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Aljishi A, Sherman BE, Huberdeau DM, Obaid S, Khan K, Lamsam L, Zibly Z, Sivaraju A, Turk-Browne NB, Damisah EC. Statistical learning in epilepsy: Behavioral and anatomical mechanisms in the human brain. Epilepsia 2024; 65:753-765. [PMID: 38116686 PMCID: PMC10948305 DOI: 10.1111/epi.17871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Statistical learning, the fundamental cognitive ability of humans to extract regularities across experiences over time, engages the medial temporal lobe (MTL) in the healthy brain. This leads to the hypothesis that statistical learning (SL) may be impaired in patients with epilepsy (PWE) involving the temporal lobe, and that this impairment could contribute to their varied memory deficits. In turn, studies done in collaboration with PWE, that evaluate the necessity of MTL circuitry through disease and causal perturbations, provide an opportunity to advance basic understanding of SL. METHODS We implemented behavioral testing, volumetric analysis of the MTL substructures, and direct electrical brain stimulation to examine SL across a cohort of 61 PWE and 28 healthy controls. RESULTS We found that behavioral performance in an SL task was negatively associated with seizure frequency irrespective of seizure origin. The volume of hippocampal subfields CA1 and CA2/3 correlated with SL performance, suggesting a more specific role of the hippocampus. Transient direct electrical stimulation of the hippocampus disrupted SL. Furthermore, the relationship between SL and seizure frequency was selective, as behavioral performance in an episodic memory task was not impacted by seizure frequency. SIGNIFICANCE Overall, these results suggest that SL may be hippocampally dependent and that the SL task could serve as a clinically useful behavioral assay of seizure frequency that may complement existing approaches such as seizure diaries. Simple and short SL tasks may thus provide patient-centered endpoints for evaluating the efficacy of novel treatments in epilepsy.
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Affiliation(s)
- Ayman Aljishi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, 37240, USA
| | - Brynn E. Sherman
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | | | - Sami Obaid
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Kamren Khan
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Layton Lamsam
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Zion Zibly
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nicholas B. Turk-Browne
- Department of Psychology, Yale University, New Haven, CT 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
| | - Eyiyemisi C. Damisah
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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Kim MS, Torres K, Kang HJ, Drane DL. Specificity of performance validity tests in patients with confirmed epilepsy. Clin Neuropsychol 2023; 37:1530-1547. [PMID: 36219095 DOI: 10.1080/13854046.2022.2127424] [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: 11/12/2021] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
Objective: While assessment of performance validity is essential to neuropsychological evaluations, use of performance validity tests (PVTs) in an epilepsy population has raised concerns due to factors that may result in performance fluctuations. The current study assessed whether specificity was maintained at previously suggested cutoffs in a confirmed epilepsy population on the Warrington Recognition Memory Test (WRMT) - Words and Test of Memory Malingering (TOMM). Method: Eighty-two confirmed epilepsy patients were administered the WRMT-Words and TOMM as part of a standardized neuropsychological evaluation. Frequency tables were utilized to investigate specificity rates on these two PVTs. Results: The suggested WRMT-Words Accuracy Score cutoff of ≤42 was associated with a specificity rate of 90.2%. Five out of the 8 individuals falling below the Accuracy Score cutoff scored 42, suggesting specificity could be further improved by slightly lowering the cutoff. The WRMT-Words Total Time cutoff of ≥207 seconds was associated with 95.1% specificity. A TOMM Trial 1 cutoff of <40 was associated with 93.9% specificity, while the established cutoff of <45 on Trial 2 and the Retention Trial yielded specificity rates of 98.6% and 100.0%, respectively. Conclusions: Our findings demonstrate acceptable performance on two PVTs in a select confirmed epilepsy population without a history of brain surgery, active seizures during testing, and/or low IQ, irrespective of various factors such as seizure type, seizure lateralization/localization, and language lateralization. The possible presence of interictal discharges were not controlled for in the current study, which may have contributed to reduced PVT performances.
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Affiliation(s)
- Michelle S Kim
- Department of Neurology, University of Washington, Seattle, USA
| | - Karen Torres
- Department of Neurology, University of Washington, Seattle, USA
| | - Hyun Jin Kang
- Department of Neurology, University of Washington, Seattle, USA
| | - Daniel L Drane
- Department of Neurology, University of Washington, Seattle, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
- Department of Pediatrics, Emory University, Atlanta, GA, USA
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Aljishi A, Sherman BE, Huberdeau DM, Obaid S, Sivaraju A, Turk-Browne NB, Damisah EC. Statistical learning in epilepsy: Behavioral, anatomical, and causal mechanisms in the human brain. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.25.538321. [PMID: 37162937 PMCID: PMC10168289 DOI: 10.1101/2023.04.25.538321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Statistical learning, the fundamental cognitive ability of humans to extract regularities across experiences over time, engages the medial temporal lobe in the healthy brain. This leads to the hypothesis that statistical learning may be impaired in epilepsy patients, and that this impairment could contribute to their varied memory deficits. In turn, epilepsy patients provide a platform to advance basic understanding of statistical learning by helping to evaluate the necessity of medial temporal lobe circuitry through disease and causal perturbations. We implemented behavioral testing, volumetric analysis of the medial temporal lobe substructures, and direct electrical brain stimulation to examine statistical learning across a cohort of 61 epilepsy patients and 28 healthy controls. Behavioral performance in a statistical learning task was negatively associated with seizure frequency, irrespective of where seizures originated in the brain. The volume of hippocampal subfields CA1 and CA2/3 correlated with statistical learning performance, suggesting a more specific role of the hippocampus. Indeed, transient direct electrical stimulation of the hippocampus disrupted statistical learning. Furthermore, the relationship between statistical learning and seizure frequency was selective: behavioral performance in an episodic memory task was impacted by structural lesions in the medial temporal lobe and by antiseizure medications, but not by seizure frequency. Overall, these results suggest that statistical learning may be hippocampally dependent and that this task could serve as a clinically useful behavioral assay of seizure frequency distinct from existing neuropsychological tests. Simple and short statistical learning tasks may thus provide patient-centered endpoints for evaluating the efficacy of novel treatments in epilepsy.
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Affiliation(s)
- Ayman Aljishi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Brynn E. Sherman
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | | | - Sami Obaid
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nicholas B. Turk-Browne
- Department of Psychology, Yale University, New Haven, CT 06520, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
| | - Eyiyemisi C. Damisah
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Wu Tsai Institute, Yale University, New Haven, CT, 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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Pizzanelli C, Pesaresi I, Milano C, Cecchi P, Fontanelli L, Giannoni S, Giorgi FS, Cosottini M, Bonanni E. Distinct limbic connectivity in left and right benign mesial temporal lobe epilepsy: Evidence from a resting state functional MRI study. Front Neurol 2022; 13:943660. [PMID: 36247782 PMCID: PMC9558280 DOI: 10.3389/fneur.2022.943660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFunctional connectivity (FC) studies showed that pharmaco-resistant mesial temporal lobe epilepsy (MTLE) affects not only the limbic system, but also several extra-limbic regions, including areas belonging to resting state networks. Less is known about FC in subjects with benign MTLE (i.e., sensitive to antiseizure medication, bMTLE).Aim and methodsWe evaluated FC of hippocampus and amygdala in subjects with bMTLE, distinguished based on the epileptic focus lateralization. We enrolled 19 patients (10 with left and 9 with right bMTLE) and 10 age-matched healthy subjects. Connectivity was investigated at rest by using a seed-based regression analyses approach with four regions of interest (left and right hippocampus, left and right amygdala). Patients were also tested with a neuropsychological battery and their scores were correlated with fMRI data.Results and conclusionsOur study documented an asymmetrical disruption of FC in bMTLE, in relation to the side of the focus. Right subjects only exhibited limited altered connections, while left subjects—who performed worse in verbal memory tests—showed a wide bilateral hypoconnectivity of hippocampus and amygdala with areas belonging to language and memory network. The strength of FC between left limbic areas and language and memory network correlated with better performances in verbal memory tests. Moreover, we observed an increased FC with areas of default mode network, more pronounced in left subjects, a possible attempt to compensate cognitive deficit but without effectiveness.We believe that these findings could help to better characterize bMTLE, in which a dysfunction of limbic connectivity is detectable despite well-controlled epilepsy.
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Affiliation(s)
- Chiara Pizzanelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
- *Correspondence: Chiara Pizzanelli
| | | | - Chiara Milano
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Paolo Cecchi
- Department of Translational Research and New Technologies in Medicine and Surgery, Neuroradiology Unit, University of Pisa, Pisa, Italy
| | - Lorenzo Fontanelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Sara Giannoni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Filippo Sean Giorgi
- Department of Translational Research and New Technologies in Medicine and Surgery, Human Anatomy, University of Pisa, Pisa, Italy
| | - Mirco Cosottini
- Neuroradiology Unit, Pisa University Hospital, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, Neuroradiology Unit, University of Pisa, Pisa, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
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The Impact of Right Temporal Lobe Epilepsy On Nonverbal Memory: Meta-regression of Stimulus- and Task-related Moderators. Neuropsychol Rev 2021; 32:537-557. [PMID: 34559363 DOI: 10.1007/s11065-021-09514-3] [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: 06/01/2020] [Accepted: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Nonverbal memory tests have great potential value for detecting the impact of lateralized pathology and predicting the risk of memory loss following right temporal lobe resection (TLR) for temporal lobe epilepsy (TLE) patients, but this potential has not been realized. Previous reviews suggest that stimulus type moderates the capacity of nonverbal memory tests to detect right-lateralized pathology (i.e., faces > designs), but the roles of other task-related factors have not been systematically explored. We address these limitations using mixed model meta-regression (k = 158) of right-lateralization effects (right worse than left TLE) testing the moderating effects of: 1) stimulus type (designs, faces, spatial), 2) learning format (single trial, repeated trials), 3) testing delay (immediate or long delay), and 4) testing format (recall, recognition) for three patient scenarios: 1) presurgical, 2) postsurgical, and 3) postsurgical change. Stimulus type significantly moderated the size of the right-lateralization effect (faces > designs) for postsurgical patients, test format moderated the size of the right-lateralization effect for presurgical-postsurgical change (recognition > recall) but learning format and test delay had no right-lateralization effect for either sample. For presurgical patients, none of the task-related factors significantly increased right-lateralization effects. This comprehensive review reveals the value of recognition testing in gauging the risk of nonverbal memory decline.
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Savic I. MRS Shows Regionally Increased Glutamate Levels among Patients with Exhaustion Syndrome Due to Occupational Stress. Cereb Cortex 2020; 30:3759-3770. [PMID: 32195540 DOI: 10.1093/cercor/bhz340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Despite the rapid increase of reports of exhaustion syndrome (ES) due to daily occupational stress, the mechanisms underlying ES are unknown. We used voxel-based 1H-MR spectroscopy to examine the potential role of glutamate in this condition. The levels of glutamate were found to be elevated among ES patients (n = 30, 16 females) compared with controls (n = 31, 15 females). Notably, this increase was detected only in the anterior cingulate and mesial prefrontal cortex (ACC/mPFC), and the glutamate levels were linearly correlated with the degree of perceived stress. Furthermore, there was a sex by group interaction, as the glutamate elevation was present only in female patients. Female but not male ES patients also showed an increase in N-acetyl aspartate (NAA) levels in the amygdala. No group differences were detected in glutamine concentration (also measured). These data show the key role of glutamate in stress-related neuronal signaling and the specific roles of the amygdala and ACC/mPFC. The data extend previous reports about the neurochemical basis of stress and identify a potential neural marker and mediator of ES due to occupational stress. The observation of specific sex differences provides a tentative explanation to the well-known female predominance in stress-related psychopathology.
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Affiliation(s)
- Ivanka Savic
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.,Department of Neurology, UCLA, Los Angeles, CA 90095-1769, USA
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Lopes TM, Campos BM, Zanão TA, Balthazar MLF, Yasuda CL, Cendes F. Hippocampal atrophy disrupts the language network but not hemispheric language lateralization. Epilepsia 2019; 60:744-755. [DOI: 10.1111/epi.14694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tátila Martins Lopes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Brunno Machado Campos
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Tamires Araújo Zanão
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | | | - Clarissa Lin Yasuda
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Fernando Cendes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
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Volumetric Changes in Hippocampal Subregions and Memory Performance in Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis. Neurosci Bull 2017; 34:389-396. [PMID: 29094314 DOI: 10.1007/s12264-017-0186-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022] Open
Abstract
In the present study we explored the different patterns of volumetric atrophy in hippocampal subregions of patients with left and right mesial temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). Meanwhile, the memory impairment patterns in Chinese-speaking TLE-HS patients and potential influencing factors were also determined. TLE-HS patients (21 left and 17 right) and 21 healthy controls were recruited to complete T2-weighted imaging and verbal/nonverbal memory assessment. The results showed that both left and right TLE-HS patients had overall reduced hippocampal subregion volumes on the sclerotic side, and cornu ammonis sectors (CA1) exhibited maximum atrophy. The verbal memory of left TLE-HS patients was significantly impaired (P < 0.001) and was not associated with the volumes of the left hippocampal subregions. Verbal or nonverbal memory impairment was not found in the patients with right TLE-HS. These results suggested that the atrophy of hippocampal subregion volumes cannot account for the verbal memory impairment, which might be related to the functional network.
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Caciagli L, Bernasconi A, Wiebe S, Koepp MJ, Bernasconi N, Bernhardt BC. A meta-analysis on progressive atrophy in intractable temporal lobe epilepsy: Time is brain? Neurology 2017; 89:506-516. [PMID: 28687722 DOI: 10.1212/wnl.0000000000004176] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/21/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE It remains unclear whether drug-resistant temporal lobe epilepsy (TLE) is associated with cumulative brain damage, with no expert consensus and no quantitative syntheses of the available evidence. METHODS We conducted a systematic review and meta-analysis of MRI studies on progressive atrophy, searching PubMed and Ovid MEDLINE databases for cross-sectional and longitudinal quantitative MRI studies on drug-resistant TLE. RESULTS We screened 2,976 records and assessed eligibility of 248 full-text articles. Forty-two articles met the inclusion criteria for quantitative evaluation. We observed a predominance of cross-sectional studies, use of different clinical indices of progression, and high heterogeneity in age-control procedures. Meta-analysis of 18/1 cross-sectional/longitudinal studies on hippocampal atrophy (n = 979 patients) yielded a pooled effect size of r = -0.42 for ipsilateral atrophy related to epilepsy duration (95% confidence interval [CI] -0.51 to -0.32; p < 0.0001; I2 = 65.22%) and r = -0.35 related to seizure frequency (95% CI -0.47 to -0.22; p < 0.0001; I2 = 61.97%). Sensitivity analyses did not change the results. Narrative synthesis of 25/3 cross-sectional/longitudinal studies on whole brain atrophy (n = 1,504 patients) indicated that >80% of articles reported duration-related progression in extratemporal cortical and subcortical regions. Detailed analysis of study design features yielded low to moderate levels of evidence for progressive atrophy across studies, mainly due to dominance of cross-sectional over longitudinal investigations, use of diverse measures of seizure estimates, and absence of consistent age control procedures. CONCLUSIONS While the neuroimaging literature is overall suggestive of progressive atrophy in drug-resistant TLE, published studies have employed rather weak designs to directly demonstrate it. Longitudinal multicohort studies are needed to unequivocally differentiate aging from disease progression.
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Affiliation(s)
- Lorenzo Caciagli
- From the Neuroimaging of Epilepsy Laboratory (L.C., A.B., N.B., B.C.B.) and Multimodal Imaging and Connectome Analysis Laboratory (B.C.B.), Montreal Neurological Institute and Hospital, McGill University; Department of Clinical Neurosciences (S.W.), University of Calgary, Canada; and Department of Clinical and Experimental Epilepsy (L.C., M.J.K.), UCL Institute of Neurology, London, UK
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (L.C., A.B., N.B., B.C.B.) and Multimodal Imaging and Connectome Analysis Laboratory (B.C.B.), Montreal Neurological Institute and Hospital, McGill University; Department of Clinical Neurosciences (S.W.), University of Calgary, Canada; and Department of Clinical and Experimental Epilepsy (L.C., M.J.K.), UCL Institute of Neurology, London, UK
| | - Samuel Wiebe
- From the Neuroimaging of Epilepsy Laboratory (L.C., A.B., N.B., B.C.B.) and Multimodal Imaging and Connectome Analysis Laboratory (B.C.B.), Montreal Neurological Institute and Hospital, McGill University; Department of Clinical Neurosciences (S.W.), University of Calgary, Canada; and Department of Clinical and Experimental Epilepsy (L.C., M.J.K.), UCL Institute of Neurology, London, UK
| | - Matthias J Koepp
- From the Neuroimaging of Epilepsy Laboratory (L.C., A.B., N.B., B.C.B.) and Multimodal Imaging and Connectome Analysis Laboratory (B.C.B.), Montreal Neurological Institute and Hospital, McGill University; Department of Clinical Neurosciences (S.W.), University of Calgary, Canada; and Department of Clinical and Experimental Epilepsy (L.C., M.J.K.), UCL Institute of Neurology, London, UK
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (L.C., A.B., N.B., B.C.B.) and Multimodal Imaging and Connectome Analysis Laboratory (B.C.B.), Montreal Neurological Institute and Hospital, McGill University; Department of Clinical Neurosciences (S.W.), University of Calgary, Canada; and Department of Clinical and Experimental Epilepsy (L.C., M.J.K.), UCL Institute of Neurology, London, UK
| | - Boris C Bernhardt
- From the Neuroimaging of Epilepsy Laboratory (L.C., A.B., N.B., B.C.B.) and Multimodal Imaging and Connectome Analysis Laboratory (B.C.B.), Montreal Neurological Institute and Hospital, McGill University; Department of Clinical Neurosciences (S.W.), University of Calgary, Canada; and Department of Clinical and Experimental Epilepsy (L.C., M.J.K.), UCL Institute of Neurology, London, UK.
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Ramos FO, Carreiro LRR, Scorza FA, Cysneiros RM. Impaired executive functions in experimental model of temporal lobe epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:470-7. [DOI: 10.1590/0004-282x20160070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/15/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective The present study aimed to investigate cognitive and behavioural changes consistent with attention deficit hyperactivity disorder (ADHD -like behavior in male Wistar rats with temporal lobe epilepsy (TLE). Method Male Wistar rats at 25 day of age were submitted to animal model of TLE by pilocarpine injection (350 mg/kg, ip) and a control group received saline 0.9%. The animals were continuously video monitored up to the end of experiments. The behavioural tests (open field, elevated plus maze and operant conditioning box) started from 60 days postnatal. Results Animals with TLE exhibited elevated locomotor activity, reduced level of anxiety-related behavior, impulsivity and impaired visuospatial working memory. Conclusion Taken as a whole, we concluded that animals with TLE exhibited some cognitive and behavioural changes consistent with ADHD-like behavior.
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Affiliation(s)
- Fabiane Ochai Ramos
- Universidade Presbiteriana Mackenzie, Brasil; Universidade Federal de São Paulo, Brasil
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Cretin B, Sellal F, Philippi N, Bousiges O, Di Bitonto L, Martin-Hunyadi C, Blanc F. Epileptic Prodromal Alzheimer’s Disease, a Retrospective Study of 13 New Cases: Expanding the Spectrum of Alzheimer’s Disease to an Epileptic Variant? J Alzheimers Dis 2016; 52:1125-33. [DOI: 10.3233/jad-150096] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Benjamin Cretin
- Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Centre Mémoire, de Ressources et de Recherche d’Alsace (Strasbourg-Colmar), France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France
| | - François Sellal
- Centre Mémoire, de Ressources et de Recherche d’Alsace (Strasbourg-Colmar), France
- Service de Neurologie, Hospices Civils de Colmar, France
- Unité INSERM U-1118, Faculté de Médecine de Strasbourg, France
| | - Nathalie Philippi
- Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Centre Mémoire, de Ressources et de Recherche d’Alsace (Strasbourg-Colmar), France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France
| | - Olivier Bousiges
- Centre Mémoire, de Ressources et de Recherche d’Alsace (Strasbourg-Colmar), France
- Unité de biochimie spécialisée, Laboratoire de biologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laure Di Bitonto
- Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Centre Mémoire, de Ressources et de Recherche d’Alsace (Strasbourg-Colmar), France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France
| | | | - Frederic Blanc
- Unité de Neuropsychologie, Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Centre Mémoire, de Ressources et de Recherche d’Alsace (Strasbourg-Colmar), France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), team IMIS/Neurocrypto Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, France
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Lee SA, Kim MJ, Lee HW, Heo K, Shin DJ, Song HK, Kim OJ, Kim SO, Lee BI. The effect of recurrent seizures on cognitive, behavioral, and quality-of-life outcomes after 12 months of monotherapy in adults with newly diagnosed or previously untreated partial epilepsy. Epilepsy Behav 2015; 53:202-8. [PMID: 26594847 DOI: 10.1016/j.yebeh.2015.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine whether seizure recurrence has a negative impact on cognition, psychological function, and health-related quality of life (HRQoL) over a 12-month period of monotherapy in adults with newly diagnosed or previously untreated partial epilepsy. METHODS Seizure freedom (SF) was defined as no seizure recurrence during the 40-week maintenance period of medication. Neuropsychological tests, the Symptom Checklist-90 (SCL-90), and the Quality of Life in Epilepsy-31 (QOLIE-31) were administered at baseline and after 48 weeks of carbamazepine or lamotrigine monotherapy. Seventy-three patients successfully continued treatment until the 48-week follow-up time point. Fifty patients (68.5%) had SF, and the remaining 23 were not seizure-free (NSF). A seizure outcome group-by-time interaction was analyzed using a linear mixed model. RESULTS A group-by-time interaction was identified for the total QOLIE-31 score (p<0.05) and score on two QOLIE-31 subscales (social function: p<0.001 and seizure worry: p<0.001), with a significant improvement over time only present in the SF group (all p<0.001). There was no significant group-by-time interaction for most cognitive function tests, with the exception of the serial clustering score (p<0.01) and number of recognition hits on the California Verbal Learning Test (p<0.05). Serial clustering did not differ between the SF and NSF groups at baseline, but was significantly more used in the NSF group than in the SF group at 48 weeks (p<0.01). There was no significant group-by-time interaction for any dimension of the SCL-90. CONCLUSION Recurrent seizures had a significant effect on HRQoL, a subtle effect on cognitive performance, and no effect on psychological symptoms over one year in newly diagnosed or previously untreated adults with partial epilepsy.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
| | - Min Ju Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Hyang-Woon Lee
- Department of Neurology, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University Medical School, Seoul, Republic of Korea
| | - Dong-Jin Shin
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Hong-Ki Song
- Department of Neurology, Hallym University Institute of Epilepsy Research, Seoul, Republic of Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA University School of Medicine, Sungnam, Republic of Korea
| | - Seon-Ok Kim
- Division of Biostatistics, Center for Medical Research and Information, University of Ulsan, Seoul, Republic of Korea
| | - Byung-In Lee
- Department of Neurology, Yonsei University Medical School, Seoul, Republic of Korea
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Pohlmann-Eden B, Aldenkamp A, Baker GA, Brandt C, Cendes F, Coras R, Crocker CE, Helmstaedter C, Jones-Gotman M, Kanner AM, Mazarati A, Mula M, Smith ML, Omisade A, Tellez-Zenteno J, Hermann BP. The relevance of neuropsychiatric symptoms and cognitive problems in new-onset epilepsy - Current knowledge and understanding. Epilepsy Behav 2015; 51:199-209. [PMID: 26291774 DOI: 10.1016/j.yebeh.2015.07.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/03/2015] [Indexed: 01/11/2023]
Abstract
Neurobehavioral and cognition problems are highly prevalent in epilepsy, but most research studies to date have not adequately addressed the precise nature of the relationship between these comorbidities and seizures. To address this complex issue and to facilitate collaborative, innovative research in the rising field of neurobehavioral comorbidities and cognition disturbances in new-onset epilepsy, international epilepsy experts met at the 3rd Halifax International Epilepsy Conference & Retreat at White Point, South Shore, Nova Scotia, Canada from September 18 to 20, 2014. This Conference Proceedings provides a summary of the conference proceedings. Specifically, the following topics are discussed: (i) role of comorbidities in epilepsy diagnosis and management, (ii) role of antiepileptic medications in understanding the relationship between epilepsy and neurobehavioral and cognition problems, and (iii) animal data and diagnostic approaches. Evidence to date, though limited, strongly suggests a bidirectional relationship between epilepsy and cognitive and psychiatric comorbidities. In fact, it is likely that seizures and neurobehavioral problems represent different symptoms of a common etiology or network-wide disturbance. As a reflection of this shared network, psychiatric comorbidities and/or cognition problems may actually precede the seizure occurrence and likely get often missed if not screened.
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Affiliation(s)
- B Pohlmann-Eden
- Division of Neurology, Dalhousie University of Halifax, Canada; Brain Repair Center, Dalhousie University of Halifax, Canada.
| | - A Aldenkamp
- Epilepsiecentrum Kempenhaeghe, The Netherlands
| | - G A Baker
- Division of Neurosciences, University of Liverpool, United Kingdom
| | - C Brandt
- Bethel Epilepsy Center, Mara Hospital, Bielefeld, Germany
| | - F Cendes
- Department of Neurology, University of Campinas, São Paulo, Brazil
| | - R Coras
- Department of Neuropathology, University of Erlangen, Germany
| | - C E Crocker
- Division of Neurology, Dalhousie University of Halifax, Canada
| | | | - M Jones-Gotman
- McGill University, Montreal Neurological Institute, Montreal, Canada
| | - A M Kanner
- Epilepsy Center, University of Miami, Miller School of Medicine, USA
| | - A Mazarati
- Children's Discovery and Innovation Institute, D. Geffen School of Medicine at UCLA, Los Angeles, USA
| | - M Mula
- Epilepsy Group, Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust and Institute of Medical and Biomedical Sciences St. George's University of London, United Kingdom
| | - M L Smith
- Department of Psychology, University of Toronto, Canada
| | - A Omisade
- Division of Neurology, Dalhousie University of Halifax, Canada
| | | | - B P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, USA
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14
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Jehi L, Wyllie E, Devinsky O. Epileptic encephalopathies: Optimizing seizure control and developmental outcome. Epilepsia 2015; 56:1486-9. [PMID: 26293588 DOI: 10.1111/epi.13107] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 01/15/2023]
Abstract
Cognitive and developmental outcomes in patients with epileptic encephalopathy are hypothesized to result from an interplay between the underlying epileptic pathologic substrate and the acquired consequences of frequent and repetitive seizures and epileptiform discharges that often straddle the interictal and ictal boundaries. This article briefly reviews the evidence related to this assumption, presents critical questions that need to be answered to clarify this relationship, and advances a set of concrete steps that may help improve developmental patient outcomes.
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Affiliation(s)
- Lara Jehi
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Elaine Wyllie
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Orrin Devinsky
- NYU Comprehensive Epilepsy Center, New York, New York, U.S.A
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15
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Voltzenlogel V, Hirsch E, Vignal JP, Valton L, Manning L. Preserved anterograde and remote memory in drug-responsive temporal lobe epileptic patients. Epilepsy Res 2015. [PMID: 26220389 DOI: 10.1016/j.eplepsyres.2015.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate cognition, particularly anterograde and remote memory, in patients suffering from unilateral drug-responsive mesial temporal lobe epilepsy (mTLE) patients and to compare their performance with that observed in drug-resistant mTLE patients. METHODS Sixteen drug-responsive mTLE patients, with only infrequent seizures in their lifetime, were matched for demographic and clinical variables to 18 patients suffering from drug-resistant unilateral mTLE. A comprehensive neuropsychological examination, including baseline, anterograde memory tasks, and a large range of remote memory tests was carried out. RESULTS Patients with drug-responsive epilepsy obtained average scores on every anterograde memory test. Although in general, they obtained lower scores than the healthy controls on remote memory tests, the differences failed to reach significance. Moreover, the drug-responsive group performed significantly better than the drug-resistant group on anterograde recall tests and an episodic autobiographical memory test. Performance was not significantly different between the patient groups in personal semantics or memory for public events. CONCLUSION Our results show that a mild clinical course of mTLE with no cognitive deficits can occur notwithstanding hippocampal sclerosis. The differences in cognitive function between the two groups are likely due to distinct pathophysiology of the underlying cause of epilepsy. Drug-resistant seizures and cognitive deficits may be the consequence of a more severe underlying cerebral process. Better understanding of the variety of pathogenesis of mTLE could help to answer this open question.
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Affiliation(s)
| | - Edouard Hirsch
- Fédération de médecine translationnelle, University Hospital, Strasbourg, France.
| | | | - Luc Valton
- Explorations Neurophysiologiques, Department of Neurology, Hôpital Pierre Paul Riquet, University Hospital, & CerCo, Centre de recherche Cerveau et Cognition UMR 5549 - CNRS, Toulouse, France.
| | - Liliann Manning
- INSERM, U1114 and Strasbourg University, Strasbourg, France.
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16
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Laufs H, Rodionov R, Thornton R, Duncan JS, Lemieux L, Tagliazucchi E. Altered FMRI connectivity dynamics in temporal lobe epilepsy might explain seizure semiology. Front Neurol 2014; 5:175. [PMID: 25309503 PMCID: PMC4160997 DOI: 10.3389/fneur.2014.00175] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/28/2014] [Indexed: 01/15/2023] Open
Abstract
Temporal lobe epilepsy (TLE) can be conceptualized as a network disease. The network can be characterized by inter-regional functional connectivity, i.e., blood oxygen level-dependent (BOLD) signal correlations between any two regions. However, functional connectivity is not constant over time, thus computing correlation at a given time and then at some later time could give different results (non-stationarity). We hypothesized (1) that non-stationarities can be induced by epilepsy (e.g., interictal epileptic activity) increasing local signal variance and that (2) these transient events contribute to fluctuations in connectivity leading to pathological functioning, i.e., TLE semiology. We analyzed fMRI data from 27 patients with TLE and 22 healthy controls focusing on EEG-confirmed wake epochs only to protect against sleep-induced connectivity changes. Testing hypothesis (1), we identified brain regions where the BOLD signal variance was significantly greater in TLE than in controls: the temporal pole – including the hippocampus. Taking the latter as the seed region and testing hypothesis (2), we calculated the time-varying inter-regional correlation values (dynamic functional connectivity) to other brain regions and found greater connectivity variance in the TLE than the control group mainly in the precuneus, the supplementary and sensorimotor, and the frontal cortices. We conclude that the highest BOLD signal variance in the hippocampi is highly suggestive of a specific epilepsy-related effect. The altered connectivity dynamics in TLE patients might help to explain the hallmark semiological features of dyscognitive seizures including impaired consciousness (precuneus, frontal cortex), sensory disturbance, and motor automatisms (sensorimotor cortices, supplementary motor cortex). Accounting for the non-stationarity and state-dependence of functional connectivity are a prerequisite in the search for potential connectivity-derived biomarkers in TLE.
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Affiliation(s)
- Helmut Laufs
- Department of Neurology and Brain Imaging Center, Goethe-University Frankfurt am Main , Frankfurt am Main , Germany ; Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel , Kiel , Germany ; National Hospital for Neurology and Neurosurgery, University College London , London , UK ; The Epilepsy Society , Chalfont St. Peter , UK
| | - Roman Rodionov
- National Hospital for Neurology and Neurosurgery, University College London , London , UK ; The Epilepsy Society , Chalfont St. Peter , UK
| | - Rachel Thornton
- National Hospital for Neurology and Neurosurgery, University College London , London , UK ; The Epilepsy Society , Chalfont St. Peter , UK
| | - John Sydney Duncan
- National Hospital for Neurology and Neurosurgery, University College London , London , UK ; The Epilepsy Society , Chalfont St. Peter , UK
| | - Louis Lemieux
- National Hospital for Neurology and Neurosurgery, University College London , London , UK ; The Epilepsy Society , Chalfont St. Peter , UK
| | - Enzo Tagliazucchi
- Department of Neurology and Brain Imaging Center, Goethe-University Frankfurt am Main , Frankfurt am Main , Germany
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