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Crespo Pimentel B, Kuchukhidze G, Xiao F, Caciagli L, Hoefler J, Rainer L, Kronbichler M, Vollmar C, Duncan JS, Trinka E, Koepp MJ, Wandschneider B. Quantitative MRI Measures and Cognitive Function in People With Drug-Resistant Juvenile Myoclonic Epilepsy. Neurology 2024; 103:e209802. [PMID: 39303180 DOI: 10.1212/wnl.0000000000209802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuroimaging studies have so far identified structural changes in individuals with juvenile myoclonic epilepsy (JME) when compared with controls. However, the underlying mechanisms of drug-resistant JME remain unknown. In this study, we aimed at characterizing the structural underpinnings of drug-resistant JME using MRI-derived cortical morphologic markers. METHODS In this prospective cross-sectional 2-center study, T1-weighted MRI and neuropsychological measures of verbal memory and executive function were obtained in individuals with drug-resistant and drug-responsive JME recruited from epilepsy outpatient clinics and healthy controls. We performed vertexwise measurements of cortical thickness, surface area, and local gyrification index (LGI). Vertexwise group comparisons were corrected for multiple comparisons at a familywise error (FWE) of 0.05. The neuropsychological profile of disease subgroups was analyzed through principal component analysis. RESULTS We studied 42 individuals with drug-resistant JME (mean age 29 ± 11 years, 50% female), 37 with drug-responsive JME (mean age 34 ± 10, years, 59% female), and 71 healthy controls (mean age 21 ± 9 years, 61% female). Surface area was increased in participants with drug-resistant JME in the left temporal lobe (Cohen d = 0.82 [-0.52 to -1.12], pFWE < 0.05) when compared with the drug-responsive group. Although no cortical thickness changes were observed between disease subgroups, drug-resistant and drug-sensitive participants showed discrete cortical thinning against controls (Cohen d = -0.42 [-0.83 to -0.01], pFWE < 0.05; Cohen d = -0.57 [-1.03 to -0.11], pFWE < 0.05, respectively). LGI was increased in the left temporal and occipital lobes in drug-resistant participants (Cohen d = 0.60 [0.34-0.86], pFWE < 0.05) when contrasting against drug-sensitive participants, but not controls. The composite executive function score was reduced in drug-resistant individuals compared with controls and drug-sensitive individuals (-1.74 [-2.58 to -0.90], p < 0.001 and -1.29 [-2.25 to -0.33], p < 0.01, respectively). Significant correlations were observed between executive function impairment and increased surface area in the precuneus and medial prefrontal regions (r = -0.79, pFWE < 0.05) in participants with drug-resistant JME. DISCUSSION We identified a developmental phenotype in individuals with drug-resistant JME characterized by changes in cortical surface area and folding complexity, the extent of which correlates with executive dysfunction. No association was observed between cortical thickness and disease severity. Our findings support a neurodevelopmental basis for drug resistance and cognitive impairment in JME.
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Affiliation(s)
- Bernardo Crespo Pimentel
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Giorgi Kuchukhidze
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Fenglai Xiao
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Lorenzo Caciagli
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Julia Hoefler
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Lucas Rainer
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Martin Kronbichler
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Christian Vollmar
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - John S Duncan
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Eugen Trinka
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Matthias J Koepp
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Britta Wandschneider
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
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Au Yong HM, Clough M, Perucca P, Malpas CB, Kwan P, O'Brien TJ, Fielding J. Ocular motility as a measure of cerebral dysfunction in adults with focal epilepsy. Epilepsy Behav 2023; 141:109140. [PMID: 36812874 DOI: 10.1016/j.yebeh.2023.109140] [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: 09/08/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Using objective oculomotor measures, we aimed to: (1) compare oculomotor performance in patients with drug-resistant focal epilepsy to healthy controls, and (2) investigate the differential impact of epileptogenic focus laterality and location on oculomotor performance. METHODS We recruited 51 adults with drug-resistant focal epilepsy from the Comprehensive Epilepsy Programs of two tertiary hospitals and 31 healthy controls to perform prosaccade and antisaccade tasks. Oculomotor variables of interest were latency, visuospatial accuracy, and antisaccade error rate. Linear mixed models were performed to compare interactions between groups (epilepsy, control) and oculomotor tasks, and between epilepsy subgroups and oculomotor tasks for each oculomotor variable. RESULTS Compared to healthy controls, patients with drug-resistant focal epilepsy exhibited longer antisaccade latencies (mean difference = 42.8 ms, P = 0.001), poorer spatial accuracy for both prosaccade (mean difference = 0.4°, P = 0.002), and antisaccade tasks (mean difference = 2.1°, P < 0.001), and more antisaccade errors (mean difference = 12.6%, P < 0.001). In the epilepsy subgroup analysis, left-hemispheric epilepsy patients exhibited longer antisaccade latencies compared to controls (mean difference = 52.2 ms, P = 0.003), while right-hemispheric epilepsy was the most spatially inaccurate compared to controls (mean difference = 2.5°, P = 0.003). The temporal lobe epilepsy subgroup displayed longer antisaccade latencies compared to controls (mean difference = 47.6 ms, P = 0.005). SIGNIFICANCE Patients with drug-resistant focal epilepsy exhibit poor inhibitory control as evidenced by a high percentage of antisaccade errors, slower cognitive processing speed, and impaired visuospatial accuracy on oculomotor tasks. Patients with left-hemispheric epilepsy and temporal lobe epilepsy have markedly impaired processing speed. Overall, oculomotor tasks can be a useful tool to objectively quantify cerebral dysfunction in drug-resistant focal epilepsy.
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Affiliation(s)
- Hue Mun Au Yong
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Meaghan Clough
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Piero Perucca
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Heidelberg, Victoria, Australia.
| | - Charles B Malpas
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
| | - Patrick Kwan
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
| | - Terence J O'Brien
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
| | - Joanne Fielding
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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