered a process requiring volition and attention. However, recent evidence showed that it can be implicitly adjusted exploiting simple 'stimulus-response' associations as for example, the probability of the stimulus occurrence. Here, we evaluated the capability to implicitly extract environmental patterns of regularities and use them to flexibly adjust proactive control motor control. We tested 21 children with epilepsy (total IQ > 80; 13 with Childhood epilepsy with centro-temporal spikes, 8 with Panayiotopoulos syndrome (PS); 5-13 years old) compared to a healthy age-matched control group (32 participants). We used the Dynamic Temporal Prediction (DTP) task to investigate how behavioral performance is implicitly shaped by the manipulation of the stimulus occurrence probability over time. We recorded EEG to identify neural markers to differentiate the two groups. SFEC group showed a reduction in accuracy (p = .0013) and response speed (p < .001) as well as an absence of response adjustment (p = .65) in relation to the implicit changes in stimulus probability occurrence, in comparison to the control group. The epilepsy group performance in the DTP showed a significant correlation with the phonemic fluency (r = -0.50) and the Perseverations index of the CPT test (r = 0.53). Finally, children with SFEC did not show the modulation of the contingent negative variation (CNV) evoked potential. Overall, children with SFEC showed poor implicit flexibility compared to a control group. This pattern is individually related to high-level executive function, suggesting to extend neuropsychological assessment to the implicit domain.
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Affiliation(s)
- Gian Marco Duma
- Department of General Psychology, University of Padova, Italy; Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy.
| | - Alberto Danieli
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Veronica Morao
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Martina Da Rold
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Martina Baggio
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Lisa Toffoli
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Arianna Zanatta
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Airis Vettorel
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Paolo Bonanni
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Giovanni Mento
- Department of General Psychology, University of Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Italy
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Childhood Epilepsy with Centrotemporal Spikes: Clinical and Neuropsychological Outcomes 5 Years after Remission. Diagnostics (Basel) 2020; 10:diagnostics10110931. [PMID: 33182826 PMCID: PMC7696372 DOI: 10.3390/diagnostics10110931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 11/29/2022] Open
Abstract
Although specific neuropsychological deficits have been recognized during the active phase of epilepsy with centrotemporal spikes (ECTS), the natural cognitive and neuropsychological history after remission has not been elucidated so far. We evaluated the natural cognitive and neuropsychological outcomes five years after disease remission and investigated possible predictors of long-term outcome among socio-demographic and electro-clinical variables. We performed an observational cross-sectional study. Electro-clinical characteristics during the active phase of epilepsy, as well as antiepileptic treatment and premorbid neurodevelopmental concerns were reviewed for 70 patients. At least five years after epilepsy remission, all patients were contacted, and 46 completed a structured questionnaire about patients’ current education and academic skills, general health, and parents’ socio-economic status. Among them, 23 patients underwent an ad hoc cognitive and neuropsychological protocol and emotional-behavioral assessment. Chi-square tests and t-tests were carried out to define the role of putative predictors of neuropsychological outcomes. Mean cognitive and neuropsychological performances appeared to be overall adequate, except for the dictation. Positive family history for epilepsy (p = 0.01769) and familial socioeconomic status (mother’s schooling (p = 0.04169), father’s schooling (p = 0.01939), mother’s income (p = 0.0262), father’s income (p = 0.01331)) were identified as predictors of outcomes. Our data suggest that ECTS with typical electro-clinical features depicts an overall preserved cognitive and neuropsychological long-term outcome. We suggest particular attention should be paid to patients with socio-economic disadvantage and familial history of epilepsy, as they may experience worse neurocognitive post-morbid performances.
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Vaudano AE, Avanzini P, Cantalupo G, Filippini M, Ruggieri A, Talami F, Caramaschi E, Bergonzini P, Vignoli A, Veggiotti P, Guerra A, Gessaroli G, Santucci M, Canevini MP, Piccolo B, Pisani F, Gobbi G, Dalla Bernardina B, Meletti S. Mapping the Effect of Interictal Epileptic Activity Density During Wakefulness on Brain Functioning in Focal Childhood Epilepsies With Centrotemporal Spikes. Front Neurol 2019; 10:1316. [PMID: 31920937 PMCID: PMC6930928 DOI: 10.3389/fneur.2019.01316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022] Open
Abstract
Childhood epilepsy with centrotemporal spikes (CECTS) is the most common type of “self-limited focal epilepsies.” In its typical presentation, CECTS is a condition reflecting non-lesional cortical hyperexcitability of rolandic regions. The benign evolution of this disorder is challenged by the frequent observation of associated neuropsychological deficits and behavioral impairment. The abundance (or frequency) of interictal centrotemporal spikes (CTS) in CECTS is considered a risk factor for deficits in cognition. Herein, we captured the hemodynamic changes triggered by the CTS density measure (i.e., the number of CTS for time bin) obtained in a cohort of CECTS, studied by means of video electroencephalophy/functional MRI during quite wakefulness. We aim to demonstrate a direct influence of the diurnal CTS frequency on epileptogenic and cognitive networks of children with CECTS. A total number of 8,950 CTS (range between 27 and 801) were recorded in 23 CECTS (21 male), with a mean number of 255 CTS/patient and a mean density of CTS/30 s equal to 10,866 ± 11.46. Two independent general linear model models were created for each patient based on the effect of interest: “individual CTS” in model 1 and “CTS density” in model 2. Hemodynamic correlates of CTS density revealed the involvement of a widespread cortical–subcortical network encompassing the sensory-motor cortex, the Broca's area, the premotor cortex, the thalamus, the putamen, and red nucleus, while in the CTS event-related model, changes were limited to blood–oxygen-level-dependent (BOLD) signal increases in the sensory-motor cortices. A linear relationship was observed between the CTS density hemodynamic changes and both disease duration (positive correlation) and age (negative correlation) within the language network and the bilateral insular cortices. Our results strongly support the critical role of the CTS frequency, even during wakefulness, to interfere with the normal functioning of language brain networks.
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Affiliation(s)
- Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Avanzini
- Italian National Research Council, Parma Research Unit, Parma, Italy
| | | | - Melissa Filippini
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Andrea Ruggieri
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Aglaia Vignoli
- Department of Health Sciences, University of Milano, Milan, Italy
| | | | - Azzura Guerra
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Giuliana Gessaroli
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Margherita Santucci
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Benedetta Piccolo
- Child Neuropsychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Pisani
- Child Neuropsychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Gobbi
- Child Neuropsychiatry Unit, IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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23
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Kim HH, Chung GH, Park SH, Kim SJ. Language-Related White-Matter-Tract Deficits in Children with Benign Epilepsy with Centrotemporal Spikes: A Retrospective Study. J Clin Neurol 2019; 15:502-510. [PMID: 31591839 PMCID: PMC6785461 DOI: 10.3988/jcn.2019.15.4.502] [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: 12/27/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Benign epilepsy with centrotemporal spikes (BECTS) is one of the most common pediatric epilepsies, and it generally has a good prognosis. However, recent research has indicated that the epileptic activity of BECTS can cause cognitive defects such as language, visuospatial, and auditory verbal memory deficits. This study assessed language-delivery deficits in BECTS patients using diffusion-tensor magnetic resonance imaging (DTI). Methods T1-weighted MRI, DTI, and language tests were conducted in 16 BECTS patients and 16 age-matched controls. DTI data were analyzed using the TRActs Constrained by Underlying Anatomy tool in FreeSurfer 5.3, and 18 major white-matter tracts were extracted, which included 4 language-related tracts: the inferior longitudinal fasciculus, superior longitudinal fasciculus-parietal terminations, superior longitudinal fasciculus-temporal terminations, and uncinate fasciculus (UNC). Language tests included the Korean version of the Receptive and Expressive Vocabulary Test, Test of Problem-Solving Abilities (TOPS), and the mean length of utterance in words. Results The BECTS group exhibited decreased mean fractional anisotropy and increased mean radial diffusivity, with significant differences in both the superior longitudinal fasciculus and the left UNC (p<0.05), which are the language-related white-matter tracts in the dual-loop model. The TOPS language test scores were significantly lower in the BECTS group than in the control group (p<0.05). Conclusions It appears that BECTS patients can exhibit language deficits. Seizure activities of BECTS could alter DTI scalar values in the language-related white-matter tracts.
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Affiliation(s)
- Hyun Ho Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyung Ho Chung
- Department of Diagnostic Radiology, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Hee Park
- Department of Rehabilitation Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.
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24
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Bourel-Ponchel E, Mahmoudzadeh M, Adebimpe A, Wallois F. Functional and Structural Network Disorganizations in Typical Epilepsy With Centro-Temporal Spikes and Impact on Cognitive Neurodevelopment. Front Neurol 2019; 10:809. [PMID: 31555191 PMCID: PMC6727184 DOI: 10.3389/fneur.2019.00809] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022] Open
Abstract
Epilepsy with Centrotemporal Spikes (ECTS) is the most common form of self-limited focal epilepsy. The pathophysiological mechanisms by which ECTS induces neuropsychological impairment in 15-30% of affected children remain unclear. The objective of this study is to review the current state of knowledge concerning the brain structural and functional changes that may be involved in cognitive dysfunctions in ECTS. Structural brain imaging suggests the presence of subtle neurodevelopmental changes over the epileptogenic zone and over distant regions in ECTS. This structural remodeling likely occurs prior to the diagnosis and evolves over time, especially in patients with cognitive impairment, suggesting that the epileptogenic processes might interfere with the dynamics of the brain development and/or the normal maturation processes. Functional brain imaging demonstrates profound disorganization accentuated by interictal epileptic spikes (IES) in the epileptogenic zone and in remote networks in ECTS. Over the epileptogenic zone, the literature demonstrates changes in term of neuronal activity and synchronization, which are effective several hundred milliseconds before the IES. In the same time window, functional changes are also observed in bilateral distant networks, notably in the frontal and temporal lobes. Effective connectivity demonstrates that the epileptogenic zone constitutes the key area at the origin of IES propagation toward distant cortical regions, including frontal areas. Altogether, structural and functional network disorganizations, in terms of: (i) power spectral values, (ii) functional and effective connectivity, are likely to participate in the cognitive impairment commonly reported in children with ECTS. These results suggest a central and causal role of network disorganizations related to IES in the neuropsychological impairment described in ECTS children.
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Affiliation(s)
- Emilie Bourel-Ponchel
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France
- INSERM UMR 1105, EFSN Pediatric, Amiens University Hospital, Amiens, France
| | - Mahdi Mahmoudzadeh
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France
- INSERM UMR 1105, EFSN Pediatric, Amiens University Hospital, Amiens, France
| | - Azeez Adebimpe
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France
| | - Fabrice Wallois
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens, France
- INSERM UMR 1105, EFSN Pediatric, Amiens University Hospital, Amiens, France
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Bear JJ, Chapman KE, Tregellas JR. The epileptic network and cognition: What functional connectivity is teaching us about the childhood epilepsies. Epilepsia 2019; 60:1491-1507. [PMID: 31247129 PMCID: PMC7175745 DOI: 10.1111/epi.16098] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/09/2019] [Accepted: 06/05/2019] [Indexed: 12/13/2022]
Abstract
Our objective was to summarize and evaluate the rapidly expanding body of literature studying functional connectivity in childhood epilepsy. In the self-limited childhood epilepsies, awareness of cognitive comorbidities has been steadily increasing, and recent advances in our understanding of the network effects of these disorders promise insights into the underlying neurobiology. We reviewed publications addressing functional connectivity in children with epilepsy with an emphasis on studies of children with self-limited childhood epilepsies. The majority of studies have been published in the past 10 years and predominantly examine childhood epilepsy with centrotemporal spikes and childhood absence epilepsy. Cognitive network alterations are commonly observed across the childhood epilepsies. Some of these effects appear to be nonspecific to epilepsy syndrome or even to category of neurological disorder. Other patterns, such as changes in the connectivity of cortical language areas in childhood epilepsy with centrotemporal spikes, provide clues to the underlying cognitive deficits seen in affected children. The literature to date is dominated by general observations of connectivity patterns without a priori hypotheses. These data-driven studies build an important foundation for hypothesis generation and are already providing useful insights into the neuropathology of the childhood epilepsies. Future work should emphasize hypothesis-driven approaches and rigorous clinical correlations to better understand how the knowledge of network alterations can be applied to guidance and treatment for the children in our clinics.
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Affiliation(s)
- Joshua J Bear
- Department of Pediatrics, Section of Neurology, Children’s Hospital Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Kevin E Chapman
- Department of Pediatrics, Section of Neurology, Children’s Hospital Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Jason R Tregellas
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
- Research Service, Rocky Mountain Regional VA Medical Center
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Siripornpanich V, Visudtibhan A, Kotchabhakdi N, Chutabhakdikul N. Delayed cortical maturation at the centrotemporal brain regions in patients with benign childhood epilepsy with centrotemporal spikes (BCECTS). Epilepsy Res 2019; 154:124-131. [PMID: 31129368 DOI: 10.1016/j.eplepsyres.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/14/2019] [Accepted: 05/01/2019] [Indexed: 11/18/2022]
Abstract
Benign childhood epilepsy with centrotemporal spikes (BCECTS) is an epilepsy syndrome commonly found in child and adolescent. Although the prognosis is mostly favorable as long as the seizure is well controlled. However, they are often suffering from the cognitive and behavioral problems which might be the consequences of the initial insults. It is still not clear whether the initial epileptiform discharges has long term impact on the resting-state brain activities at later ages. This study investigated the resting-state brain activities in BCECTS patients with clinical seizure remission stage (n = 16; 11 males) and compared with the non-epileptic, age-matched control subjects. Quantitative electroencephalography (qEEG) revealed a significantly higher absolute power of the theta and alpha waves in BCECTS patients with clinical seizure remission as compared with the non-epileptic control subjects. Interestingly, the differences were observed mainly over the centrotemporal electrodes which are the common sites of the initial epileptiform discharges. The differences were more significant in patients with bilateral epileptiform discharges than those with the unilateral epileptic activities. Typically, the brain wave power continuously decreases with increasing ages. Therefore, higher absolute powers of the brain waves indicate more delayed in cortical maturation compared with the non-epileptic control group. These findings indicated that BCECTS patients have delay cortical maturation at the centrotemporal brain regions even at the clinical seizure remission phase.
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Affiliation(s)
- Vorasith Siripornpanich
- Research Center for Neuroscience, Institute of Molecular Biosciences, Mahidol University, Nakhonpathom, 73170, Thailand
| | - Anannit Visudtibhan
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Naiphinich Kotchabhakdi
- Research Center for Neuroscience, Institute of Molecular Biosciences, Mahidol University, Nakhonpathom, 73170, Thailand
| | - Nuanchan Chutabhakdikul
- Research Center for Neuroscience, Institute of Molecular Biosciences, Mahidol University, Nakhonpathom, 73170, Thailand.
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Levetiracetam versus carbamazepine in treatment of rolandic epilepsy. Epilepsy Behav 2019; 94:1-8. [PMID: 30884401 DOI: 10.1016/j.yebeh.2019.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of the current study was to systematically review the literature to compare the efficacy of levetiracetam (LEV) with that of carbamazepine (CBZ) to control seizures and reduce the burden of interictal epileptiform discharges in children with rolandic epilepsy (RE) and also to compare their tolerability. METHODS We searched the electronic database PubMed on January 9, 2019 for original articles that included the following English-language search terms in the title: "Rolandic epilepsy" OR "benign childhood epilepsy with centrotemporal spikes" since 2000. We concentrated our review on three main areas: 1. Neuropsychological impairments in children with RE; 2. Influence of epileptic activity on cognitive performance in RE; 3. Effects of antiepileptic drug (AED) therapies in RE. RESULTS The primary search yielded 308 papers. We reviewed the results and removed duplicate articles and all nonoriginal, non-English papers. Finally, after carefully reviewing the full texts, we included 44 original articles to achieve the aims of this review. CONCLUSION Physicians taking care of children with RE should be aware of the risks for cognitive dysfunctions in these patients and screen their patients for any subtle dysfunction that may affect their academic performance and achievement. If and when the physician decides to prescribe an AED for their patients with RE, LEV is probably a better option compared with CBZ to prescribe for these children.
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28
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Kagitani-Shimono K, Kato Y, Hanaie R, Matsuzaki J, Tanigawa J, Iwatani Y, Azuma J, Taniike M. Abnormal cortical activation during an auditory word comprehension task in benign childhood epilepsy with centrotemporal spikes: A magnetoencephalographic study. Epilepsy Behav 2018; 87:159-166. [PMID: 30120072 DOI: 10.1016/j.yebeh.2018.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/06/2018] [Accepted: 05/20/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Benign childhood epilepsy with centrotemporal spikes (BECTS), also known as rolandic epilepsy, has recently been reported to be associated with variable degrees of cognitive dysfunction. Many studies reported poor language ability in children with BECTS compared with healthy control children. To elucidate the harmful effects of BECTS on language cognition, we studied the magnetoencephalographic activity elicited by an auditory language comprehension task. METHODS The participants (N = 20) included 10 children diagnosed with BECTS (aged 10.8 ± 2.8 years) and 10 age-matched healthy children (control) (aged 10.6 ± 1.6 years). Cognitive function was assessed using general intellectual function and language ability. In patients with BECTS, we reviewed the clinical course and electroencephalogram (EEG) findings. We recorded the cortical responses elicited by an auditory language comprehension task using magnetoencephalography (MEG). We compared those results between groups and analyzed the correlation with cognitive scores and frequency of spikes. RESULTS The full-scale intelligence quotient (FSIQ) by the Wechsler Intelligence Scale for Children-4th edition was significantly reduced in the group with BECTS (96.4 ± 12.3) compared with the control group (110.0 ± 7.4). In half of the group with BECTS, the auditory comprehension score fell below the age-standard level. In the group with BECTS, the cortical activation during the task showed reduced intensity in language-associated areas such as the bilateral primary auditory cortex, left superior and mid-temporal areas, and inferior frontal area compared with those in the control group. In addition, the cortical activation in the left superior temporal area was negatively correlated with spike frequency and positively correlated with FSIQ in the group with BECTS. Conversely, the right inferior frontal and mid-temporal areas had increased the activations in the group with BECTS. From the time frequency analysis, low gamma band event-related desynchronization was reduced in the group with BECTS. CONCLUSION Epileptic spikes negatively influenced responsiveness to the auditory language comprehension task in the language-associated cortices. These findings suggest that epileptic spikes could have a negative impact on the functional activity in rolandic areas and become a reason to change the functional development of the language network.
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Affiliation(s)
- Kuriko Kagitani-Shimono
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan; Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Epilepsy center, Osaka University Hospital, Suita, Osaka, Japan.
| | - Yoko Kato
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
| | - Ryuzo Hanaie
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
| | - Junko Matsuzaki
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan
| | - Junpei Tanigawa
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiko Iwatani
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan; Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Epilepsy center, Osaka University Hospital, Suita, Osaka, Japan
| | | | - Masako Taniike
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Suita, Osaka, Japan; Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Tristano I, Nicita F, Garone G, Ursitti F, Nardone C, Rocchi V, Guido CA, Spalice A. Could Rolandic spikes be a prognostic factor of the neurocognitive outcome of children with BECTS? Epilepsy Behav 2018; 86:157-162. [PMID: 30031676 DOI: 10.1016/j.yebeh.2018.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rolandic epilepsy, also known as benign childhood epilepsy with centrotemporal spikes (BECTS), is one of the most common epileptic syndromes in previously healthy children. Despite what was known about the benignity of this syndrome, there is always more evidence about the involvement of the cognitive functions with different deficits in several domains to be investigated. AIM OF THE STUDY The aim of our study was to describe prognostic electroencephalogram (EEG) pattern of an adverse cognitive development to recognize patients at higher risk of lasting cognitive deficits that could need antiepileptic drugs (AEDs) or an improved neurocognitive therapy. In addition, we wanted to investigate the existence of a possible linkage between the number of interictal epileptiform discharges (IEDs) in the EEG and the more pronounced cognitive deficits. MATERIAL AND METHODS We performed a case-control study on a cohort of 16 patients (10 male and 6 female) aged 4-14, diagnosed with BECTS who underwent EEG, magnetic resonance imaging (MRI), and neurocognitive assessment at the Pediatric Neurology Unit at the Umberto I Hospital, Sapienza University of Rome. Patients were divided into two groups according to the percentage of IEDs evaluated based on their sleep EEG: group A with less than 50% of the entire EEG invaded by discharges in more than 70% of the total number of EEG performed, so-called with low or intermediate activation. On the contrary, group B had a high activation, with more than 50% of the entire EEG invaded by discharges in the same percentage of the EEG performed. All children were assessed based on a protocol designed to study neuropsychological functions with specific tests chosen depending on age (Wechsler Intelligence Scale for Children IV: WISC IV; Wechsler Preschool and Primary Scale of Intelligence III: WPPSI III). Groups were compared for cognitive outcomes achieved by each patient through Student's t-test with a significance level of p<0.05 (two-tailed). RESULTS There is no statistically significant difference in the cognitive outcomes of these patients: Student's t-test showed a statistical significance (p) for each cognitive index always higher than 0.05, demonstrating that the intellectual quotient (IQ) and all other indexes analyzed (verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), and processing speed index (PSI)) are not affected by the difference in EEG anomalies presented by our patients. Interestingly, all patients had an IQ equal to or greater than the Italian average (12 out of 16 patients showed an IQ>100), with selective drops, particularly significant in the WMI and also in the PSI. CONCLUSIONS Our results clearly demonstrate the importance of a proper evaluation of patients with this kind of epilepsy, without paying attention only to those with the greatest number of IEDs or seizures because all of them had a neurocognitive impairment, especially in memory. These data may be reinforced by a larger sample for an even more significant statistical value. These results also highlight the importance of a neurocognitive therapy for these children to treat for their specific needs.
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Affiliation(s)
- Isabella Tristano
- "La Sapienza" University, Department of Pediatrics, Child Neurology Division, Italy
| | - Francesco Nicita
- "La Sapienza" University, Department of Pediatrics, Child Neurology Division, Italy
| | - Giacomo Garone
- "La Sapienza" University, Department of Pediatrics, Child Neurology Division, Italy
| | - Fabiana Ursitti
- "La Sapienza" University, Department of Pediatrics, Child Neurology Division, Italy
| | - Consuelo Nardone
- "La Sapienza" University, Department of Pediatrics, Child Neurology Division, Italy
| | - Valerio Rocchi
- "La Sapienza" University, Department of Pediatrics, Child Neurology Division, Italy
| | | | - Alberto Spalice
- "La Sapienza" University, Department of Pediatrics, Child Neurology Division, Italy.
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Lima EM, Rzezak P, Dos Santos B, Gentil L, Montenegro MA, Guerreiro MM, Valente KD. The relevance of attention deficit hyperactivity disorder in self-limited childhood epilepsy with centrotemporal spikes. Epilepsy Behav 2018; 82:164-169. [PMID: 29649723 DOI: 10.1016/j.yebeh.2018.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022]
Abstract
In this study, we aimed to evaluate the attentional and executive functions in patients with benign childhood epilepsy with centrotemporal spikes (BCECTS) with and without attention-deficit hyperactivity disorder (ADHD) compared with controls and compared with patients with ADHD without epilepsy. We evaluated 12 patients with BCECTS and ADHD (66.7% boys; mean age of 9.67years); 11 children with non-ADHD BCECTS (63.6% boys; mean age of 11.91years); 20 healthy children (75% boys; mean age of 10.15years); and 20 subjects with ADHD without epilepsy (60% boys; mean age of 10.9years). We used a comprehensive battery of neuropsychological tests to evaluate attentional and executive functions in their broad domains. Patients with BCECTS and ADHD had worse performance in Conners' Continuous Performance Test II (reaction time standard error [p=0.008], variability [p=0.033], perseverations [p=0.044] and in reaction time interstimuli interval [p=0.016]). Patients with ADHD showed worse performance in Trail Making Test B errors [p=0.012]. In conclusion, patients with BCECTS and ADHD had worse executive and attentional performance compared with controls than non-ADHD patients with BCECTS. Regardless of the presence of epilepsy, ADHD also negatively impacted executive and attentional functions but in different executive subdomains compared with patients with epilepsy.
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Affiliation(s)
- Ellen Marise Lima
- Department of Psychiatry, Hospital das Clinicas, University of São Paulo-HCFMUSP, Sao Paulo, Brazil
| | - Patricia Rzezak
- Department of Psychiatry, Hospital das Clinicas, University of São Paulo-HCFMUSP, Sao Paulo, Brazil
| | | | - Letícia Gentil
- Department of Psychiatry, Hospital das Clinicas, University of São Paulo-HCFMUSP, Sao Paulo, Brazil
| | - Maria A Montenegro
- Department of Neurology, University of Campinas - UNICAMP, Sao Paulo, Brazil
| | | | - Kette D Valente
- Department of Psychiatry, Hospital das Clinicas, University of São Paulo-HCFMUSP, Sao Paulo, Brazil.
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31
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Baumer FM, Cardon AL, Porter BE. Language Dysfunction in Pediatric Epilepsy. J Pediatr 2018; 194:13-21. [PMID: 29241678 PMCID: PMC5826845 DOI: 10.1016/j.jpeds.2017.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA.
| | - Aaron L Cardon
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Brenda E Porter
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
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Black CL, Shih SW, Sepeta LN, Facella-Ervolini JM, Isquith PK, Berl MM. Everyday executive function in focal onset pediatric epilepsy on the parent-report BRIEF2. Child Neuropsychol 2018; 25:22-43. [PMID: 29375005 DOI: 10.1080/09297049.2018.1424326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Executive function (EF) difficulties are a core neuropsychological feature of pediatric epilepsy, and parent-report measures of EF concerns are an important complement to task-based EF measures. The Behavior Rating Inventory of Executive Function (BRIEF) has shown sensitivity to parent-reported EF concerns in epilepsy and other pediatric populations. We compared profiles of parent-reported EF concerns using the BRIEF and its revision, the BRIEF2, in 117 pediatric patients with focal onset epilepsy to examine the clinical utility of the revised scale. We then compared BRIEF2 profiles between patients and age- and gender-matched healthy controls. Among patients, profiles on the BRIEF did not globally differ from the BRIEF2, and agreement was very good across scales. Patients and controls differed significantly on the BRIEF2, with patients showing higher EF difficulties reported by parents across most scales. High rates of clinical elevation among patients emerged on the Task Monitor, Plan/Organize, Working Memory, and Shift scales. Younger age of epilepsy onset, chronic epilepsy, and right hemisphere seizure focus were associated with higher parent-reported EF concerns. Findings suggest that the BRIEF2 demonstrates similar performance to the BRIEF among pediatric patients with focal onset epilepsy who are most at risk in the areas of task monitoring, working memory, planning and organization, and flexibility. These findings are informative when comparing literature across versions and provide additional insight into the nature of parent-reported EF difficulties among children with focal onset epilepsy.
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Affiliation(s)
- Chelsea L Black
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
| | - Sharon W Shih
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA.,b Department of Psychology , Georgia State University , Atlanta , GA , USA
| | - Leigh N Sepeta
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
| | - Joy M Facella-Ervolini
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA.,c Institute of Health Professions , Massachusetts General Hospital , Charlestown , MA , USA
| | - Peter K Isquith
- d Department of Psychiatry , Boston Children's Hospital, Harvard Medical School , Boston , MA , USA
| | - Madison M Berl
- a Division of Pediatric Neuropsychology , Children's National Medical Center , Washington , DC , USA
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Kim HJ, Lee JH, Park CH, Hong HS, Choi YS, Yoo JH, Lee HW. Role of Language-Related Functional Connectivity in Patients with Benign Childhood Epilepsy with Centrotemporal Spikes. J Clin Neurol 2018; 14:48-57. [PMID: 29629540 PMCID: PMC5765256 DOI: 10.3988/jcn.2018.14.1.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose Benign childhood epilepsy with centrotemporal spikes (BECTS) does not always have a benign cognitive outcome. We investigated the relationship between cognitive performance and altered functional connectivity (FC) in the resting-state brain networks of BECTS patients. Methods We studied 42 subjects, comprising 19 BECTS patients and 23 healthy controls. Cognitive performance was assessed using the Korean version of the Wechsler Intelligence Scale for Children-III, in addition to verbal and visuospatial memory tests and executive function tests. Resting-state functional magnetic resonance imaging was acquired in addition to high-resolution structural data. We selected Rolandic and language-related areas as regions of interest (ROIs) and analyzed the seed-based FC to voxels throughout the brain. We evaluated the correlations between the neuropsychological test scores and seed-based FC values using the same ROIs. Results The verbal intelligence quotient (VIQ) and full-scale intelligence quotient (FSIQ) were lower in BECTS patients than in healthy controls (p<0.001). The prevalence of subjects with a higher performance IQ than VIQ was significantly higher in BECTS patients than in healthy controls (73.7% vs. 26.1%, respectively; p=0.002). Both the Rolandic and language-related ROIs exhibited more enhanced FC to voxels in the left inferior temporal gyrus in BECTS patients than in healthy controls. A particularly interestingly finding was that the enhanced FC was correlated with lower cognitive performance as measured by the VIQ and the FSIQ in both patients and control subjects. Conclusions Our findings suggest that the FC alterations in resting-state brain networks related to the seizure onset zone and language processing areas could be related to adaptive plasticity for coping with cognitive dysfunction.
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Affiliation(s)
- Hyeon Jin Kim
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Jung Hwa Lee
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Changwon, Korea
| | - Chang Hyun Park
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Hye Sun Hong
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Yun Seo Choi
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Jeong Hyun Yoo
- Department of Radiology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea
| | - Hyang Woon Lee
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.,Department of Medical Science, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.
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34
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Yan X, Yu Q, Gao Y, Li L, Yu D, Chen Y, Yao X, Yang W, Chen Z, Yin J, An Y, Tan K. Cognition in patients with benign epilepsy with centrotemporal spikes: A study with long-term VEEG and RS-fMRI. Epilepsy Behav 2017; 76:120-125. [PMID: 28882722 DOI: 10.1016/j.yebeh.2017.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/24/2017] [Accepted: 06/24/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between alterations of functional brain network and cognition in patients with benign epilepsy with centrotemporal spikes (BECTS) as a function of spike-wave index (SWI) during slow wave sleep. METHODS Resting-state functional magnetic resonance imaging (RS-fMRI) data and Intelligence Quotient (IQ) were collected from two groups of patients with BECTS, including a SWI<50% group (5 cases) and a SWI≥50% group (7 cases). The SWI was calculated from the long-term video-electroencephalogram monitoring (one sleep cycle was included at least). The RS-fMRI data were analyzed by regional homogeneity (ReHo) method. RESULTS There were three main findings. Firstly, Full Intelligence Quotient (FIQ), Verbal Intelligence Quotient (VIQ), and Performance Intelligence Quotient (PIQ) of the SWI≥50% group were significantly lower than SWI<50% group (p<0.05). Secondly, there was a negative correlation between the FIQ, VIQ, PIQ, and SWI (p<0.05), and the FIQ, VIQ, and PIQ were not dependent on age, age of onset, disease course, years of education, and total number of seizures (p>0.05). Finally, compared with the SWI<50% group, the SWI≥50% group showed increased ReHo in the bilateral precentral gyrus, bilateral premotor area, bilateral subcortical structure, right temporal lobe, and bilateral insular lobe, while they showed decreased ReHo in the posterior cingulate cortex and posterior of right inferior temporal lobe. CONCLUSIONS The alterations of functional brain network caused by the frequent discharges during slow wave sleep could affect cognition in patients with BECTS.
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Affiliation(s)
- Xinxin Yan
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Yu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.
| | - Yuting Gao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Liting Li
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Danhua Yu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Chen
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaojuan Yao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Weidong Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhijuan Chen
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianzhong Yin
- Department of Radiology, The First Central Hospital of Tianjin, Tianjin, China
| | - Yang An
- Department of Radiology, The First Central Hospital of Tianjin, Tianjin, China
| | - Ke Tan
- Tianjin Normal University, Tianjin, China
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Wickens S, Bowden SC, D'Souza W. Cognitive functioning in children with self-limited epilepsy with centrotemporal spikes: A systematic review and meta-analysis. Epilepsia 2017; 58:1673-1685. [DOI: 10.1111/epi.13865] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Steven Wickens
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria Australia
| | - Stephen C. Bowden
- Department of Clinical Neurosciences; St. Vincent's Hospital Melbourne; Fitzroy Victoria Australia
| | - Wendyl D'Souza
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
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Lima EM, Rzezak P, Guimarães CA, Montenegro MA, Guerreiro MM, Valente KD. The executive profile of children with Benign Epilepsy of Childhood with Centrotemporal Spikes and Temporal Lobe Epilepsy. Epilepsy Behav 2017. [PMID: 28622557 DOI: 10.1016/j.yebeh.2017.04.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
RATIONALE Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS) and temporal lobe epilepsy (TLE) represent two distinct models of focal epilepsy of childhood. In both, there is evidence of executive dysfunction. The purpose of the present study was to identify particular deficits in the executive function that would distinguish children with BECTS from children with TLE. METHODS We prospectively evaluated 19 consecutive children and adolescents with TLE with hippocampal sclerosis (HS) (57.9% male; mean 11.74years [SD 2.05]; mean IQ 95.21 [SD 15.09]), 19 with BECTS (36.8% male; mean 10.95years [SD 2.33]; mean IQ 107.40 [SD 16.01]), and 21 age and gender-matched controls (33.3% male; mean 11.86years [SD 2.25]; mean IQ 108.67 [15.05]). All participants underwent a neuropsychological assessment with a comprehensive battery for executive and attentional functions. We used ANOVA and chi-square to evaluate differences on demographic aspects among groups (BECTS, TLE-HS, and control groups). Group comparisons on continuous variables were complemented by MANOVA and Bonferroni posthoc comparisons. RESULTS Patients with BECTS had worse performance than controls in: Matching Familiar Figures Test, time (p=0.001); Matching Familiar Figures Test, time×errors index (p<0.001); Verbal Fluency for foods (p=0.038); Trail Making Test, part B time (p=0.030); Trail Making Test, part B number of errors (p=0.030); and WCST, number of categories achieved (p=0.043). Patients with BECTS had worse performance than patients with TLE-HS on Matching Familiar Figures Test, time (p=0.004), and Matching Familiar Figures Test, time×errors index (p<0.001). Patients with TLE-HS had worse performance than controls on the following tests: Verbal Fluency for foods (p=0.004); Wisconsin Card Sorting Test, the number of categories achieved (p<0.001); and Wisconsin Card Sorting Test, the number of perseverative errors (p=0.028). Patients with TLE-HS had worse performance than patients with BECTS on Digit Backward (p=0.002); and the Wisconsin Card Sorting Test, the number of perseverative errors (p<0.001). CONCLUSIONS Patients with TLE and BECTS present distinct cognitive profiles. Patients with TLE-HS had worse performance in mental flexibility, concept formation, and working memory compared to BECTS. Patients with BECTS had worse inhibitory control compared to children with TLE-HS. Both TLE-HS and BECTS had a higher number of errors on an inhibitory control test. However, patients with BECTS had a slower mental processing even when compared to patients with TLE-HS. Rehabilitation programs for children with epilepsy must include children with benign epilepsies and must take into account the epileptic syndrome and its particular neurocognitive phenotype.
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Affiliation(s)
- Ellen M Lima
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Patricia Rzezak
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Kette D Valente
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil.
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Cheng D, Yan X, Gao Z, Xu K, Zhou X, Chen Q. Common and Distinctive Patterns of Cognitive Dysfunction in Children With Benign Epilepsy Syndromes. Pediatr Neurol 2017; 72:36-41.e1. [PMID: 28533141 DOI: 10.1016/j.pediatrneurol.2016.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/09/2016] [Accepted: 12/10/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Childhood absence epilepsy and benign childhood epilepsy with centrotemporal spikes are the most common forms of benign epilepsy syndromes. Although cognitive dysfunctions occur in children with both childhood absence epilepsy and benign childhood epilepsy with centrotemporal spikes, the similarity between their patterns of underlying cognitive impairments is not well understood. To describe these patterns, we examined multiple cognitive functions in children with childhood absence epilepsy and benign childhood epilepsy with centrotemporal spikes. METHODS In this study, 43 children with childhood absence epilepsy, 47 children with benign childhood epilepsy with centrotemporal spikes, and 64 control subjects were recruited; all received a standardized assessment (i.e., computerized test battery) assessing processing speed, spatial skills, calculation, language ability, intelligence, visual attention, and executive function. Groups were compared in these cognitive domains. Simple regression analysis was used to analyze the effects of epilepsy-related clinical variables on cognitive test scores. RESULTS Compared with control subjects, children with childhood absence epilepsy and benign childhood epilepsy with centrotemporal spikes showed cognitive deficits in intelligence and executive function, but performed normally in language processing. Impairment in visual attention was specific to patients with childhood absence epilepsy, whereas impaired spatial ability was specific to the children with benign childhood epilepsy with centrotemporal spikes. Simple regression analysis showed syndrome-related clinical variables did not affect cognitive functions. CONCLUSIONS This study provides evidence of both common and distinctive cognitive features underlying the relative cognitive difficulties in children with childhood absence epilepsy and benign childhood epilepsy with centrotemporal spikes. Our data suggest that clinicians should pay particular attention to the specific cognitive deficits in children with childhood absence epilepsy and benign childhood epilepsy with centrotemporal spikes, to allow for more discriminative and potentially more effective interventions.
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Affiliation(s)
- Dazhi Cheng
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Xiuxian Yan
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Zhijie Gao
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Keming Xu
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Xinlin Zhou
- National Key Laboratory of Cognitive Neuroscience and Learning, Institute of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Qian Chen
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing, China.
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Psychosocial and behavioral functioning and their relationship to seizure timing in children with benign epilepsy with centrotemporal spikes. Brain Dev 2017; 39:515-520. [PMID: 28214048 DOI: 10.1016/j.braindev.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Psychosocial and behavioral problems have been reported in children with benign epilepsy with centrotemporal spikes (BECTS). Distinctive features of typical BECTS associated with cognitive and behavioral problems have not clearly been defined. PURPOSE We aimed to identify psychosocial and behavioral functioning and their relationship to seizure timing in BECTS. METHODS Consecutive patients with BECTS were recruited from the pediatric neurology outpatient clinic between May 2015 and May 2016. The patients were divided into two subgroups in according to seizure timing; group 1 consisted of patients with seizures only in the morning short before awakening, and group 2 consisted of patients with seizure shortly after falling asleep or in both time periods. Neuropsychological and behavioral evaluation in patients and healthy controls were examined using the Wechsler Intelligence Scale for Children-Revised test and the Turkish version of Strengths and Difficulties Questionnaire (SDQ). RESULTS The participants comprised 46 children with BECTS and 49 healthy controls aged 7-16years. There was no significant difference between group 1, group 2, and control group regarding intelligence quantity in full-scale or verbal and performance subscales. Behavioral scores for overall stress significantly differed between group 2 and controls on the SDQ test, while group 1 and control group had no difference on the SDQ scores. CONCLUSION Patients with BECTS who have seizure shortly after falling asleep may have a tendency towards behavior difficulties.
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Leôncio DC, Aragão L, Cassiano MA, Andrade P, De Medeiros TM, Rocha TF, Azoni C, Hazin I. Working memory and phonological awareness in children with rolandic epilepsy. UNIVERSITAS PSYCHOLOGICA 2017. [DOI: 10.11144/javeriana.upsy15-5.wmpa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study investigated how the difficulties in language in children with Rolandic Epilepsy (RE) could be related to alterations in their development of phonological awareness and/or working memory. We evaluated fourty-two children aged 6 to 13 years old. From these, twenty-one children were diagnosed with RE and formed the experimental group; and twenty-one children without RE, paired with the experimental group by sex, age, education and socioeconomic status, formed the control group. The results showed significant differences in the performances of children with RE and healthy children in the tests that evaluated working memory and phonological awareness. Also, positive and high significant correlations were found between working memory and phonological awareness in the RE clinical subgroup. Generally, the results suggest that compromises in both cognitive functions might be associated to loss of language capabilities in children with RE, and also point that the development of working memory and phonological awareness are interconnected.
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