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Pugh R, Vaughan DN, Jackson GD, Ponsford J, Tailby C. Cognitive and psychological dysfunction is present after a first seizure, prior to epilepsy diagnosis and treatment at a First Seizure Clinic. Epilepsia Open 2024; 9:717-726. [PMID: 38319041 PMCID: PMC10984291 DOI: 10.1002/epi4.12909] [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: 11/09/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Neuropsychological comorbidities found in chronic epilepsy have also been reported earlier in the disease course. However, recurrent seizures, antiseizure medication (ASM), and adjustment to a chronic diagnosis remain potential confounds of this literature. It thus remains unclear whether these comorbidities are primary or secondary attributes of epilepsy. To capture individuals as close to disease onset as possible, we studied the cognitive and psychological functioning in adults after their first seizure, yet prior to epilepsy diagnosis and treatment. METHODS Using a telehealth-based prospective design, we screened cognition, mood, and anxiety symptoms in adult patients referred to a First Seizure Clinic (FSC), who were over 18 years, English-speaking and not taking ASM. We screened cognition via telephone, and psychological symptoms via online questionnaires, all prior to the patients' diagnostic evaluation. Data were collected on 32 individuals subsequently diagnosed with epilepsy at the FSC, and 30 healthy controls from the community, who were matched to the epilepsy group for age, gender, and education. RESULTS A multivariate analysis of variance revealed that the groups differed significantly on combined cognitive measures with a large effect size (F[1,56] = 5.75, p < 0.001, η2 = 0.45). Post-hoc analyses showed that performances on measures of verbal memory, working memory, and executive functions were significantly worse for the newly diagnosed epilepsy group than controls. The epilepsy group also exhibited higher rates of clinically significant depressive and anxiety symptoms. SIGNIFICANCE Cognitive and psychological dysfunction is prevalent in people with epilepsy as early as the first seizure event, before the influence of diagnosis, ASM and recurrent seizures. Their neuropsychological profile parallels that seen in chronic epilepsy, showing that this dysfunction is already present at the very onset of the disease. The current study demonstrates the viability of telehealth neuropsychological screening for all new epilepsy cases. PLAIN LANGUAGE STATEMENT The results of this study show, using telephone-based cognitive assessment and online questionnaires, that people with newly diagnosed epilepsy can experience problems with their thinking and memory skills, and low mood and anxiety, as early as after their first seizure. These issues are apparent at the very beginning of the disease, before an epilepsy diagnosis is made and before antiseizure medication is commenced, which suggests that they are due to the underlying brain disturbance, rather than the secondary effects of seizures, treatment, or lifestyle changes. Telehealth-screening of thinking skills and mental health for all new epilepsy cases is recommended to promote early management of such problems.
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Affiliation(s)
- Remy Pugh
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
| | - David N. Vaughan
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
| | - Jennie Ponsford
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Epworth Rehabilitation Research CentreEpworth HealthcareMelbourneVictoriaAustralia
| | - Chris Tailby
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of Clinical NeuropsychologyAustin HealthMelbourneVictoriaAustralia
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Pang X, Liang X, Chang W, Lv Z, Zhao J, Wu P, Li X, Wei W, Zheng J. The role of the thalamus in modular functional networks in temporal lobe epilepsy with cognitive impairment. CNS Neurosci Ther 2024; 30:e14345. [PMID: 37424152 PMCID: PMC10848054 DOI: 10.1111/cns.14345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 06/04/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE Cognitive deficit is common in patients with temporal lobe epilepsy (TLE). Here, we aimed to investigate the modular architecture of functional networks associated with distinct cognitive states in TLE patients together with the role of the thalamus in modular networks. METHODS Resting-state functional magnetic resonance imaging scans were acquired from 53 TLE patients and 37 matched healthy controls. All patients received the Montreal Cognitive Assessment test and accordingly were divided into TLE patients with normal cognition (TLE-CN, n = 35) and TLE patients with cognitive impairment (TLE-CI, n = 18) groups. The modular properties of functional networks were calculated and compared including global modularity Q, modular segregation index, intramodular connections, and intermodular connections. Thalamic subdivisions corresponding to the modular networks were generated by applying a 'winner-take-all' strategy before analyzing the modular properties (participation coefficient and within-module degree z-score) of each thalamic subdivision to assess the contribution of the thalamus to modular functional networks. Relationships between network properties and cognitive performance were then further explored. RESULTS Both TLE-CN and TLE-CI patients showed lower global modularity, as well as lower modular segregation index values for the ventral attention network and the default mode network. However, different patterns of intramodular and intermodular connections existed for different cognitive states. In addition, both TLE-CN and TLE-CI patients exhibited anomalous modular properties of functional thalamic subdivisions, with TLE-CI patients presenting a broader range of abnormalities. Cognitive performance in TLE-CI patients was not related to the modular properties of functional network but rather to the modular properties of functional thalamic subdivisions. CONCLUSIONS The thalamus plays a prominent role in modular networks and potentially represents a key neural mechanism underlying cognitive impairment in TLE.
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Affiliation(s)
- Xiaomin Pang
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Xiulin Liang
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Weiwei Chang
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Zongxia Lv
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Jingyuan Zhao
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Peirong Wu
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Xinrong Li
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Wutong Wei
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
| | - Jinou Zheng
- Department of NeurologyGuangxi Medical University First Affiliated HospitalNanningChina
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Ai H, Yang C, Lu M, Ren J, Li Z, Zhang Y. Abnormal white matter structural network topological property in patients with temporal lobe epilepsy. CNS Neurosci Ther 2024; 30:e14414. [PMID: 37622409 PMCID: PMC10805448 DOI: 10.1111/cns.14414] [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: 02/13/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) studies have demonstrated white matter (WM) abnormalities in patients with temporal lobe epilepsy (TLE). However, alterations in the topological properties of the WM structural network in patients with TLE remain unclear. Graph theoretical analysis provides a new perspective for evaluating the connectivity of WM structural networks. METHODS DTI was used to map the structural networks of 18 patients with TLE (10 males and 8 females) and 29 (17 males and 12 females) age- and gender-matched normal controls (NC). Graph theory was used to analyze the whole-brain networks and their topological properties between the two groups. Finally, partial correlation analyses were performed on the weighted network properties and clinical characteristics, namely, duration of epilepsy, verbal intelligence quotient (IQ), and performance IQ. RESULTS Patients with TLE exhibited reduced global efficiency and increased characteristic path length. A total of 31 regions with nodal efficiency alterations were detected in the fractional anisotropy_ weighted network of the patients. Communication hubs, such as the middle temporal gyrus, right inferior temporal gyrus, left calcarine, and right superior parietal gyrus, were also differently distributed in the patients compared with the NC. Several node regions showed close relationships with duration of epilepsy, verbal IQ, and performance IQ. CONCLUSIONS Our results demonstrate the disruption of the WM structural network in TLE patients. This study may contribute to the further understanding of the pathological mechanism of TLE.
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Affiliation(s)
- Haiming Ai
- Faculty of Science and TechnologyBeijing Open UniversityBeijingChina
| | - Chunlan Yang
- College of Life Science and BioengineeringBeijing University of TechnologyBeijingChina
| | - Min Lu
- College of Life Science and BioengineeringBeijing University of TechnologyBeijingChina
| | - Jiechuan Ren
- Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Zhimei Li
- Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yining Zhang
- Department of EquipmentBaoding first Central HospitalBaodingChina
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Chauvière L. Early cognitive comorbidities before disease onset: A common symptom towards prevention of related brain diseases? Heliyon 2022; 8:e12259. [PMID: 36590531 PMCID: PMC9800323 DOI: 10.1016/j.heliyon.2022.e12259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
Brain diseases are very heterogeneous; however they also display multiple common risk factors and comorbidities. With a paucity of disease-modifying therapies, prevention became a health priority. Towards prevention, one strategy is to focus on similar symptoms of brain diseases occurring before disease onset. Cognitive deficits are a promising candidate as they occur across brain diseases before disease onset. Based on recent research, this review highlights the similarity of brain diseases and discusses how early cognitive deficits can be exploited to tackle disease prevention. After briefly introducing common risk factors, I review common comorbidities across brain diseases, with a focus on cognitive deficits before disease onset, reporting both experimental and clinical findings. Next, I describe network abnormalities associated with early cognitive deficits and discuss how these abnormalities can be targeted to prevent disease onset. A scenario on brain disease etiology with the idea that early cognitive deficits may constitute a common symptom of brain diseases is proposed.
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Bakhtiari A, Bjørke AB, Larsson PG, Olsen KB, Nævra MCJ, Taubøll E, Heuser K, Østby Y. Episodic Memory Dysfunction and Effective Connectivity in Adult Patients With Newly Diagnosed Nonlesional Temporal Lobe Epilepsy. Front Neurol 2022; 13:774532. [PMID: 35222242 PMCID: PMC8866246 DOI: 10.3389/fneur.2022.774532] [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: 09/12/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Epilepsy is associated with both changes in brain connectivity and memory function, usually studied in the chronic patients. The aim of this study was to explore the presence of connectivity alterations measured by EEG in the parietofrontal network in patients with temporal lobe epilepsy (TLE), and to examine episodic memory, at the time point of diagnosis. Methods The parietofrontal network of newly diagnosed patients with TLE (N = 21) was assessed through electroencephalography (EEG) effective connectivity and compared with that of matched controls (N = 21). Furthermore, we assessed phenomenological aspects of episodic memory in both groups. Association between effective connectivity and episodic memory were assessed through correlation. Results Patients with TLE displayed decreased episodic (p ≤ 0.001, t = −5.18) memory scores compared with controls at the time point of diagnosis. The patients showed a decreased right parietofrontal connectivity (p = 0.03, F = 4.94) compared with controls, and significantly weaker connectivity in their right compared with their left hemisphere (p = 0.008, t = −2.93). There were no significant associations between effective connectivity and episodic memory scores. Conclusions We found changes in both memory function and connectivity at the time point of diagnosis, supporting the notion that TLE involves complex memory functions and brain networks beyond the seizure focus to strongly interconnected brain regions, already early in the disease course. Whether the observed connectivity changes can be interpreted as functionally important to the alterations in memory function, it remains speculative.
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Affiliation(s)
- Aftab Bakhtiari
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Agnes Balint Bjørke
- Division of Clinical Neuroscience, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Neurology, Rheumatology and Habilitation, Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Gunnar Larsson
- Section of Clinical Neurophysiology, Division of Clinical Neuroscience, Department of Neurosurgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway
| | - Ketil Berg Olsen
- Section of Clinical Neurophysiology, Division of Clinical Neuroscience, Department of Neurosurgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway
| | - Marianne C. Johansen Nævra
- Section of Clinical Neurophysiology, Division of Clinical Neuroscience, Department of Neurosurgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway
| | - Erik Taubøll
- Division of Clinical Neuroscience, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Neurology, Rheumatology and Habilitation, Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Kjell Heuser
- Division of Clinical Neuroscience, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- *Correspondence: Kjell Heuser
| | - Ylva Østby
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Ylva Østby
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Merten JE, Villarrubia SA, Holly KS, Kemp AS, Kumler AC, Larson-Prior LJ, Murray TA. The use of rodent models to better characterize the relationship among epilepsy, sleep, and memory. Epilepsia 2022; 63:525-536. [PMID: 34985784 DOI: 10.1111/epi.17161] [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: 08/24/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
Epilepsy, a neurological disorder characterized by recurrent seizures, is known to be associated with impaired sleep and memory. Although the specific mechanisms underlying these impairments are uncertain, the known role of sleep in memory consolidation suggests a potential relationship may exist between seizure activity, disrupted sleep, and memory impairment. A possible mediator in this relationship is the sleep spindle, the characteristic electroencephalographic (EEG) feature of non-rapid-eye-movement (NREM) sleep in humans and other mammals. Growing evidence supports the idea that sleep spindles, having thalamic origin, may mediate the process of long-term memory storage and plasticity by generating neuronal conditions that favor these processes. To study this potential relationship, a single model in which memory, sleep, and epilepsy can be simultaneously observed is of necessity. Rodent models of epilepsy appear to fulfill this requirement. Not only do rodents express both sleep spindles and seizure-induced sleep disruptions, but they also allow researchers to invasively study neurobiological processes both pre- and post- epileptic onset via the artificial induction of epilepsy (a practice that cannot be carried out in human subjects). However, the degree to which sleep architecture differs between rodents and humans makes direct comparisons between the two challenging. This review addresses these challenges and concludes that rodent sleep studies are useful in observing the functional roles of sleep and how they are affected by epilepsy.
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Affiliation(s)
- John E Merten
- College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA
| | | | - Kevin S Holly
- Biomedical Engineering, Louisiana Tech University, Ruston, Louisina, USA
| | - Aaron S Kemp
- Departments of Psychiatry and Biomedical Informatics, UAMS, Little Rock, Arkansas, USA
| | - Allison C Kumler
- Biomedical Engineering, Louisiana Tech University, Ruston, Louisina, USA
| | - Linda J Larson-Prior
- Departments of Psychiatry and Biomedical Informatics, UAMS, Little Rock, Arkansas, USA.,Departments of Neurology, Neurobiology & Developmental Sciences, Pediatrics, UAMS, Little Rock, Arkansas, USA
| | - Teresa A Murray
- Biomedical Engineering, Louisiana Tech University, Ruston, Louisina, USA
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Hatlestad-Hall C, Bruña R, Erichsen A, Andersson V, Syvertsen MR, Skogan AH, Renvall H, Marra C, Maestú F, Heuser K, Taubøll E, Solbakk AK, Haraldsen IH. The organization of functional neurocognitive networks in focal epilepsy correlates with domain-specific cognitive performance. J Neurosci Res 2021; 99:2669-2687. [PMID: 34173259 DOI: 10.1002/jnr.24896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/28/2021] [Accepted: 05/15/2021] [Indexed: 11/10/2022]
Abstract
Understanding and diagnosing cognitive impairment in epilepsy remains a prominent challenge. New etiological models suggest that cognitive difficulties might not be directly linked to seizure activity, but are rather a manifestation of a broader brain pathology. Consequently, treating seizures is not sufficient to alleviate cognitive symptoms, highlighting the need for novel diagnostic tools. Here, we investigated whether the organization of three intrinsic, resting-state functional connectivity networks was correlated with domain-specific cognitive test performance. Using individualized EEG source reconstruction and graph theory, we examined the association between network small worldness and cognitive test performance in 23 patients with focal epilepsy and 17 healthy controls, who underwent a series of standardized pencil-and-paper and digital cognitive tests. We observed that the specific networks robustly correlated with test performance in distinct cognitive domains. Specifically, correlations were evident between the default mode network and memory in patients, the central-executive network and executive functioning in controls, and the salience network and social cognition in both groups. Interestingly, the correlations were evident in both groups, but in different domains, suggesting an alteration in these functional neurocognitive networks in focal epilepsy. The present findings highlight the potential clinical relevance of functional brain network dysfunction in cognitive impairment.
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Affiliation(s)
| | - Ricardo Bruña
- Center for Biomedical Technology, Technical University of Madrid, Pozuelo de Alarcón, Spain.,Department of Experimental Psychology, Complutense University of Madrid, Pozuelo de Alarcón, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Aksel Erichsen
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Marte Roa Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Care Trust, Drammen, Norway
| | - Annette Holth Skogan
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Hanna Renvall
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, Finland.,BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, University of Helsinki and Aalto, Helsinki, Finland
| | - Camillo Marra
- Department of Neuroscience, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Fernando Maestú
- Center for Biomedical Technology, Technical University of Madrid, Pozuelo de Alarcón, Spain.,Department of Experimental Psychology, Complutense University of Madrid, Pozuelo de Alarcón, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Kjell Heuser
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erik Taubøll
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Kristin Solbakk
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Ira H Haraldsen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
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