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Hu J, Chen G, Zeng Z, Ran H, Zhang R, Yu Q, Xie Y, He Y, Wang F, Li X, Huang K, Liu H, Zhang T. Systematically altered connectome gradient in benign childhood epilepsy with centrotemporal spikes: Potential effect on cognitive function. Neuroimage Clin 2024; 43:103628. [PMID: 38850833 PMCID: PMC11201345 DOI: 10.1016/j.nicl.2024.103628] [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: 02/25/2024] [Revised: 05/06/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Benign childhood epilepsy with centrotemporal spikes (BECTS) affects brain network hierarchy and cognitive function; however, itremainsunclearhowhierarchical changeaffectscognition in patients with BECTS. A major aim of this study was to examine changes in the macro-network function hierarchy in BECTS and its potential contribution to cognitive function. METHODS Overall, the study included 50 children with BECTS and 69 healthy controls. Connectome gradient analysis was used to determine the brain network hierarchy of each group. By comparing gradient scores at each voxel level and network between groups, we assessed changes in whole-brain voxel-level and network hierarchy. Functional connectivity was used to detect the functional reorganization of epilepsy caused by these abnormal brain regions based on these aberrant gradients. Lastly, we explored the relationships between the change gradient and functional connectivity values and clinical variables and further predicted the cognitive function associated with BECTS gradient changes. RESULTS In children with BECTS, the gradient was extended at different network and voxel levels. The gradient scores frontoparietal network was increased in the principal gradient of patients with BECTS. The left precentral gyrus (PCG) and right angular gyrus gradient scores were significantly increased in the principal gradient of children with BECTS. Moreover, in regions of the brain with abnormal principal gradients, functional connectivity was disrupted. The left PCG gradient score of children with BECTS was correlated with the verbal intelligence quotient (VIQ), and the disruption of functional connectivity in brain regions with abnormal principal gradients was closely related to cognitive function. VIQ was significantly predicted by the principal gradient map of patients. SIGNIFICANCE The results indicate connectome gradient disruption in children with BECTS and its relationship to cognitive function, thereby increasing our understanding of the functional connectome hierarchy and providing potential biomarkers for cognitive function of children with BECTS.
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Affiliation(s)
- Jie Hu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China; Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guiqin Chen
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China; Department of Radiology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang 550001, China
| | - Zhen Zeng
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Haifeng Ran
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Ruoxi Zhang
- Department of Radiology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang 550001, China
| | - Qiane Yu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Yuxin Xie
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Yulun He
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Fuqin Wang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Xuhong Li
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Kexing Huang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China.
| | - Tijiang Zhang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China.
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Li Y, Chen J, Sun J, Jiang P, Xiang J, Chen Q, Hu Z, Wang X. Changes in functional connectivity in newly diagnosed self-limited epilepsy with centrotemporal spikes and cognitive impairment: An MEG study. Brain Behav 2022; 12:e2830. [PMID: 36408856 PMCID: PMC9759146 DOI: 10.1002/brb3.2830] [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: 02/19/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Our purpose was to explore the relationship between cognitive impairment and neural network changes in patients newly diagnosed with self-limited epilepsy with centrotemporal spikes (SeLECTS). METHODS The Wechsler Intelligence Scale for Children, fourth edition was used to divide all SeLECTS patients into two groups: patients with full-scale intelligence quotient (FSIQ) below 80 that corresponded to cognitive impairment, and patients with FSIQ above 80 that corresponded to a normal cognitive function. The data on the resting state were recorded using magnetoencephalography. The properties of the networks were analyzed using graph theory (GT) analysis. RESULTS The functional connectivity (FC) of the frontal cortex in patients with FSIQ < 80 was reduced in the 12-30 Hz frequency band, and the FC of the posterior cingulate cortex was reduced in the 80-250 and 250-500 Hz frequency bands. The GT analysis showed that patients in the FSIQ < 80 group had higher strength in the 8-12 and 12-30 Hz frequency bands than those in the healthy control and FSIQ > 80 group. However, the path length was reduced in the 80-250 Hz band, and the clustering coefficient was reduced in the 12-30, 80-250, and 250-500 Hz frequency bands. Moreover, the receiver operator characteristic analysis showed that the clustering coefficient in the 12-30 and 80-250 Hz frequency bands, as well as the path length in the 80-250 Hz frequency band possessed a good discriminative ability in distinguishing the FSIQ > 80 group. CONCLUSIONS SeLECTS patients with cognitive impairment in the early stage of the disease developed disordered networks in cognitive-related brain regions. The clustering coefficient in the 12-30 and 80-250 Hz frequency bands as well as the path length in the 80-250 Hz frequency band might be good indicators to distinguish the cognitive impairment of SeLECTS patients at the early stage.
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Affiliation(s)
- Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinan Chen
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping Jiang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Li Y, Wang Y, Jiang P, Sun J, Chen Q, Wang X. Alterations in the default mode network in rolandic epilepsy with mild spike-wave index in non-rapid eye movement sleep. Front Neurosci 2022; 16:944391. [PMID: 36017188 PMCID: PMC9395966 DOI: 10.3389/fnins.2022.944391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Rolandic epilepsy (RE) is one of the most common epilepsy syndromes during childhood. The aim of this study was to investigate the alterations in the default mode network (DMN) of RE patients whose spike-wave index (SWI) was within the 50–85% range during non-rapid eye movement (NREM) during sleep, as well as to detect early neuroimaging markers. Methods Resting-state data was recorded for each subject using magnetoencephalography (MEG). DMN-related brain regions were chosen as regions of interest. The spectral power and functional connectivity (FC) of the DMN were estimated through the use of minimum norm estimation (MNE) combined with Welch technique and corrected amplitude envelope correlation (AEC-c). Results The patient group included 20 patients with NREM phase 50% ≤ SWI < 85% (mild SWI group), and 18 typical RE patients (SWI < 50% group). At the regional level, the mild SWI group exhibited enhanced spectral power in the delta band of the bilateral posterial cingulate cortex and attenuated the spectral power in the alpha band of the bilateral posterial cingulate cortex. Enhanced spectral power in the bilateral precuneus (PCu) in the delta band and attenuated spectral power in the right lateral temporal cortex (LTC) in the alpha band were common across all RE patients. At the FC level, patients in the mild SWI group indicated increased AEC-c values between the bilateral posterial cingulate cortex in the delta band and between the left medial frontal cortex (MFC) and bilateral posterial cingulate cortex in the alpha band. Increased AEC-c values between the right PCu and left MFC in the delta band, and between the left PCu and right MFC in the theta band, were common across all RE patients. Moreover, the spectral power in the bilateral posterial cingulate cortex in the alpha band and the AEC-c value between the bilateral posterial cingulate cortex in the delta band demonstrated good discrimination ability. Conclusion The spectral power of the bilateral posterior cingulate cortex (PCC) in the alpha band and the AEC-c value between the bilateral PCC in the delta band may be promising indicators of early differentiation between mild SWI and typical RE.
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Affiliation(s)
- Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Jiang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xiaoshan Wang,
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Abstract
SUMMARY Although interictal spikes (IISs) are a well-established EEG biomarker for epilepsy, whether they are also a biomarker of cognitive deficits is unclear. Interictal spikes are dynamic events consisting of a synchronous discharge of neurons producing high frequency oscillations and a succession of action potentials which disrupt the ongoing neural activity. There are robust data showing that IISs result in transitory cognitive impairment with the type of deficit specific to the cognitive task and anatomic location of the IIS. Interictal spike, particularly if frequent and widespread, can impair cognitive abilities, through interference with waking learning and memory and memory consolidation during sleep. Interictal spikes seem to be particularly concerning in the developing brain where animal data suggest that IISs can lead to adverse cognitive effects even after the disappearance of the spikes. Whether a similar phenomenon occurs in human beings is unclear. Thus, although IISs are a clear biomarker of transitory cognitive impairment, currently, they lack sensitivity and specificity as a biomarker for enduring cognitive impairment.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences Larner College of Medicine at the University of Vermont, Burlington, Vermont, U.S.A
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Jiang L, Ma X, Liu H, Wang J, Zhang J, Zhang G, Li S, Zhang T. Aberrant Dynamics of Regional Coherence Measured by Resting-State fMRI in Children With Benign Epilepsy With Centrotemporal Spikes (BECTS). Front Neurol 2021; 12:712071. [PMID: 34975706 PMCID: PMC8715032 DOI: 10.3389/fneur.2021.712071] [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: 05/22/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the dynamic features of intrinsic brain activity measured by fMRI in children with benign epilepsy with centrotemporal spikes (BECTS) and examine whether these indexes were associated with behaviors. Methods: We recruited 26 children with BECTS (10.35 ± 2.91 years) and 26 sex-, and age-matched (11.35 ± 2.51 years) healthy controls (HC) and acquired resting-state functional magnetic resonance imaging (rs-fMRI) and behavioral data. Dynamic regional homogeneity (dReHo), including mean and coefficient of variation (CV) metrics derived from the rs-fMRI data, and were compared between the BECTS and the HC groups. Results: Significantly decreased mean dReHo in bilateral supramarginal gyrus, left middle temporal gyrus (MTG.L), left postcentral gyrus and superior occipital gyrus were found in children with BECTS. Meanwhile, increased CV of dReHo in MTG.L and right fusiform in children with BECTS was revealed compared with HC. Further analyses of functional connectivity revealed decreased global signal FC existed in similar regions, linked with linguistic, social cognition, and sensorimotor processes, in children with BECTS compared with HCs. Moreover, the association analyses showed that the CV of dReHo in MTG.L was positively associated with age and a negative correlation was found between mean dReHo of MTG.L and disease duration. Besides, the CV of dReHo in MTG.L was found positively associated with the intelligence quotient (IQ) language scores and full IQ scores in children with BECTS, and the CV of dReHo in the left inferior temporal gyrus and Rolandic operculum were positively correlated with IQ operation scores and full IQ scores. Conclusion: Aberrant dynamic regional coherence in sensorimotor, linguistic, and lateral temporal regions suggests dynamical interplay that underlying cognitive performance in children with BECTS, suggesting an intrinsic dynamic mechanism for BECTS.
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Affiliation(s)
- Lin Jiang
- Department of Radiology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
- Department of Radiology, Medical Imaging Center, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xuejin Ma
- Department of Radiology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Heng Liu
- Department of Radiology, Medical Imaging Center, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ji Wang
- Department of Radiology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Jiaren Zhang
- Department of Radiology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Guoming Zhang
- Department of Radiology, Medical Imaging Center, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shiguang Li
- Department of Radiology, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Tijiang Zhang
- Department of Radiology, Medical Imaging Center, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Kessi M, Yan F, Pan L, Chen B, Olatoutou E, Li D, He F, Rugambwa T, Yang L, Peng J, Yin F. Treatment for the Benign Childhood Epilepsy With Centrotemporal Spikes: A Monocentric Study. Front Neurol 2021; 12:670958. [PMID: 34025572 PMCID: PMC8134665 DOI: 10.3389/fneur.2021.670958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose: To date, there is no specific treatment guideline for the benign childhood epilepsy with centrotemporal spikes (BECTS). Several countries recommend levetiracetam, carbamazepine, sodium valproate, oxcarbazepine, and lamotrigine as first-line drugs. Nevertheless, some of these drugs are associated with cognitive decline. Available studies that investigated the efficacy of levetiracetam and sodium valproate on BECTS involved small sample sizes. This study aimed to evaluate the efficacy of levetiracetam and sodium valproate on cognition, and to investigate the prognostic factors for BECTS as whole. Methods: Clinical data and treatment status of all patients with BECTS at Xiangya Hospital, Central South University followed from 2008 to 2013 were analyzed retrospectively. Since electrical status epilepticus in sleep (ESES) has been confirmed to play a role in cognitive deterioration, in order to evaluate the response to drugs and their cognitive effects, we created two groups of patients according to the levels of spike wave index (SWI): group 1; 0–50% SWI and group 2; >50% SWI at the last follow up. Results: A total of 195 cases were enrolled: 49.7% received monotherapies, 24.1% duotherapies and 27.2% polytherapies. Medications included; levetiracetam plus other drug (s) (75.9%), levetiracetam alone (32.8%), sodium valproate plus other drug (s) (31.3%), and sodium valproate alone (5.1%). After 2 years of treatment and follow up, 71% of the cases had a good seizure outcome, 15.9% had an improvement of SWI, and 91.7% had a normal DQ/IQ. Sodium valproate combined with levetiracetam, and sodium valproate alone correlated with good improvement of SWI, whereas, focal spikes were linked with poor improvement. For both groups (group 1 and group 2): monotherapy, levetiracetam alone, and a normal DQ/IQ at seizure onset correlated with good cognitive outcomes, in contrast, polytherapy, sodium valproate plus other drug (s), levetiracetam plus sodium valproate, an initial SWI of ≥85%, and multifocal spikes were linked to cognitive deterioration. Conclusions: Monotherapy, particularly levetiracetam seems to be a good first-line therapy which can help in normalizing the electroencephalograph and preventing cognitive decline. Polytherapy, mostly the administration of sodium valproate seems to relate with poor cognition, therefore, it is recommended to avoid it.
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Affiliation(s)
- Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fangling Yan
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Langui Pan
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Baiyu Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Eleonore Olatoutou
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Dong Li
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Tibera Rugambwa
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
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Li Y, Sun Y, Zhang T, Shi Q, Sun J, Xiang J, Chen Q, Hu Z, Wang X. The relationship between epilepsy and cognitive function in benign childhood epilepsy with centrotemporal spikes. Brain Behav 2020; 10:e01854. [PMID: 32959999 PMCID: PMC7749571 DOI: 10.1002/brb3.1854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This study was aimed to explore the relationship between neural network changes in newly diagnosed children with Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) and cognitive impairment. METHODS Children's cognition was evaluated using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). Magnetoencephalographic (MEG) data of 18 healthy children and 22 BECTS patients were recorded in order to construct a functional connectivity (FC) network, which was quantified by graph theory (GT). RESULTS The mean age of the control group was 7.94 ± 1.89 years, and the mean age of BECTS patients was 8.14 ± 1.73 years. Our results show that the WISC-IV index scores in the BECTS group were significantly lower than those in the control group. Besides, the FC network pattern of BECTS patients changed significantly in the 12-30, 30-80, and 250-500 Hz frequency band. The local functional connections between posterior cingulate cortex (PCC) and frontal lobe varied significantly in 12-30, 80-250, and 250-500 Hz. Our GT analysis shows that the connection strength of BECTS patients increases significantly in the 12-30 Hz frequency band, the path length decreases significantly in the 12-30 Hz and 30-80 Hz frequency bands, with the clustering coefficient decreasing significantly in the 12-30 Hz, 30-80 Hz, and 250-500 Hz frequency bands. Correlation analysis showed that the full-scale IQ (FSIQ) was positively correlated with the 12-30 Hz clustering coefficient, verbal comprehension index (VCI) was positively correlated with the 250-500 Hz clustering coefficient, perceptual reasoning index (PRI) was positively correlated with the 12-30 Hz clustering coefficient, and perceptual reasoning index (PSI) was negatively correlated with the 12-30 Hz path length. CONCLUSION There is a trend of cognitive impairment in patients with early BECTS. This trend of cognitive impairment in early BECTS children may be related to the changes in the FC network pattern.
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Affiliation(s)
- Yihan Li
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yulei Sun
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Tingting Zhang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Qi Shi
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
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Li Y, Sun Y, Niu K, Wang P, Xiang J, Chen Q, Hu Z, Wang X. The relationship between neuromagnetic activity and cognitive function in benign childhood epilepsy with centrotemporal spikes. Epilepsy Behav 2020; 112:107363. [PMID: 32858366 DOI: 10.1016/j.yebeh.2020.107363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Our aim was to explore the pathophysiological mechanism of cognitive function changes in early untreated children with benign childhood epilepsy with centrotemporal spikes (BECTS). METHODS Magnetoencephalography (MEG) was performed in 33 children with BECTS and 18 healthy children. Wechsler Intelligence Scale for Children, fourth edition (WISC-IV) was used to divide children with BECTS into two groups. Normal cognitive function was defined as a full-scale intelligence quotient (FSIQ) of >80, while decreased cognitive function was defined as a FSIQ of <80. Accumulated source imaging was used to evaluate the neuromagnetic source activity in multifrequency bands. RESULTS Of the 33 patients with early untreated BECTS, a total of 17 had a FSIQ of <80 and 16 had FSIQ of >80. The course of epilepsy and number of seizures in the FSIQ <80 group were higher than that in the FSIQ >80 group. Our MEG results showed that in the 4-8 Hz frequency band, both patient groups had inactivation of the posterior cingulate cortex (PCC) region compared with the healthy control group. In the 30-80 Hz frequency band, the FSIQ <80 group showed inactivation of the PCC region compared with both the healthy control group and the FSIQ >80 group. In the 80-250 Hz frequency band, the FSIQ <80 group had inactivated of the medial frontal cortex (MFC) region compared with the healthy control group. In the 30-80 Hz frequency band, the strength of neuromagnetic source in patients with BECTS with FSIQ <80 was higher than that in the FSIQ >80 group and the healthy control group. CONCLUSIONS The magnetic source inactivation of the MFC and PCC regions during the interictal time may be the reason for cognitive decline in early untreated children with BECTS. Children with BECTS with cognitive decline had a longer course of epilepsy and more seizures. The magnetic source localization in the 4-8 Hz frequency band may be a new imaging marker for the diagnosis of new BECTS.
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Affiliation(s)
- Yihan Li
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yulei Sun
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Kai Niu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Pengfei Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45220, USA
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Disrupted alertness and related functional connectivity in patients with focal impaired awareness seizures in temporal lobe epilepsy. Epilepsy Behav 2020; 112:107369. [PMID: 32858367 DOI: 10.1016/j.yebeh.2020.107369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Focal impaired awareness seizures are common in temporal lobe epilepsy (TLE). The cognitive impairment associated with this type of seizure is unclear. Alertness is a fundamental aspect of cognition. The locus coeruleus (LC) is closely related to alertness. We aimed to assess the impairment in alertness and LC-related alertness network in patients with focal impaired awareness seizures. METHODS Patients with unilateral TLE were grouped into the only focal impaired awareness seizure group (focal group, n = 19) and the focal impaired awareness seizure with focal to bilateral tonic-clonic seizure (FBTCS) group (FBTCS group, n = 19) and compared with matched healthy controls (HC, n = 19). Alertness was assessed with the attention network test. Functional magnetic resonance imaging (fMRI) was used to construct an alertness-related LC-based functional connectivity (FC) network. RESULTS The focal group exhibited impaired tonic and phasic alertness and exhibited a decreased trend of LC-based FC to the left superior frontal gyrus (SFG). The FBTCS group exhibited impaired tonic alertness, phasic alertness, and alertness efficiency. No significant difference or trend in LC-based FC was found in the FBTCS group. SIGNIFICANCE This study reveals disrupted alertness and alertness-related LC-based FC in patients with focal impaired awareness seizures. Our results further demonstrate that the patterns of impaired alertness and of changed LC-based FC were not significantly different between focal impaired awareness seizures and FBTCS.
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He W, Liu H, Liu Z, Wu Q. Electrical status epilepticus in sleep affects intrinsically connected networks in patients with benign childhood epilepsy with centrotemporal spikes. Epilepsy Behav 2020; 106:107032. [PMID: 32220803 DOI: 10.1016/j.yebeh.2020.107032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/14/2020] [Accepted: 03/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although outcomes of benign childhood epilepsy with centrotemporal spikes (BECTS) are frequently excellent, some atypical forms of BECTS, especially electrical status epilepticus in sleep (ESES), are characterized by worse outcomes and negative impacts on cognitive development. METHODS To explore specific ESES-related brain networks in patients with BECTS, we used resting-state functional magnetic resonance imaging (fMRI) to scan patients with BECTS with ESES (n = 9), patients with BECTS without ESES (n = 17), and healthy controls (n = 36). Unbiased seed-based whole-brain functional connectivity (FC) was adopted to explore the connectivity mode of three resting-state cerebral networks: the default mode network (DMN), salience network (SN), and central executive network (CEN). RESULTS Compared with the other two groups, patients with BECTS with ESES showed FC in the SN or in the CEN decreased, but not in the DMN. Moreover, we found the FC in the CEN in patients with BECTS without ESES decreased when compared with controls. Our currently intrinsically defined anticorrelated networks strength was disrupted in BECTS and connote greater deactivation than the results from FC for a seed region in children with BECTS. CONCLUSION These results indicated that children with BECTS with ESES showed brain activity altered in the CEN and the SN. The difference of impairment in the SN and CEN may lead to improve the understanding of the underlying neuropathophysiology, and to assess the activity of patients with BECTS with ESES, which is crucial for measuring disease activity, improving patient care, and assessing the effect of antiepilepsy therapy.
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Affiliation(s)
- Wen He
- Radiology Department of Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Renmin Middle Road 253rd, Guangzhou 510220, China
| | - Hongsheng Liu
- Radiology Department of Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Renmin Middle Road 253rd, Guangzhou 510220, China.
| | - Zhenqing Liu
- Radiology Department of Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Renmin Middle Road 253rd, Guangzhou 510220, China
| | - Qianqian Wu
- Radiology Department of Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Renmin Middle Road 253rd, Guangzhou 510220, China
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Hale AT, Sen S, Haider AS, Perkins FF, Clarke DF, Lee MR, Tomycz LD. Open Resection versus Laser Interstitial Thermal Therapy for the Treatment of Pediatric Insular Epilepsy. Neurosurgery 2020; 85:E730-E736. [PMID: 30888028 DOI: 10.1093/neuros/nyz094] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Various studies suggest that the insular cortex may play an underappreciated role in pediatric frontotemporal/parietal epilepsy. Here, we report on the postsurgical outcomes in 26 pediatric patients with confirmed insular involvement by depth electrode monitoring. OBJECTIVE To describe one of the largest series of pediatric patients with medically refractory epilepsy undergoing laser interstitial thermal therapy (LITT) or surgical resection of at least some portion of the insular cortex. METHODS Pediatric patients in whom invasive insular sampling confirmed insular involvement and who subsequently underwent a second stage surgery (LITT or open resection) were included. Complications and Engel Class outcomes at least 1 yr postsurgery were compiled as well as pathology results in the open surgical cases. RESULTS The average age in our cohort was 10.3 yr, 58% were male, and the average length of follow-up was 2.43 ± 0.20 (SEM) yr. A total of 14 patients underwent LITT, whereas 12 patients underwent open resection. Complications in patients undergoing either LITT or open resection were mostly minimal and generally transient. Forty-three percent of patients who underwent LITT were Engel Class I, compared to 50% of patients who underwent open insular resection. CONCLUSION Both surgical resection and LITT are valid management options in the treatment of medically refractory insular/opercular epilepsy in children. Although LITT may be a less invasive alternative to craniotomy, further studies are needed to determine its noninferiority in terms of complication rates and seizure freedom, especially in cases of cortical dysplasia that may involve extensive regions of the brain.
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Affiliation(s)
- Andrew T Hale
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sonali Sen
- Division of Child Neurology, Baylor College of Medicine, Houston, Texas
| | - Ali S Haider
- Department of Neurological Surgery, Texas A&M College of Medicine, Bryan, Texas
| | - Freedom F Perkins
- Department of Pediatric Neurology, Dell Children's Hospital, Austin, Texas
| | - Dave F Clarke
- Department of Pediatric Neurology, Texas Children's Hospital, Houston, Texas
| | - Mark R Lee
- Department of Neurological Surgery, Dell Children's Medical Center, Austin, Texas.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Luke D Tomycz
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
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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: 10] [Impact Index Per Article: 2.0] [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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13
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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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