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Struck AF, Garcia-Ramos C, Nair VA, Prabhakaran V, Dabbs K, Conant LL, Binder JR, Loring D, Meyerand M, Hermann BP. The relevance of Spearman's g for epilepsy. Brain Commun 2024; 6:fcae176. [PMID: 38883806 PMCID: PMC11179110 DOI: 10.1093/braincomms/fcae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
Whilst the concept of a general mental factor known as 'g' has been of longstanding interest, for unknown reasons, it has never been interrogated in epilepsy despite the 100+ year empirical history of the neuropsychology of epilepsy. This investigation seeks to identify g within a comprehensive neuropsychological data set and compare participants with temporal lobe epilepsy to controls, characterize the discriminatory power of g compared with domain-specific cognitive metrics, explore the association of g with clinical epilepsy and sociodemographic variables and identify the structural and network properties associated with g in epilepsy. Participants included 110 temporal lobe epilepsy patients and 79 healthy controls between the ages of 19 and 60. Participants underwent neuropsychological assessment, clinical interview and structural and functional imaging. Cognitive data were subjected to factor analysis to identify g and compare the group of patients with control participants. The relative power of g compared with domain-specific tests was interrogated, clinical and sociodemographic variables were examined for their relationship with g, and structural and functional images were assessed using traditional regional volumetrics, cortical surface features and network analytics. Findings indicate (i) significantly (P < 0.005) lower g in patients compared with controls; (ii) g is at least as powerful as individual cognitive domain-specific metrics and other analytic approaches to discriminating patients from control participants; (iii) lower g was associated with earlier age of onset and medication use, greater number of antiseizure medications and longer epilepsy duration (Ps < 0.04); and lower parental and personal education and greater neighbourhood deprivation (Ps < 0.012); and (iv) amongst patients, lower g was linked to decreased total intracranial volume (P = 0.019), age and intracranial volume adjusted total tissue volume (P = 0.019) and age and intracranial volume adjusted total corpus callosum volume (P = 0.012)-particularly posterior, mid-posterior and anterior (Ps < 0.022) regions. Cortical vertex analyses showed lower g to be associated specifically with decreased gyrification in bilateral medial orbitofrontal regions. Network analysis of resting-state data with focus on the participation coefficient showed g to be associated with the superior parietal network. Spearman's g is reduced in patients, has considerable discriminatory power compared with domain-specific metrics and is linked to a multiplex of factors related to brain (size, connectivity and frontoparietal networks), environment (familial and personal education and neighbourhood disadvantage) and disease (epilepsy onset, treatment and duration). Greater attention to contemporary models of human cognition is warranted in order to advance the neuropsychology of epilepsy.
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Affiliation(s)
- Aaron F Struck
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
| | - Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Veena A Nair
- Department of Radiology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - David Loring
- Department of Neurology and Pediatrics, Emory University, Atlanta, GA 30322, USA
| | - Mary Meyerand
- Department of Medical Physics, Wisconsin-Madison, Madison, WI 53726, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin–Madison, Madison, WI 53726, USA
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Hu J, Chen G, Zeng Z, Ran H, Zhang R, Yu Q, Xie Y, He Y, Wang F, Li X, Huang K, Liu H, Zhang T. Systematically altered connectome gradient in benign childhood epilepsy with centrotemporal spikes: Potential effect on cognitive function. Neuroimage Clin 2024; 43:103628. [PMID: 38850833 PMCID: PMC11201345 DOI: 10.1016/j.nicl.2024.103628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/06/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Benign childhood epilepsy with centrotemporal spikes (BECTS) affects brain network hierarchy and cognitive function; however, itremainsunclearhowhierarchical changeaffectscognition in patients with BECTS. A major aim of this study was to examine changes in the macro-network function hierarchy in BECTS and its potential contribution to cognitive function. METHODS Overall, the study included 50 children with BECTS and 69 healthy controls. Connectome gradient analysis was used to determine the brain network hierarchy of each group. By comparing gradient scores at each voxel level and network between groups, we assessed changes in whole-brain voxel-level and network hierarchy. Functional connectivity was used to detect the functional reorganization of epilepsy caused by these abnormal brain regions based on these aberrant gradients. Lastly, we explored the relationships between the change gradient and functional connectivity values and clinical variables and further predicted the cognitive function associated with BECTS gradient changes. RESULTS In children with BECTS, the gradient was extended at different network and voxel levels. The gradient scores frontoparietal network was increased in the principal gradient of patients with BECTS. The left precentral gyrus (PCG) and right angular gyrus gradient scores were significantly increased in the principal gradient of children with BECTS. Moreover, in regions of the brain with abnormal principal gradients, functional connectivity was disrupted. The left PCG gradient score of children with BECTS was correlated with the verbal intelligence quotient (VIQ), and the disruption of functional connectivity in brain regions with abnormal principal gradients was closely related to cognitive function. VIQ was significantly predicted by the principal gradient map of patients. SIGNIFICANCE The results indicate connectome gradient disruption in children with BECTS and its relationship to cognitive function, thereby increasing our understanding of the functional connectome hierarchy and providing potential biomarkers for cognitive function of children with BECTS.
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Affiliation(s)
- Jie Hu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China; Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guiqin Chen
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China; Department of Radiology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang 550001, China
| | - Zhen Zeng
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Haifeng Ran
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Ruoxi Zhang
- Department of Radiology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang 550001, China
| | - Qiane Yu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Yuxin Xie
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Yulun He
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Fuqin Wang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Xuhong Li
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Kexing Huang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China.
| | - Tijiang Zhang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi 563000, China.
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Nordli DR, Mclaren JR, Araujo G, Gupta M, Nordli DR, Galan F. Pediatric epilepsy syndromes with associated developmental impairment. Dev Med Child Neurol 2024; 66:691-701. [PMID: 38140949 DOI: 10.1111/dmcn.15838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/19/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
In 2022, the International League Against Epilepsy revised their classification of epilepsy syndromes for clinicians to better understand the relationships between different epilepsy syndromes, their underlying causes, and their associated developmental and behavioral features. This review highlights portions of the current classification with an emphasis on epilepsy syndromes that readily present with developmental challenges and provides a unique framework, based on electroencephalography, to easily identify and understand these syndromes. Included in this review are a helpful categorization scheme with visual aid, descriptions of updated epilepsy syndromes, figures of relevant identifiers of syndrome and information regarding future directions toward treatment and research. Covered syndromes include developmental and epileptic encephalopathy, Dravet syndrome, Rasmussen syndrome, and infantile epileptic spasm syndrome, among others. WHAT THIS PAPER ADDS: The revised epilepsy syndrome classification by the International League Against Epilepsy aims to improve the outcomes for children with epilepsy. The electroencephalography features of epilepsy syndromes are grouped based on a categorization model. This model allows clinicians to understand overlapping phenotypes and aid with both identification and diagnosis.
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Affiliation(s)
- Douglas R Nordli
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - John R Mclaren
- Department of Pediatric Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Gabriel Araujo
- Department of Pediatric Neurology, Nemours Children's Health, Jacksonville, FL, USA
| | - Megan Gupta
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Douglas R Nordli
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Fernando Galan
- Department of Pediatric Neurology, Nemours Children's Health, Jacksonville, FL, USA
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Talami F, Lemieux L, Avanzini P, Ballerini A, Cantalupo G, Laufs H, Meletti S, Vaudano AE. The influence of wakefulness fluctuations on brain networks involved in centrotemporal spike occurrence. Clin Neurophysiol 2024; 164:47-56. [PMID: 38848666 DOI: 10.1016/j.clinph.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/18/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Drowsiness has been implicated in the modulation of centro-temporal spikes (CTS) in Self-limited epilepsy with Centro-Temporal Spikes (SeLECTS). Here, we explore this relationship and whether fluctuations in wakefulness influence the brain networks involved in CTS generation. METHODS Functional MRI (fMRI) and electroencephalography (EEG) was simultaneously acquired in 25 SeLECTS. A multispectral EEG index quantified drowsiness ('EWI': EEG Wakefulness Index). EEG (Pearson Correlation, Cross Correlation, Trend Estimation, Granger Causality) and fMRI (PPI: psychophysiological interactions) analytic approaches were adopted to explore respectively: (a) the relationship between EWI and changes in CTS frequency and (b) the functional connectivity of the networks involved in CTS generation and wakefulness oscillations. EEG analyses were repeated on a sample of routine EEG from the same patient's cohort. RESULTS No correlation was found between EWI fluctuations and CTS density during the EEG-fMRI recordings, while they showed an anticorrelated trend when drowsiness was followed by proper sleep in routine EEG traces. According to PPI findings, EWI fluctuations modulate the connectivity between the brain networks engaged by CTS and the left frontal operculum. CONCLUSIONS While CTS frequency per se seems unrelated to drowsiness, wakefulness oscillations modulate the connectivity between CTS generators and key regions of the language circuitry, a cognitive function often impaired in SeLECTS. SIGNIFICANCE This work advances our understanding of (a) interaction between CTS occurrence and vigilance fluctuations and (b) possible mechanisms responsible for language disruption in SeLECTS.
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Affiliation(s)
- Francesca Talami
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy; Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Louis Lemieux
- Department of Clinical and Experimental and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, Queen Square, London WC1N 3BG, United Kingdom
| | - Pietro Avanzini
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
| | - Alice Ballerini
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gaetano Cantalupo
- Innovation Biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy; Child Neuropsychiatry Unit and Center for Research on Epilepsies in Pediatric age (CREP), University Hospital of Verona (full member of the European Reference Network EpiCARE), Verona, Italy
| | - Helmut Laufs
- University Medical Center Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Germany
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurophysiology Unit and Epilepsy Centre, Neuroscience Department, AOU Modena, Italy.
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurophysiology Unit and Epilepsy Centre, Neuroscience Department, AOU Modena, Italy.
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Kwon H, Chinappen DM, Kinard EA, Goodman SK, Huang JF, Berja ED, Walsh KG, Shi W, Manoach DS, Kramer MA, Chu CJ. Impaired sleep-dependent memory consolidation predicted by reduced sleep spindles in Rolandic epilepsy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.16.594515. [PMID: 38798414 PMCID: PMC11118409 DOI: 10.1101/2024.05.16.594515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Background and Objectives Sleep spindles are prominent thalamocortical brain oscillations during sleep that have been mechanistically linked to sleep-dependent memory consolidation in animal models and healthy controls. Sleep spindles are decreased in Rolandic epilepsy and related sleep-activated epileptic encephalopathies. We investigate the relationship between sleep spindle deficits and deficient sleep dependent memory consolidation in children with Rolandic epilepsy. Methods In this prospective case-control study, children were trained and tested on a validated probe of memory consolidation, the motor sequence task (MST). Sleep spindles were measured from high-density EEG during a 90-minute nap opportunity between MST training and testing using a validated automated detector. Results Twenty-three children with Rolandic epilepsy (14 with resolved disease), and 19 age- and sex-matched controls were enrolled. Children with active Rolandic epilepsy had decreased memory consolidation compared to control children (p=0.001, mean percentage reduction: 25.7%, 95% CI [10.3, 41.2]%) and compared to children with resolved Rolandic epilepsy (p=0.007, mean percentage reduction: 21.9%, 95% CI [6.2, 37.6]%). Children with active Rolandic epilepsy had decreased sleep spindle rates in the centrotemporal region compared to controls (p=0.008, mean decrease 2.5 spindles/min, 95% CI [0.7, 4.4] spindles/min). Spindle rate positively predicted sleep-dependent memory consolidation (p=0.004, mean MST improvement of 3.9%, 95% CI [1.3, 6.4]%, for each unit increase in spindles per minute). Discussion Children with Rolandic epilepsy have a sleep spindle deficit during the active period of disease which predicts deficits in sleep dependent memory consolidation. This finding provides a mechanism and noninvasive biomarker to aid diagnosis and therapeutic discovery for cognitive dysfunction in Rolandic epilepsy and related sleep activated epilepsy syndromes.
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Affiliation(s)
- Hunki Kwon
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dhinakaran M Chinappen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Elizabeth A Kinard
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Skyler K Goodman
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan F Huang
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Erin D Berja
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine G Walsh
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Wen Shi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dara S Manoach
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
- Center for Systems Neuroscience, Boston University, Boston, Massachusetts, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Fu Y, Zhang J, Cao Y, Ye L, Zheng R, Li Q, Shen B, Shi Y, Cao J, Fang J. Recognition memory deficits detected through eye-tracking in well-controlled children with self-limited epilepsy with centrotemporal spikes. Epilepsia 2024; 65:1128-1140. [PMID: 38299621 DOI: 10.1111/epi.17902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Children with self-limited epilepsy characterized by centrotemporal spikes (SeLECTS) exhibit cognitive deficits in memory during the active phase, but there is currently a lack of studies and techniques to assess their memory development after well-controlled seizures. In this study, we employed eye-tracking techniques to investigate visual memory and its association with clinical factors and global intellectual ability, aiming to identify potential risk factors by examining encoding and recognition processes. METHODS A total of 26 recruited patients diagnosed with SeLECTS who had been seizure-free for at least 2 years, along with 24 control subjects, underwent Wechsler cognitive assessment and an eye-movement-based memory task while video-electroencephalographic (EEG) data were recorded. Fixation and pupil data related to eye movements were utilized to detect distinct memory processes and subsequently to compare the cognitive performance of patients exhibiting different regression patterns on EEG. RESULTS The findings revealed persistent impairments in visual memory among children with SeLECTS after being well controlled, primarily observed in the recognition stage rather than the encoding phase. Furthermore, the age at onset, frequency of seizures, and interictal epileptiform discharges exhibited significant correlations with eye movement data. SIGNIFICANCE Children with SeLECTS exhibit persistent recognition memory impairment after being well controlled for the disease. Controlling the frequency of seizures and reducing prolonged epileptiform activity may improve memory cognitive development. The application of the eye-tracking technique may provide novel insights into exploring memory cognition as well as underlying mechanisms associated with pediatric epilepsy.
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Affiliation(s)
- Yanlu Fu
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jingxin Zhang
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yina Cao
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Linmei Ye
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Runze Zheng
- Artificial Intelligence Institute, Hangzhou Dianzi University School of Automation, Hangzhou, Zhejiang, China
| | - Qiwei Li
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Beibei Shen
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yi Shi
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jiuwen Cao
- Artificial Intelligence Institute, Hangzhou Dianzi University School of Automation, Hangzhou, Zhejiang, China
| | - Jiajia Fang
- Department of Neurology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
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Feng J, Zhang L, Tang J, Zhang B, Xiao X, Shi X. Clinical Analysis of Lacosamide Monotherapy in the Treatment of Self-Limited Epilepsy with Centrotemporal Spikes. Neuropsychiatr Dis Treat 2024; 20:459-467. [PMID: 38463459 PMCID: PMC10924107 DOI: 10.2147/ndt.s452784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/22/2024] [Indexed: 03/12/2024] Open
Abstract
Objective To evaluate the efficacy and safety of lacosamide (LCM) monotherapy in the treatment of self-limited epilepsy with centrotemporal spikes (SeLECTS). Methods In this study, 89 children with SeLECTS who were treated with LCM monotherapy in the Children's Hospital Affiliated to Soochow University from June 2019 to June 2021 were included. Clinical seizures and spike wave index (SWI) on video EEG during slow-wave sleep were evaluated before and after treatment. The role of LCM monotherapy in improving SWI, controlling clinical seizures and improving cognition was analyzed, and corresponding adverse reactions were documented. Results There were 52 males and 37 females in this group, with an average age of 7.6 ± 2.1 years. The total effective rate was 93.83% and at 18 months of treatment, the cumulative control rate was 85.19%, the retention rate was 91.01% and the effective rate in terms of EEG spike index was 72.92%, all of which showed a high rate; there was no statistically significant difference in intelligence quotient before and after treatment (P > 0.05). In addition, it was found in the study that the earlier the age of onset, the less obvious the improvement in SWI after LCM treatment; the lower the baseline seizure frequency, the more significant the improvement in SWI after LCM treatment. Conclusion LCM monotherapy had curative effect and adverse reactions for SeLECTS, with no negative impact on cognition. These significant findings indicate that LCM is likely to become a widely prescribed ASM for the treatment of SeLECTS. Meanwhile, the onset age and baseline seizure frequency had certain value in judging prognosis and predicting curative effect.
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Affiliation(s)
- Jun Feng
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Liya Zhang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Jihong Tang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Bingbing Zhang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Xiao Xiao
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Xiaoyan Shi
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
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Neumann H, Daseking M, Thiels C, Köhler C, Lücke T. Cognitive development in children with new-onset Rolandic epilepsy and Rolandic discharges without seizures: Focusing on intelligence, visual perception, working memory and the role of parents' education. Epilepsy Behav 2024; 152:109596. [PMID: 38350362 DOI: 10.1016/j.yebeh.2023.109596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE Our aim was to assess intelligence, visual perception and working memory in children with new-onset Rolandic epilepsy (RE) and children with Rolandic discharges without seizures (RD). METHODS The participants in the study were 12 children with RE and 26 children with RD aged 4 to 10 years (all without medication and shortly after diagnosis) and 31 healthy controls. Their cognitive performance was assessed using the German versions of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), the Wechsler Intelligence Scale for Children (WISC-IV), the Developmental Test of Visual Perception-2 (DTVP-2), the Developmental Test of Visual Perception-Adolescent and Adult (DTVP-A) (each according to age) and the Word Order, Hand Movements and Spatial Memory subtests of the German version of the Kaufman Assessment Battery for Children (K-ABC). RESULTS The comparison of the entire group of children with RE/RD and the control group conducted in the first step of our analysis revealed a weaker performance of the children with RE/RD in all cognitive domains. Significant deficits, however, were found exclusively in the RD group. Compared to the controls, they performed significantly weaker regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.002; processing speed: p = 0.005), visual perception (general visual perception: p = 0.005; visual-motor integration: p = 0.002) and working memory (WISC working memory: p = 0.002 and K-ABC Word Order (p = 0.010) and Hand Movements (p = 0.001) subtests. Also, the children without seizures scored significantly lower than those with seizures on the WISC Working Memory Index (p = 0.010) and on the K-ABC Word Order (p = 0.021) and Hand Movements (p = 0.027) subtests. Further analysis of our data demonstrated the particular importance of the family context for child development. Significant cognitive deficits were found only in children with RD from parents with lower educational levels. This group consistently scored lower compared to the control group regarding IQ (full scale IQ: p < 0.001; verbal IQ: p < 0.001; performance IQ: p = 0.012; processing speed: p = 0.034), visual perception (general visual perception: p = 0.018; visual-motor integration: p = 0.010) and auditory working memory (WISC working memory: p = 0.014). Furthermore, compared to the children with RE, they performed significantly weaker on verbal IQ (p = 0.020), auditory working memory consistently (WISC working memory: p = 0.027; K-ABC: Word Order: p = 0.046) as well as in one of the K-ABC spatial working memory subtests (Hand Movements: p = 0.029). Although we did not find significant deficits in children with new-onset RE compared to healthy controls, the performance of this group tended to be weaker more often. No statistically significant associations were observed between selected clinical markers (focus types: centrotemporal/other foci/laterality of foci and spread of Rolandic discharges) and cognitive test results. Except for spatial working memory, we also found no evidence that the age of our patients at the time of study participation was of significant importance to their cognitive performance. CONCLUSIONS Our study provides some evidence that children with Rolandic discharges, with and without seizures, may be at higher risk of cognitive impairment. In addition to medical care, we emphasise early differentiated psychosocial diagnostics to provide these children and their families with targeted support if developmental problems are present.
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Affiliation(s)
- Helmut Neumann
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany.
| | - Monika Daseking
- Department of Educational Psychology, Helmut Schmidt University/University of the Armed Forces Hamburg, Hamburg, Germany
| | - Charlotte Thiels
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Cornelia Köhler
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, Ruhr University Bochum, Department of Neuropediatrics Bochum, Germany
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Xu F, Li Y, Wang Y, Wang S, Sun F, Wang X. Interictal magnetic signals in new-onset Rolandic epilepsy may help with timing of treatment selection. Epilepsia Open 2024; 9:368-379. [PMID: 38145506 PMCID: PMC10839299 DOI: 10.1002/epi4.12884] [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: 04/26/2023] [Revised: 11/03/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE With research progress on Rolandic epilepsy (RE), its "benign" nature has been phased out. Clinicians are exhibiting an increasing tendency toward a more assertive treatment approach for RE. Nonetheless, in clinical practice, delayed treatment remains common because of the "self-limiting" nature of RE. Therefore, this study aimed to identify an imaging marker to aid treatment decisions and select a more appropriate time for initiating therapy for RE. METHODS We followed up with children newly diagnosed with RE, classified them into medicated and non-medicated groups according to the follow-up results, and compared them with matched healthy controls. Before beginning follow-up visits, interictal magnetic data were collected using magnetoencephalography in treatment-naïve recently diagnosed patients. The spectral power of the whole brain during initial diagnosis was determined using minimum normative estimation combined with the Welch technique. RESULTS A difference was observed in the magnetic source intensity within the left caudal anterior cingulate and precentral and postcentral gyri in the delta band between the medicated and non-medicated groups. The results revealed good discriminatory ability within the receiver operator characteristic curve. In the medicated group, there was a specific change in the frontotemporal magnetic source intensity, which shifted from high to low frequencies, compared with the healthy control group. SIGNIFICANCE The intensity of the precentral gyrus magnetic source within the delta band showed good specificity. Considering the rigor of initial treatment, the intensity of the precentral gyrus magnetic source can provide some help as an imaging marker for initial RE treatment, particularly for the timing of treatment initiation.
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Affiliation(s)
- Fengyuan Xu
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Yihan Li
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Yingfan Wang
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Siyi Wang
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Fangling Sun
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Xiaoshan Wang
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
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10
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Dontaine P, Rouge C, Urbain C, Galer S, Raffoul R, Nonclercq A, Van Dyck D, Baijot S, Aeby A. How the Spreading and Intensity of Interictal Epileptic Activity Are Associated with Visuo-Spatial Skills in Children with Self-Limited Focal Epilepsy with Centro-Temporal Spikes. Brain Sci 2023; 13:1566. [PMID: 38002525 PMCID: PMC10669985 DOI: 10.3390/brainsci13111566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This paper investigates brain-behaviour associations between interictal epileptic discharges and cognitive performance in a population of children with self-limited focal epilepsy with centro-temporal spikes (SeLECTS). Sixteen patients with SeLECTS underwent an extensive neuropsychological assessment, including verbal short-term and episodic memory, non-verbal short-term memory, attentional abilities and executive function. Two quantitative EEG indices were analysed, i.e., the Spike Wave Index (SWI) and the Spike Wave Frequency (SWF), and one qualitative EEG index, i.e., the EEG score, was used to evaluate the spreading of focal SW to other parts of the brain. We investigated associations between EEG indices and neuropsychological performance with non-parametric Spearman correlation analyses, including correction for multiple comparisons. The results showed a significant negative correlation between (i) the awake EEG score and the Block Tapping Test, a visuo-spatial short-term memory task, and (ii) the sleep SWI and the Tower of London, a visuo-spatial planning task (pcorr < 0.05). These findings suggest that, in addition to the usual quantitative EEG indices, the EEG analysis should include the qualitative EEG score evaluating the spreading of focal SW to other parts of the brain and that neuropsychological assessment should include visuo-spatial skills.
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Affiliation(s)
- Pauline Dontaine
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Coralie Rouge
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Charline Urbain
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Sophie Galer
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Romain Raffoul
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Antoine Nonclercq
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Dorine Van Dyck
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Simon Baijot
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Alec Aeby
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
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11
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Steinruecke M, Gillespie C, Ahmed N, Bandyopadhyay S, Duklas D, Ghahfarokhi MH, Henshall DE, Khan M, de Koning R, Madden J, Marston JSN, Mohamed RAA, Nischal SA, Norton EJ, Parameswaran G, Vasilica AM, Wei JOY, Williams CE, Williams F, Agrawal S, Grigoratos DN, Israni A, Kumar R, McCrea N, Patel J, Petropoulos MC, Singh J. Care and three-year outcomes of children with Benign Epilepsy with Centro-Temporal Spikes in England. Epilepsy Behav 2023; 148:109465. [PMID: 37844441 DOI: 10.1016/j.yebeh.2023.109465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Benign Epilepsy with Centro-Temporal Spikes (BECTS) is a pediatric epilepsy with typically good seizure control. Although BECTS may increase patients' risk of developing neurological comorbidities, their clinical care and short-term outcomes are poorly quantified. METHODS We retrospectively assessed adherence to National Institute for Health and Care Excellence (NICE) guidelines relating to specialist referral, electroencephalogram (EEG) conduct and annual review in the care of patients with BECTS, and measured their seizure, neurodevelopmental and learning outcomes at three years post-diagnosis. RESULTS Across ten centers in England, we identified 124 patients (74 male) diagnosed with BECTS between 2015 and 2017. Patients had a mean age at diagnosis of 8.0 (95% CI = 7.6-8.4) years. 24/95 (25%) patients were seen by a specialist within two weeks of presentation; 59/100 (59%) received an EEG within two weeks of request; and 59/114 (52%) were reviewed annually. At three years post-diagnosis, 32/114 (28%) experienced ongoing seizures; 26/114 (23%) had reported poor school progress; 15/114 (13%) were diagnosed with a neurodevelopmental disorder (six autism spectrum disorder, six attention-deficit/hyperactivity disorder); and 10/114 (8.8%) were diagnosed with a learning difficulty (three processing deficit, three dyslexia). Center-level random effects models estimated neurodevelopmental diagnoses in 9% (95% CI: 2-16%) of patients and learning difficulty diagnoses in 7% (95% CI: 2-12%). CONCLUSIONS In this multicenter work, we found variable adherence to NICE guidelines in the care of patients with BECTS and identified a notable level of neurological comorbidity. Patients with BECTS may benefit from enhanced cognitive and behavioral assessment and monitoring.
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Affiliation(s)
- Moritz Steinruecke
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, UK; University of Cambridge School of Clinical Medicine, UK.
| | - Conor Gillespie
- School of Medicine, University of Liverpool, UK; Department of Clinical Neurosciences, University of Cambridge, UK
| | - Najma Ahmed
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Soham Bandyopadhyay
- Clinical Neurosciences, School of Clinical and Experimental Sciences, University of Southampton, UK; Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, UK; Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, UK
| | | | | | - David E Henshall
- Deanery of Clinical Sciences, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, UK
| | - Mehdi Khan
- UCL Medical School, Faculty of Medical Sciences, University College London, UK
| | | | - James Madden
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, UK
| | | | | | | | - Emma Jane Norton
- University Division of Anaesthesia, University of Cambridge, UK; Faculty of Medicine, University of Southampton, UK
| | | | | | - John Ong Ying Wei
- College of Medical and Dental Sciences, University of Birmingham, UK
| | - Chloe Ec Williams
- School of Medicine, University of Liverpool, UK; Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, UK
| | | | - Shakti Agrawal
- Paediatric Neurology, Birmingham Women's and Children's NHS Foundation Trust, UK
| | | | - Anil Israni
- Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, UK; Faculty of Medicine, Parul University, India
| | - Ram Kumar
- Alder Hey Children's Hospital, Alder Hey Children's NHS Foundation Trust, UK
| | - Nadine McCrea
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jayesh Patel
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Maria-Christina Petropoulos
- UCL Medical School, Faculty of Medical Sciences, University College London, UK; University College Hospital, University College London Hospitals NHS Foundation Trust, UK
| | - Jaspal Singh
- University Hospital Southampton NHS Foundation Trust, UK
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12
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Smith SDW, McGinnity CJ, Smith AB, Barker GJ, Richardson MP, Pal DK. A prospective 5-year longitudinal study detects neurocognitive and imaging correlates of seizure remission in self-limiting Rolandic epilepsy. Epilepsy Behav 2023; 147:109397. [PMID: 37619460 DOI: 10.1016/j.yebeh.2023.109397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Self-limiting Rolandic epilepsy (RE) is the most common epilepsy in school-age children. Seizures are generally infrequent, but cognitive, language, and motor coordination problems can significantly impact the child's life. To better understand brain structure and function changes in RE, we longitudinally assessed neurocognition, cortical thickness, and subcortical volumes. METHODS At baseline, we recruited 30 participants diagnosed with RE and 24-healthy controls and followed up for 4.94 ± 0.8 years when the participants with RE were in seizure remission. Measures included were as follows: T1-weighted magnetic resonance brain imaging (MRI) with FreeSurfer analysis and detailed neuropsychological assessments. MRI and neuropsychological data were compared between baseline and follow-up in seizure remission. RESULTS Longitudinal MRI revealed excess cortical thinning in the left-orbitofrontal (p = 0.0001) and pre-central gyrus (p = 0.044). There is a significant association (p = 0.003) between a reduction in cortical thickness in the left-orbitofrontal cluster and improved processing of filtered words. Longitudinal neuropsychology revealed significant improvements in the symptoms of developmental coordination disorder (DCD, p = 0.005) in seizure remission. CONCLUSIONS There is evidence for altered development of neocortical regions between active seizure state and seizure remission in RE within two clusters maximal in the left-orbitofrontal and pre-central gyrus. There is significant evidence for improvement in motor coordination between active seizures and seizure remission and suggestive evidence for a decline in fluid intelligence and gains in auditory processing.
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Affiliation(s)
- Stuart D W Smith
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Evelina London Children's Hospital, London, UK; Great Ormond Street Hospital, London, UK
| | - Colm J McGinnity
- Department of PET Neuroimaging, St-Thomas Hospital, Kings College London, UK
| | - Anna B Smith
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Mark P Richardson
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, UK; King's College Hospital, UK
| | - Deb K Pal
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, UK; King's College Hospital, UK.
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13
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Chinappen DM, Ostrowski LM, Spencer ER, Kwon H, Kramer MA, Hämäläinen MS, Chu CJ. Decreased thalamocortical connectivity in resolved Rolandic epilepsy. Clin Neurophysiol 2023; 153:21-27. [PMID: 37419052 PMCID: PMC10520846 DOI: 10.1016/j.clinph.2023.05.013] [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: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Median nerve somatosensory evoked fields (SEFs) conduction times reflect the integrity of neural transmission across the thalamocortical circuit. We hypothesized median nerve SEF conduction time would be abnormal in children with Rolandic epilepsy (RE). METHODS 22 children with RE (10 active; 12 resolved) and 13 age-matched controls underwent structural and diffusion MRI and median nerve and visual stimulation during magnetoencephalography (MEG). N20 SEF responses were identified in contralateral somatosensory cortices. P100 were identified in contralateral occipital cortices as controls. Conduction times were compared between groups in linear models controlling for height. N20 conduction time was also compared to thalamic volume and Rolandic thalamocortical structural connectivity inferred using probabilistic tractography. RESULTS The RE group had slower N20 conduction compared to controls (p = 0.042, effect size 0.6 ms) and this difference was driven by the resolved RE group (p = 0.046). There was no difference in P100 conduction time between groups (p = 0.83). Ventral thalamic volume positively correlated with N20 conduction time (p = 0.014). CONCLUSIONS Children with resolved RE have focally decreased Rolandic thalamocortical connectivity. SIGNIFICANCE These results identify a persistent focal thalamocortical circuit abnormality in resolved RE and suggest that decreased Rolandic thalamocortical connectivity may support symptom resolution in this self-limited epilepsy.
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Affiliation(s)
- Dhinakaran M Chinappen
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Graduate Program in Neuroscience, Boston University, Boston, MA 02215, USA.
| | - Lauren M Ostrowski
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA
| | - Elizabeth R Spencer
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Graduate Program in Neuroscience, Boston University, Boston, MA 02215, USA
| | - Hunki Kwon
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics and Center for Systems Neuroscience, Boston University, Boston, MA 02215, USA
| | - Matti S Hämäläinen
- Massachusetts General Hospital, Department of Radiology, Boston, MA 02114, USA; Athinoula A, Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Catherine J Chu
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA.
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14
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Zhang Q, Li J, He Y, Yang F, Xu Q, Larivière S, Bernhardt BC, Liao W, Lu G, Zhang Z. Atypical functional connectivity hierarchy in Rolandic epilepsy. Commun Biol 2023; 6:704. [PMID: 37429897 DOI: 10.1038/s42003-023-05075-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
Functional connectivity hierarchy is an important principle in the process of brain functional organization and an important feature reflecting brain development. However, atypical brain network hierarchy organization in Rolandic epilepsy have not been systematically investigated. We examined connectivity alteration with age and its relation to epileptic incidence, cognition, or underlying genetic factors in 162 cases of Rolandic epilepsy and 117 typically developing children, by measuring fMRI multi-axis functional connectivity gradients. Rolandic epilepsy is characterized by contracting and slowing expansion of the functional connectivity gradients, highlighting the atypical age-related change of the connectivity hierarchy in segregation properties. The gradient alterations are relevant to seizure incidence, cognition, and connectivity deficit, and development-associated genetic basis. Collectively, our approach provides converging evidence for atypical connectivity hierarchy as a system-level substrate of Rolandic epilepsy, suggesting this is a disorder of information processing across multiple functional domains, and established a framework for large-scale brain hierarchical research.
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Affiliation(s)
- Qirui Zhang
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Jiao Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Yan He
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, 210002, China
| | - Fang Yang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
| | - Qiang Xu
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China
- College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210002, China
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, H3A 2B4, Canada
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, H3A 2B4, Canada
| | - Wei Liao
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China.
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China.
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China.
- Department of Diagnostic Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China.
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15
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Ostrowski LM, Chinappen DM, Stoyell SM, Song DY, Ross EE, Kramer MA, Emerton BC, Chu CJ. Children with Rolandic epilepsy have micro- and macrostructural abnormalities in white matter constituting networks necessary for language function. Epilepsy Behav 2023; 144:109254. [PMID: 37209552 PMCID: PMC10330597 DOI: 10.1016/j.yebeh.2023.109254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Self-limited epilepsy with centrotemporal spikes is a transient developmental epilepsy with a seizure onset zone localized to the centrotemporal cortex that commonly impacts aspects of language function. To better understand the relationship between these anatomical findings and symptoms, we characterized the language profile and white matter microstructural and macrostructural features in a cohort of children with SeLECTS. METHODS Children with active SeLECTS (n = 13), resolved SeLECTS (n = 12), and controls (n = 17) underwent high-resolution MRIs including diffusion tensor imaging sequences and multiple standardized neuropsychological measures of language function. We identified the superficial white matter abutting the inferior rolandic cortex and superior temporal gyrus using a cortical parcellation atlas and derived the arcuate fasciculus connecting them using probabilistic tractography. We compared white matter microstructural characteristics (axial, radial and mean diffusivity, and fractional anisotropy) between groups in each region, and tested for linear relationships between diffusivity metrics in these regions and language scores on neuropsychological testing. RESULTS We found significant differences in several language modalities in children with SeLECTS compared to controls. Children with SeLECTS performed worse on assessments of phonological awareness (p = 0.045) and verbal comprehension (p = 0.050). Reduced performance was more pronounced in children with active SeLECTS compared to controls, namely, phonological awareness (p = 0.028), verbal comprehension (p = 0.028), and verbal category fluency (p = 0.031), with trends toward worse performance also observed in verbal letter fluency (p = 0.052), and the expressive one-word picture vocabulary test (p = 0.068). Children with active SeLECTS perform worse than children with SeLECTS in remission on tests of verbal category fluency (p = 0.009), verbal letter fluency (p = 0.006), and the expressive one-word picture vocabulary test (p = 0.045). We also found abnormal superficial white matter microstructure in centrotemporal ROIs in children with SeLECTS, characterized by increased diffusivity and fractional anisotropy compared to controls (AD p = 0.014, RD p = 0.028, MD p = 0.020, and FA p = 0.024). Structural connectivity of the arcuate fasciculus connecting perisylvian cortical regions was lower in children with SeLECTS (p = 0.045), and in the arcuate fasciculus children with SeLECTS had increased diffusivity (AD p = 0.007, RD p = 0.006, MD p = 0.016), with no difference in fractional anisotropy (p = 0.22). However, linear tests comparing white matter microstructure in areas constituting language networks and language performance did not withstand correction for multiple comparisons in this sample, although a trend was seen between FA in the arcuate fasciculus and verbal category fluency (p = 0.047) and the expressive one-word picture vocabulary test (p = 0.036). CONCLUSION We found impaired language development in children with SeLECTS, particularly in those with active SeLECTS, as well as abnormalities in the superficial centrotemporal white matter as well as the fibers connecting these regions, the arcuate fasciculus. Although relationships between language performance and white matter abnormalities did not pass correction for multiple comparisons, taken together, these results provide evidence of atypical white matter maturation in fibers involved in language processing, which may contribute to the aspects of language function that are commonly affected by the disorder.
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Affiliation(s)
- Lauren M Ostrowski
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Dhinakaran M Chinappen
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Mathematics and Statistics, Boston University, Boston, MA 02215, USA
| | - Sally M Stoyell
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniel Y Song
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Erin E Ross
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215, USA
| | - Britt C Emerton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02115, USA
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16
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Halász P, Szũcs A. Self-limited childhood epilepsies are disorders of the perisylvian communication system, carrying the risk of progress to epileptic encephalopathies-Critical review. Front Neurol 2023; 14:1092244. [PMID: 37388546 PMCID: PMC10301767 DOI: 10.3389/fneur.2023.1092244] [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: 11/07/2022] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
"Sleep plasticity is a double-edged sword: a powerful machinery of neural build-up, with a risk to epileptic derailment." We aimed to review the types of self-limited focal epilepsies..."i.e. keep as two separate paragraphs" We aimed to review the types of self-limited focal epilepsies: (1) self-limited focal childhood epilepsy with centrotemporal spikes, (2) atypical Rolandic epilepsy, and (3) electrical status epilepticus in sleep with mental consequences, including Landau-Kleffner-type acquired aphasia, showing their spectral relationship and discussing the debated topics. Our endeavor is to support the system epilepsy concept in this group of epilepsies, using them as models for epileptogenesis in general. The spectral continuity of the involved conditions is evidenced by several features: language impairment, the overarching presence of centrotemporal spikes and ripples (with changing electromorphology across the spectrum), the essential timely and spatial independence of interictal epileptic discharges from seizures, NREM sleep relatedness, and the existence of the intermediate-severity "atypical" forms. These epilepsies might be the consequences of a genetically determined transitory developmental failure, reflected by widespread neuropsychological symptoms originating from the perisylvian network that have distinct time and space relations from secondary epilepsy itself. The involved epilepsies carry the risk of progression to severe, potentially irreversible encephalopathic forms.
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Affiliation(s)
- Péter Halász
- Department of Neurology, University Medical School, Pécs, Hungary
| | - Anna Szũcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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Chinappen DM, Xiao G, Jing J, Spencer ER, Eden UT, Kramer MA, Westover MB, Chu CJ. Spike height improves prediction of future seizure risk. Clin Neurophysiol 2023; 150:49-55. [PMID: 37002980 PMCID: PMC10192090 DOI: 10.1016/j.clinph.2023.02.180] [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: 10/24/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE We evaluated whether interictal epileptiform discharge (IED) rate and morphological characteristics predict seizure risk. METHODS We evaluated 10 features from automatically detectable IEDs in a stereotyped population with self-limited epilepsy with centrotemporal spikes (SeLECTS). We tested whether the average value or the most extreme values from each feature predicted future seizure risk in cross-sectional and longitudinal models. RESULTS 10,748 individual centrotemporal IEDs were analyzed from 59 subjects at 81 timepoints. In cross-sectional models, increases in average spike height, spike duration, slow wave rising slope, slow wave falling slope, and the most extreme values of slow wave rising slope each improved prediction of an increased risk of a future seizure compared to a model with age alone (p < 0.05, each). In longitudinal model, spike rising height improved prediction of future seizure risk compared to a model with age alone (p = 0.04) CONCLUSIONS: Spike height improves prediction of future seizure risk in SeLECTS. Several other morphological features may also improve prediction and should be explored in larger studies. SIGNIFICANCE Discovery of a relationship between novel IED features and seizure risk may improve clinical prognostication, visual and automated IED detection strategies, and provide insights into the underlying neuronal mechanisms that contribute to IED pathology.
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Affiliation(s)
- D M Chinappen
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Graduate Program for Neuroscience, Boston University, Boston, MA, USA; Department of Mathematics and Statistics, and Center for Systems Neuroscience, Boston University, Boston, MA, USA.
| | - G Xiao
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; Harvard University, Cambridge, MA, USA.
| | - J Jing
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - E R Spencer
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Graduate Program for Neuroscience, Boston University, Boston, MA, USA.
| | - U T Eden
- Department of Mathematics and Statistics, and Center for Systems Neuroscience, Boston University, Boston, MA, USA.
| | - M A Kramer
- Department of Mathematics and Statistics, and Center for Systems Neuroscience, Boston University, Boston, MA, USA.
| | - M B Westover
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - C J Chu
- Massachusetts General Hospital, Department of Neurology, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
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Xu Y, Wang Y, Xu F, Li Y, Sun J, Niu K, Wang P, Li Y, Zhang K, Wu D, Chen Q, Wang X. Impact of interictal epileptiform discharges on brain network in self-limited epilepsy with centrotemporal spikes: A magnetoencephalography study. Brain Behav 2023; 13:e3038. [PMID: 37137814 PMCID: PMC10275544 DOI: 10.1002/brb3.3038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the differences on resting-state brain networks between the interictal epileptiform discharge (IED) group with self-limited epilepsy with centrotemporal spikes (SeLECTS), the non-IED group with SeLECTS, and the healthy control (HC) group. METHODS Patients were divided into the IED and non-IED group according to the presence or absence of IED during magnetoencephalography (MEG). We used Wechsler Intelligence Scale for Children, fourth edition (WISC-IV) to assess cognition in 30 children with SeLECTS and 15 HCs. Functional networks were constructed at the whole-brain level and graph theory (GT) analysis was used to quantify the topology of the brain network. RESULTS The IED group had the lowest cognitive function scores, followed by the non-IED group and then HCs. Our MEG results showed that the IED group had more dispersed functional connectivity (FC) in the 4-8 Hz frequency band, and more brain regions were involved compared to the other two groups. Furthermore, the IED group had fewer FC between the anterior and posterior brain regions in the 12-30 Hz frequency band. Both the IED group and the non-IED group had fewer FC between the anterior and posterior brain regions in the 80-250 Hz frequency band compared to the HC group. GT analysis showed that the IED group had a higher clustering coefficient compared to the HC group and a higher degree compared to the non-IED group in the 80-250 Hz frequency band. The non-IED group had a lower path length in the 30-80 Hz frequency band compared to the HC group. CONCLUSIONS The study data obtained in this study suggested that intrinsic neural activity was frequency-dependent and that FC networks of the IED group and the non-IED group underwent changes in different frequency bands. These network-related changes may contribute to cognitive dysfunction in children with SeLECTS.
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Affiliation(s)
- Yue Xu
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Yingfan Wang
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Fengyuan Xu
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Yihan Li
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Jintao Sun
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Kai Niu
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Pengfei Wang
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Yanzhang Li
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Ke Zhang
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Di Wu
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
| | - Qiqi Chen
- MEG CenterNanjing Brain HospitalNanjingJiangsuP. R. China
| | - Xiaoshan Wang
- Department of NeurologyThe Affiliated Brain HospitalNanjing Medical UniversityNanjingJiangsuP. R. China
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Xu F, Xu Y, Wang Y, Niu K, Li Y, Wang P, Li Y, Sun J, Chen Q, Wang X. Language-related brain areas in childhood epilepsy with centrotemporal spikes studied with MEG. Clin Neurophysiol 2023; 152:11-21. [PMID: 37257319 DOI: 10.1016/j.clinph.2023.05.005] [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: 12/19/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Children with self-limited epilepsy with centrotemporal spikes (SeLECTS) typically indicate cognitive impairment with widespread speech impairment. We explored how epilepsy affects language-related brain areas and areas in their vicinity. METHODS Twenty-two children with SeLECTS and declined verbal comprehension (DVC), 21 with SeLECTS and normal verbal comprehension (NVC), and 23 healthy controls (HCs) underwent high-sampling magnetoencephalography recordings. According to a previous study, 24 language-related regions of interest were selected bilaterally, and the relative spectral power was estimated using a minimum norm estimate. RESULTS The highest mean power spectral density was observed in the delta band for the DVC group, in the theta band for the NVC group, and in the alpha band for HCs within language-specific brain regions. The distinctions between the DVC and NVC groups in the delta and theta frequency bands were primarily concentrated in the right linguistic brain area. CONCLUSIONS Children with SeLECTS may have developmental problems in language-related brain areas, with different developmental levels observed in the DVC, NVC, and HC groups. The DVC group could have inferior speech comprehension due to a more significant number of seizures and more left-sided spike locations. SIGNIFICANCE Children having SeLECTS showed impaired brain maturation, leading to associated language impairment.
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Affiliation(s)
- Fengyuan Xu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Xu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Niu
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzhang Li
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- Country MEG Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Country Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
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Francey G, Currie N, Lew A, De Goede C, Basu H, Cain K. Text integration processes in children with Childhood Epilepsy with Centro-Temporal Spikes. Epilepsy Res 2023; 192:107136. [PMID: 37068422 DOI: 10.1016/j.eplepsyres.2023.107136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Although Childhood Epilepsy with Centro-Temporal Spikes (CECTS) is considered a 'benign' form of epilepsy, word reading, listening comprehension, and reading comprehension difficulties have been reported. We examined two core skills for text comprehension, coherence monitoring and inference generation, in children with CECTS and compared performance with typically developing controls. Children with CECTS (n = 23; 9 females; mean age 9 y 0 m) and the comparison group (n = 38; 14 females; mean age 9 y 1 m) completed two tasks. For coherence monitoring they heard 24 narrative texts, 16 containing two inconsistent sentences, and responded to a yes/no question to assess identification of the inconsistency after each text; for inference making they heard 16 texts designed to elicit a target inference by integrating information in two sentences and responded to a yes/no question to assess generation of the inference. In both tasks there was a near condition, in which critical sentences were adjacent, and a far condition in which these sentences were separated by filler sentences. Accuracy to the question and the processing time for critical sentences in the text were measured. We used listening comprehension tasks to control for variation in word reading ability. Mixed effects analyses for each task revealed that children with CECTS show comparable levels of accuracy to age-matched peers in these tasks tapping two core text integration skills: detection of inconsistencies and generation of inferences. However, they take longer to process texts indicating a likely source of their listening and reading comprehension difficulties.
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Brain Connectivity: When too much of a good thing is not so good. Clin Neurophysiol 2022; 144:117-118. [PMID: 36244914 DOI: 10.1016/j.clinph.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/20/2022]
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Goad BS, Lee-Messer C, He Z, Porter BE, Baumer FM. Connectivity increases during spikes and spike-free periods in self-limited epilepsy with centrotemporal spikes. Clin Neurophysiol 2022; 144:123-134. [PMID: 36307364 PMCID: PMC10883644 DOI: 10.1016/j.clinph.2022.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To understand the impact of interictal spikes on brain connectivity in patients with Self-Limited Epilepsy with Centrotemporal Spikes (SeLECTS). METHODS Electroencephalograms from 56 consecutive SeLECTS patients were segmented into periods with and without spikes. Connectivity between electrodes was calculated using the weighted phase lag index. To determine if there are chronic alterations in connectivity in SeLECTS, we compared spike-free connectivity to connectivity in 65 matched controls. To understand the acute impact of spikes, we compared connectivity immediately before, during, and after spikes versus baseline, spike-free connectivity. We explored whether behavioral state, spike laterality, or antiseizure medications affected connectivity. RESULTS Children with SeLECTS had markedly higher connectivity than controls during sleep but not wakefulness, with greatest difference in the right hemisphere. During spikes, connectivity increased globally; before and after spikes, left frontal and bicentral connectivity increased. Right hemisphere connectivity increased more during right-sided than left-sided spikes; left hemisphere connectivity was equally affected by right and left spikes. CONCLUSIONS SeLECTS patient have persistent increased connectivity during sleep; connectivity is further elevated during the spike and perispike periods. SIGNIFICANCE Testing whether increased connectivity impacts cognition or seizure susceptibility in SeLECTS and more severe epilepsies could help determine if spikes should be treated.
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Affiliation(s)
- Beatrice S Goad
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA.
| | | | - Zihuai He
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Brenda E Porter
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Fiona M Baumer
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA.
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Li Y, Chen J, Sun J, Jiang P, Xiang J, Chen Q, Hu Z, Wang X. Changes in functional connectivity in newly diagnosed self-limited epilepsy with centrotemporal spikes and cognitive impairment: An MEG study. Brain Behav 2022; 12:e2830. [PMID: 36408856 PMCID: PMC9759146 DOI: 10.1002/brb3.2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Our purpose was to explore the relationship between cognitive impairment and neural network changes in patients newly diagnosed with self-limited epilepsy with centrotemporal spikes (SeLECTS). METHODS The Wechsler Intelligence Scale for Children, fourth edition was used to divide all SeLECTS patients into two groups: patients with full-scale intelligence quotient (FSIQ) below 80 that corresponded to cognitive impairment, and patients with FSIQ above 80 that corresponded to a normal cognitive function. The data on the resting state were recorded using magnetoencephalography. The properties of the networks were analyzed using graph theory (GT) analysis. RESULTS The functional connectivity (FC) of the frontal cortex in patients with FSIQ < 80 was reduced in the 12-30 Hz frequency band, and the FC of the posterior cingulate cortex was reduced in the 80-250 and 250-500 Hz frequency bands. The GT analysis showed that patients in the FSIQ < 80 group had higher strength in the 8-12 and 12-30 Hz frequency bands than those in the healthy control and FSIQ > 80 group. However, the path length was reduced in the 80-250 Hz band, and the clustering coefficient was reduced in the 12-30, 80-250, and 250-500 Hz frequency bands. Moreover, the receiver operator characteristic analysis showed that the clustering coefficient in the 12-30 and 80-250 Hz frequency bands, as well as the path length in the 80-250 Hz frequency band possessed a good discriminative ability in distinguishing the FSIQ > 80 group. CONCLUSIONS SeLECTS patients with cognitive impairment in the early stage of the disease developed disordered networks in cognitive-related brain regions. The clustering coefficient in the 12-30 and 80-250 Hz frequency bands as well as the path length in the 80-250 Hz frequency band might be good indicators to distinguish the cognitive impairment of SeLECTS patients at the early stage.
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Affiliation(s)
- Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinan Chen
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping Jiang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Yin Y, Wang F, Ma Y, Yang J, Li R, Li Y, Wang J, Liu H. Structural and functional changes in drug-naïve benign childhood epilepsy with centrotemporal spikes and their associated gene expression profiles. Cereb Cortex 2022; 33:5774-5782. [PMID: 36444721 PMCID: PMC10183734 DOI: 10.1093/cercor/bhac458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Benign epilepsy with centrotemporal spikes (BECTS) is a common pediatric epilepsy syndrome that has been widely reported to show abnormal brain structure and function. However, the genetic mechanisms underlying structural and functional changes remain largely unknown. Based on the structural and resting-state functional magnetic resonance imaging data of 22 drug-naïve children with BECTS and 33 healthy controls, we conducted voxel-based morphology (VBM) and fractional amplitude of low-frequency fluctuation (fALFF) analyses to compare cortical morphology and spontaneous brain activity between the 2 groups. In combination with the Allen Human Brain Atlas, transcriptome-neuroimaging spatial correlation analyses were applied to explore gene expression profiles associated with gray matter volume (GMV) and fALFF changes in BECTS. VBM analysis demonstrated significantly increased GMV in the right brainstem and right middle cingulate gyrus in BECTS. Moreover, children with BECTS exhibited significantly increased fALFF in left temporal pole, while decreased fALFF in right thalamus and left precuneus. These brain structural and functional alterations were closely related to behavioral and cognitive deficits, and the fALFF-linked gene expression profiles were enriched in voltage-gated ion channel and synaptic activity as well as neuron projection. Our findings suggest that brain morphological and functional abnormalities in children with BECTS involve complex polygenic genetic mechanisms.
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Affiliation(s)
- Yu Yin
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province , Zunyi 563003 , China
| | - Fuqin Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province , Zunyi 563003 , China
| | - Yingzi Ma
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology , Kunming 650500 , China
- Yunnan Key Laboratory of Primate Biomedical Research , Kunming 650500, Yunnan , China
| | - Jia Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology , Kunming 650500 , China
- Yunnan Key Laboratory of Primate Biomedical Research , Kunming 650500, Yunnan , China
| | - Rui Li
- School of Electrical Engineering and Electronic Information, Xihua University , Chengdu 610039 , China
| | - Yuanyuan Li
- School of Life Science and Technology, University of Electronic Science and Technology of China , Chengdu 625014 , China
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology , Kunming 650500 , China
- Yunnan Key Laboratory of Primate Biomedical Research , Kunming 650500, Yunnan , China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province , Zunyi 563003 , China
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Li Y, Li Y, Sun J, Niu K, Wang P, Xu Y, Wang Y, Chen Q, Zhang K, Wang X. Relationship between brain activity, cognitive function, and sleep spiking activation in new-onset self-limited epilepsy with centrotemporal spikes. Front Neurol 2022; 13:956838. [DOI: 10.3389/fneur.2022.956838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveThis study aimed to investigate the relationship between cognitive function sleep spiking activation and brain activity in self-limited epilepsy with centrotemporal spikes (SeLECTS).MethodsWe used spike-wave index (SWI), which means the percentage of the spike and slow wave duration to the total non-REM (NREM) sleep time, as the grouping standard. A total of 14 children with SeLECTS (SWI ≥ 50%), 21 children with SeLECTS (SWI < 50%), and 20 healthy control children were recruited for this study. Cognitive function was evaluated using the Wechsler Intelligence Scale for Children, Fourth Edition (Chinese version) (WISC-IV). Magnetic source activity was assessed using magnetoencephalography calculated for each frequency band using the accumulated source imaging (ASI) technique.ResultsChildren with SeLECTS (SWI ≥ 50%) had the lowest cognitive function scores, followed by those with SeLECTS (SWI < 50%) and then healthy controls. There were significant differences in the localization of magnetic source activity between the three groups: in the alpha (8–12 Hz) frequency band, children with SeLECTS (SWI ≥ 50%) showed deactivation of the medial frontal cortex (MFC) region; in the beta (12–30 Hz) frequency band, children with SeLECTS (SWI ≥ 50%) showed deactivation of the posterior cingulate cortex (PCC) segment; and in the gamma (30–80 Hz) frequency band, children in the healthy group showed activation of the PCC region.ConclusionThis study revealed significant decreases in cognitive function in children with SeLECTS (SWI ≥ 50%) compared to children with SeLECTS (SWI < 50%) and healthy children, as well as significant differences in magnetic source activity between the three groups. The findings suggest that deactivation of magnetic source activity in the PCC and MFC regions is the main cause of cognitive function decline in SeLECTS patients with some frequency dependence.
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Abnormalities of hemispheric specialization in drug-naïve and drug-receiving self-limited epilepsy with centrotemporal spikes. Epilepsy Behav 2022; 136:108940. [PMID: 36228484 DOI: 10.1016/j.yebeh.2022.108940] [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: 06/10/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Self-limited epilepsy with centrotemporal spikes (SLECTS) is a pediatric benign epilepsy but often accompanied by subsequent (in adulthood) functional changes such as language, which are thought to have distinct areas of hemispheric lateralization and functional differentiation. This study aimed to explore hemispheric specialization measured by resting-state functional magnetic resonance imaging (rs-fMRI) functional connectivity in drug-naïve and drug-receiving SLECTS. METHODS Hemispheric specialization was quantified in three groups of children, including 21 drug-naïve patients (DNP) with SLECTS, 34 drug-receiving patients (DRP) with SLECTS and 36 demographically matched typical development (TD). RESULTS Compared with the TD group, both the DNP and DRP groups exhibited significantly higher specialization in the left superior temporal gyrus, right parahippocampus, left putamen, and right caudate. The DNP group exhibited significantly higher hemispheric specialization in the right precentral gyrus and right inferior temporal gyrus, while the DRP group demonstrated significantly higher hemispheric specialization in the left postcentral gyrus and right hippocampus than the TD group. Furthermore, bilateral cerebellum_6 showed opposing hemispheric specialization trends in the two patient groups. Further meta-analytical mapping demonstrated that hemispheric specialization-related differential brain regions are primarily involved in language processing. CONCLUSION Our findings showed that children with SLECTS had altered hemispheric specialization, mainly in language processing regions, suggesting both abnormal intrahemispheric segregation and interhemispheric integration in these children.
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Yang Y, Wang F, Andrade-Machado R, De Vito A, Wang J, Zhang T, Liu H. Disrupted functional connectivity patterns of the left inferior frontal gyrus subregions in benign childhood epilepsy with centrotemporal spikes. Transl Pediatr 2022; 11:1552-1561. [PMID: 36247884 PMCID: PMC9561512 DOI: 10.21037/tp-22-270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Benign epilepsy with centrotemporal spikes (BECTS) is one of the most common pediatric epileptic syndromes. Recent studies have shown that BECTS can lead to significant language dysfunction. Although research supports the role of the left inferior frontal gyrus (LIFG) in BECTS, it is unclear whether the subregions of the LIFG show different change patterns in patients with this syndrome. METHODS Using resting-state functional magnetic resonance imaging (fMRI) data in a group of 49 BECTS patients and 49 healthy controls, we investigated whether the BECTS patients show abnormal connectivity patterns of the LIFG subregions. RESULTS Compared with healthy controls, the BECTS patients exhibited higher connectivity between the following: the inferior frontal sulcus (IFS) and the right anterior cingulate cortex (ACC), and the ventral area 44 (A44v) region and the left hippocampus/parahippocampus. Also, a decreased connectivity was found between the IFS and the left inferior temporal gyrus (ITG). No other significant differences in functional connectivity were found in the other 4 functional subregions of the LIFG in the BECTS. CONCLUSIONS These findings provide evidence for BECTS-related functional connectivity patterns of the LIFG subregions and suggest that different subregions may be involved in different neural circuits associated with language function in the BECTS.
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Affiliation(s)
- Yang Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China.,Department of Radiology, Suining Central Hospital, Suining, China
| | - Fuqin Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - René Andrade-Machado
- Epilepsy Fellow at Children Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - Andrea De Vito
- Department of Neuroradiology, H. S. Gerardo Monza, Monza, Italy
| | - Jiaojian Wang
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.,Center for Language and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China
| | - Tijiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
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Li Y, Wang Y, Jiang P, Sun J, Chen Q, Wang X. Alterations in the default mode network in rolandic epilepsy with mild spike-wave index in non-rapid eye movement sleep. Front Neurosci 2022; 16:944391. [PMID: 36017188 PMCID: PMC9395966 DOI: 10.3389/fnins.2022.944391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Rolandic epilepsy (RE) is one of the most common epilepsy syndromes during childhood. The aim of this study was to investigate the alterations in the default mode network (DMN) of RE patients whose spike-wave index (SWI) was within the 50–85% range during non-rapid eye movement (NREM) during sleep, as well as to detect early neuroimaging markers. Methods Resting-state data was recorded for each subject using magnetoencephalography (MEG). DMN-related brain regions were chosen as regions of interest. The spectral power and functional connectivity (FC) of the DMN were estimated through the use of minimum norm estimation (MNE) combined with Welch technique and corrected amplitude envelope correlation (AEC-c). Results The patient group included 20 patients with NREM phase 50% ≤ SWI < 85% (mild SWI group), and 18 typical RE patients (SWI < 50% group). At the regional level, the mild SWI group exhibited enhanced spectral power in the delta band of the bilateral posterial cingulate cortex and attenuated the spectral power in the alpha band of the bilateral posterial cingulate cortex. Enhanced spectral power in the bilateral precuneus (PCu) in the delta band and attenuated spectral power in the right lateral temporal cortex (LTC) in the alpha band were common across all RE patients. At the FC level, patients in the mild SWI group indicated increased AEC-c values between the bilateral posterial cingulate cortex in the delta band and between the left medial frontal cortex (MFC) and bilateral posterial cingulate cortex in the alpha band. Increased AEC-c values between the right PCu and left MFC in the delta band, and between the left PCu and right MFC in the theta band, were common across all RE patients. Moreover, the spectral power in the bilateral posterial cingulate cortex in the alpha band and the AEC-c value between the bilateral posterial cingulate cortex in the delta band demonstrated good discrimination ability. Conclusion The spectral power of the bilateral posterior cingulate cortex (PCC) in the alpha band and the AEC-c value between the bilateral PCC in the delta band may be promising indicators of early differentiation between mild SWI and typical RE.
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Affiliation(s)
- Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Jiang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xiaoshan Wang,
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Abstract
PURPOSE OF REVIEW To review the mutual interactions between sleep and epilepsy, including mechanisms of epileptogenesis, the relationship between sleep apnea and epilepsy, and potential strategies to treat seizures. RECENT FINDINGS Recent studies have highlighted the role of functional network systems underlying epileptiform activation in sleep in several epilepsy syndromes, including absence epilepsy, benign focal childhood epilepsy, and epileptic encephalopathy with spike-wave activation in sleep. Sleep disorders are common in epilepsy, and early recognition and treatment can improve seizure frequency and potentially reduce SUDEP risk. Additionally, epilepsy is associated with cyclical patterns, which has led to new treatment approaches including chronotherapy, seizure monitoring devices, and seizure forecasting. Adenosine kinase and orexin receptor antagonists are also promising new potential drug targets that could be used to treat seizures. Sleep and epilepsy have a bidirectional relationship that intersects with many aspects of clinical management. In this article, we identify new areas of research involving future therapeutic opportunities in the field of epilepsy.
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Bartolini E, Ferrari AR, Lattanzi S, Pradella S, Zaccara G. Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology. Epilepsy Behav 2022; 132:108739. [PMID: 35636351 DOI: 10.1016/j.yebeh.2022.108739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
The incidence of epilepsy is highest at the extreme age ranges: childhood and elderly age. The most common syndromes in these demographics - self-limited epilepsies of childhood and idiopathic generalized epilepsies in pediatric age, focal epilepsy with structural etiology in older people - are expected to be drug responsive. In this work, we focus on such epilepsy types, overviewing the complex clinical background of unexpected drug-resistance. For self-limited epilepsies of childhood and idiopathic generalized epilepsies, we illustrate drug-resistance resulting from syndrome misinterpretation, reason on possible unexpected courses of epilepsy, and explicate the influence of inappropriate treatments. For elderly-onset epilepsy, we show the challenges in differential diagnosis possibly leading to pseudoresistance and analyze how drug-resistant epilepsy can arise in stroke, neurocognitive disorders, brain tumors, and autoimmune encephalitis. In children and senior people, drug-resistance can be regarded as a hint to review the diagnosis or explore alternative therapeutic strategies. Refractory seizures are not only a therapeutic challenge, but also a cardinal sign not to be overlooked in syndromes commonly deemed to be drug-responsive.
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Affiliation(s)
- Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Pradella
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy.
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Zhang S, Tang J, Huang J, Suo G, Zhou Z, You B, Dai Y, Liu Y. Whole-Brain Dynamic Resting-State Functional Network Analysis in Benign Epilepsy with Centrotemporal Spikes. IEEE J Biomed Health Inform 2022; 26:3813-3821. [PMID: 35380976 DOI: 10.1109/jbhi.2022.3164907] [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: 11/08/2022]
Abstract
Benign epilepsy with centrotemporal spikes (BECTS), the most common type of epilepsy among children, is considered a network disorder. Both fMRI and EEG source imaging (ESI) studies have indicated that BECTS is associated with static resting-state functional network (SFN) alterations (e.g., decreased global efficiency) in source space. However, we find that the abovementioned alterations are not significant when the SFN calculations are performed in the scalp space using only clinical routine low-density (e.g., 19 channels) EEG recordings (shown in our results). In the context of EEG microstates, it is clear that networks in the scalp space with resting-state EEG recordings dynamically reconfigure in a well-organized way based on different functional states. We are therefore inspired to propose a whole-brain dynamic resting-state functional network (DFN) computation method based on resting-state low-density EEG recordings with four classical microstates in scalp space. Notably, on the one hand, this approach is suitable for clinical conditions, and, on the other hand, the dynamic alternations calculated with a DFN may promote our understanding of how the networks change in BECTS. We analysed the changes in a DFN in six frequency bands (, low, high, and) in patients with BECTS compared to those for healthy controls. Superior to traditional SFNs, the proposed DFN can reveal significant differences between individuals with BECTS and healthy controls (e.g., lower global efficiency), thus matching traditional fMRI and ESI methods in the source space. Our method directly performs DFN computations from low-density EEG recordings and avoids complex ESI computations, making it promising for clinical applications, especially in the outpatient diagnosis stage.
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Spencer ER, Chinappen D, Emerton BC, Morgan AK, Hämäläinen MS, Manoach DS, Eden UT, Kramer MA, Chu CJ. Source EEG reveals that Rolandic epilepsy is a regional epileptic encephalopathy. Neuroimage Clin 2022; 33:102956. [PMID: 35151039 PMCID: PMC8844714 DOI: 10.1016/j.nicl.2022.102956] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/10/2022] [Accepted: 02/03/2022] [Indexed: 01/15/2023]
Abstract
Children with RE have fewer spindles but they have typical time–frequency features. Spindle deficits extend to multiple cortical regions in Rolandic epilepsy. Cognitive deficits are predicted by spindle rate in Rolandic epilepsy. Regional spindle rate predicts motor deficits better than Rolandic spindle deficit. Spindle features in RE identify a regional thalamocortical epileptic encephalopathy.
Rolandic epilepsy is the most common form of epileptic encephalopathy, characterized by sleep-potentiated inferior Rolandic epileptiform spikes, seizures, and cognitive deficits in school-age children that spontaneously resolve by adolescence. We recently identified a paucity of sleep spindles, physiological thalamocortical rhythms associated with sleep-dependent learning, in the Rolandic cortex during the active phase of this disease. Because spindles are generated in the thalamus and amplified through regional thalamocortical circuits, we hypothesized that: 1) deficits in spindle rate would involve but extend beyond the inferior Rolandic cortex in active epilepsy and 2) regional spindle deficits would better predict cognitive function than inferior Rolandic spindle deficits alone. To test these hypotheses, we obtained high-resolution MRI, high-density EEG recordings, and focused neuropsychological assessments in children with Rolandic epilepsy during active (n = 8, age 9–14.7 years, 3F) and resolved (seizure free for > 1 year, n = 10, age 10.3–16.7 years, 1F) stages of disease and age-matched controls (n = 8, age 8.9–14.5 years, 5F). Using a validated spindle detector applied to estimates of electrical source activity in 31 cortical regions, including the inferior Rolandic cortex, during stages 2 and 3 of non-rapid eye movement sleep, we compared spindle rates in each cortical region across groups. Among detected spindles, we compared spindle features (power, duration, coherence, bilateral synchrony) between groups. We then used regression models to examine the relationship between spindle rate and cognitive function (fine motor dexterity, phonological processing, attention, and intelligence, and a global measure of all functions). We found that spindle rate was reduced in the inferior Rolandic cortices in active but not resolved disease (active P = 0.007; resolved P = 0.2) compared to controls. Spindles in this region were less synchronous between hemispheres in the active group (P = 0.005; resolved P = 0.1) compared to controls; but there were no differences in spindle power, duration, or coherence between groups. Compared to controls, spindle rate in the active group was also reduced in the prefrontal, insular, superior temporal, and posterior parietal regions (i.e., “regional spindle rate”, P < 0.039 for all). Independent of group, regional spindle rate positively correlated with fine motor dexterity (P < 1e-3), attention (P = 0.02), intelligence (P = 0.04), and global cognitive performance (P < 1e-4). Compared to the inferior Rolandic spindle rate alone, models including regional spindle rate trended to improve prediction of global cognitive performance (P = 0.052), and markedly improved prediction of fine motor dexterity (P = 0.006). These results identify a spindle disruption in Rolandic epilepsy that extends beyond the epileptic cortex and a potential mechanistic explanation for the broad cognitive deficits that can be observed in this epileptic encephalopathy.
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Affiliation(s)
- Elizabeth R Spencer
- Graduate Program in Neuroscience, Boston University, Boston, MA 02215; Department of Neurology, Massachusetts General Hospital, Boston, MA 02114
| | - Dhinakaran Chinappen
- Graduate Program in Neuroscience, Boston University, Boston, MA 02215; Department of Neurology, Massachusetts General Hospital, Boston, MA 02114
| | - Britt C Emerton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Amy K Morgan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Matti S Hämäläinen
- Harvard Medical School, Boston, MA 02115; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129; Massachusetts General Hospital, Department of Radiology, Boston, MA 02114
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114; Harvard Medical School, Boston, MA 02115; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129
| | - Uri T Eden
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215; Center for Systems Neuroscience, Boston University, Boston, MA 02215
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215; Center for Systems Neuroscience, Boston University, Boston, MA 02215
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114; Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114.
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Li Y, Zhang T, Feng J, Qian S, Wu S, Zhou R, Wang J, Sa G, Wang X, Li L, Chen F, Yang H, Zhang H, Tian M. Processing speed dysfunction is associated with functional corticostriatal circuit alterations in childhood epilepsy with centrotemporal spikes: a PET and fMRI study. Eur J Nucl Med Mol Imaging 2022; 49:3186-3196. [PMID: 35199226 PMCID: PMC9250469 DOI: 10.1007/s00259-022-05740-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/17/2022] [Indexed: 11/19/2022]
Abstract
Purpose Epilepsy with centrotemporal spikes (ECTS) is the most common epilepsy syndrome in children and usually presents with cognitive dysfunctions. However, little is known about the processing speed dysfunction and the associated neuroimaging mechanism in ECTS. This study aims to investigate the brain functional abnormality of processing speed dysfunction in ECTS patients by using the 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and resting-state functional magnetic resonance imaging (rs-fMRI). Methods This prospective study recruited twenty-eight ECTS patients who underwent the 18F-FDG PET, rs-fMRI, and neuropsychological examinations. Twenty children with extracranial tumors were included as PET controls, and 20 healthy children were recruited as MRI controls. The PET image analysis investigated glucose metabolism by determining standardized uptake value ratio (SUVR). The MRI image analysis explored abnormal functional connectivity (FC) within the cortical–striatal circuit through network-based statistical (NBS) analysis. Correlation analysis was performed to explore the relationship between SUVR, FC, and processing speed index (PSI). Results Compared with healthy controls, ECTS patients showed normal intelligence quotient but significantly decreased PSI (P = 0.04). PET analysis showed significantly decreased SUVRs within bilateral caudate, putamen, pallidum, left NAc, right rostral middle frontal gyrus, and frontal pole of ECTS patients (P < 0.05). Rs-fMRI analysis showed absolute values of 20 FCs were significantly decreased in ECTS patients compared with MRI controls, which connected 16 distinct ROIs. The average SUVR of right caudate and the average of 20 FCs were positively correlated with PSI in ECTS patients (P = 0.034 and P = 0.005, respectively). Conclusion This study indicated that ECTS patients presented significantly reduced PSI, which is closely associated with decreased SUVR and FC of cortical–striatal circuit. Caudate played an important role in processing speed dysfunction. Clinical trial registration NCT04954729; registered on July 8, 2021, public site, https://clinicaltrials.gov/ct2/show/NCT04954729 Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05740-w.
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Affiliation(s)
- Yuting Li
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Teng Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shufang Qian
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jing Wang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Guo Sa
- Department of Radiology, The First Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiawan Wang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Lina Li
- College of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Feng Chen
- Department of Radiology, The First Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Yang
- Department of Radiology, The First Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China. .,The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
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Baggio M, Toffoli L, Da Rold M, Duma GM, Mento G, Morao V, Danieli A, Bonanni P. Neuropsychological and behavioral profiles of self-limited epileptic syndromes of childhood: a cross-syndrome comparison. Child Neuropsychol 2022; 28:878-902. [PMID: 35086426 DOI: 10.1080/09297049.2022.2028754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood epilepsy with centro-temporal spikes (CECTS), Childhood absence epilepsy (CAE) and Panayiotopoulos syndrome (PS) are some of the most common pediatric epileptic syndromes. Despite the relatively benign (self-limited) course of epilepsy, current evidence suggests that these conditions are associated with an increased risk of neuropsychological and behavioral comorbidities. This study provides a cross-epileptic syndromes' comparison reporting on the cognitive and behavioral profile of a cohort of 32 children with CECTS (n = 14), CAE (n = 10) and PS (n = 8), aged 6 to 15 years old. Frequent, although often subclinical cognitive difficulties involving attention, executive functions and academic abilities were found in children with CECTS and CAE, and to a lesser extent in PS. Internalizing symptoms (particularly anxiety) were more common in the PS group compared to CECTS and CAE based on parental reports. Correlational analysis revealed a significant correlation between phonemic fluency and seizure-free interval at the time of evaluation, suggesting a beneficial effect of epilepsy remission on this executive function measure in all the three groups. These results add to existing literature providing further detail on neuropsychological and behavioral peculiarities of children with CECTS, CAE, and PS. Moreover, the need for neuropsychological assessment as part of the standard childhood epilepsy evaluation is stressed. The results are discussed in the context of the current literature, highlighting areas of consensus and controversies related to the clinical management of these epileptic syndromes as well as directions for future research.
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Affiliation(s)
- Martina Baggio
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Lisa Toffoli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Martina Da Rold
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Gian Marco Duma
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Giovanni Mento
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Padova Neuroscience Center (PNC), University of Padova, Italy
| | - Veronica Morao
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
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Cheng W, Yang Y, Chen Y, Shan S, Li C, Fang L, Zhang W, Lan S, Zhang X. Anti-Seizure Medication Treatment of Benign Childhood Epilepsy With Centrotemporal Spikes: A Systematic Review and Meta-analysis. Front Pharmacol 2022; 13:821639. [PMID: 35359874 PMCID: PMC8960983 DOI: 10.3389/fphar.2022.821639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background: This study aimed to evaluate the efficacy and tolerability of Anti-Seizure medication (ASM) treatment in patients with BECTS. Method: We searched PubMed, Cochrane Library, Embase, MEDLINE, Web of Science, China National Knowledge Infrastructure (CNKI), WANFANG DATA, and China Science and Technology Journal Database (VIP) between 1 Jan 1990, and 1 Sep 2021, for randomized controlled studies. Data on seizure freedom rate, rate of treatment withdrawal due to serious adverse events, rate of any adverse events and dropout, 50% remission rate, the proportion of patients whose EEG to be normalized, and improvement in cognitive function were extracted by two authors independently. The pooled data were meta-analyzed using a random effects model. Results: A total of 27 studies evaluating 9 ASMs were included, 19 of which were suitable for meta-analysis. Compared with sulthiame (STM), levetiracetam (LEV) was associated with a higher probability of treatment withdrawal due to serious adverse events [RR = 5.12, 95% CI (1.19, 22.01), I 2 = 0.0%], experiencing any adverse events [RR = 5.12, 95% CI (1.19, 22.01)], and dropping out for any reason [RR = 3.17, 95% CI (1.36, 10.11)], while it did not affect the seizure freedom rate [RR = 0.90, 95% CI (0.75, 1.06)]. LEV significantly improved cognitive performance relative to carbamazepine (CBZ) but had no effect on the proportion of any adverse events [RR = 0.62, 95% CI (0.25, 1.59)] and EEG to be normalized [RR = 1.27, 95% CI (0.94, 1.71)]. There was no higher probability of a 50% remission rate when comparing valproic acid (VPA) to LEV [RR = 0.96, 95% CI (0.57, 1.61)] and oxcarbazepine (OXC) [RR = 0.61, 95% CI (0.31, 1.20)]. In addition, STM was related to a higher probability of EEG normalization than placebo [RR = 4.61, 95% CI (2.12, 10.01)]. The included single studies also provided some evidence for the efficacy and/or tolerability of other ASMs in BECTS, including topiramate, lamotrigine, clobazam, and clonazepam. The risk of bias of the included studies was frequently low or unclear. Conclusion: This study indicated some discrepancies in efficacy and tolerability among ASMs used in patients with BECTS. More randomized controlled trials (RCTs) comparing ASMs with larger populations are required to ascertain the optimum antiepileptic drug treatment to guide clinicians.
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Affiliation(s)
- Wenwen Cheng
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Yan Yang
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Ying Chen
- Department of Ideological and Political Theory Teaching, Maoming Polytechnic, Maoming, China
| | - Sharui Shan
- Department of Rehabilitation, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Changhui Li
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Ling Fang
- Department of Neurology, Maoming People’s Hospital, Maoming, China
| | - Weiguo Zhang
- Department of Neurology, Maoming People’s Hospital, Maoming, China
- *Correspondence: Weiguo Zhang, ; Song Lan, ; Xiong Zhang,
| | - Song Lan
- Department of Neurology, Maoming People’s Hospital, Maoming, China
- *Correspondence: Weiguo Zhang, ; Song Lan, ; Xiong Zhang,
| | - Xiong Zhang
- Department of Neurology, Maoming People’s Hospital, Maoming, China
- *Correspondence: Weiguo Zhang, ; Song Lan, ; Xiong Zhang,
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Kwon H, Chinappen DM, Huang JF, Berja ED, Walsh KG, Shi W, Kramer MA, Chu CJ. Transient, developmental functional and structural connectivity abnormalities in the thalamocortical motor network in Rolandic epilepsy. NEUROIMAGE: CLINICAL 2022; 35:103102. [PMID: 35777251 PMCID: PMC9251597 DOI: 10.1016/j.nicl.2022.103102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022] Open
Abstract
Children with active Rolandic epilepsy have increasing thalamocortical functional connectivity in the motor circuit with age. Children with resolved Rolandic epilepsy have increasing thalamocortical structural connectivity in the motor circuit with age. Children with Rolandic epilepsy have no differences in thalamocortical connectivity in the sensory circuit compared to controls. Rolandic thalamocortical structural connectivity does not predict functional connectivity in Rolandic epilepsy or controls.
Rolandic epilepsy (RE) is the most common focal, idiopathic, developmental epilepsy, characterized by a transient period of sleep-potentiated seizures and epileptiform discharges in the inferior Rolandic cortex during childhood. The cause of RE remains unknown but converging evidence has identified abnormalities in the Rolandic thalamocortical circuit. To better localize this transient disease, we evaluated Rolandic thalamocortical functional and structural connectivity in the sensory and motor circuits separately during the symptomatic and asymptomatic phases of this disease. We collected high resolution structural, diffusion, and resting state functional MRI data in a prospective cohort of children with active RE (n = 17), resolved RE (n = 21), and controls (n = 33). We then computed the functional and structural connectivity between the inferior Rolandic cortex and the ventrolateral (VL) nucleus of the thalamus (efferent pathway) and the ventroposterolateral (VPL) nucleus of the thalamus (afferent pathway) across development in children with active, resolved RE and controls. We compared connectivity with age in each group using linear mixed-effects models. We found that children with active RE have increasing thalamocortical functional connectivity between the VL thalamus and inferior motor cortex with age (p = 0.022) that is not observed in controls or resolved RE. In contrast, children with resolved RE have increasing thalamocortical structural connectivity between the VL nucleus and the inferior motor cortex with age (p = 0.025) that is not observed in controls or active RE. No relationships were identified between VPL nuclei and the inferior sensory cortex with age in any group. These findings localize the functional and structural thalamocortical circuit disruption in RE to the efferent thalamocortical motor pathway. Further work is required to determine how these circuit abnormalities contribute to the emergence and resolution of symptoms in this developmental disease.
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Affiliation(s)
- Hunki Kwon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Dhinakaran M Chinappen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Jonathan F Huang
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Erin D Berja
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Katherine G Walsh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Wen Shi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA; Center for Systems Neuroscience, Boston University, Boston, MA, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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37
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Hermann BP, Struck AF, Busch RM, Reyes A, Kaestner E, McDonald CR. Neurobehavioural comorbidities of epilepsy: towards a network-based precision taxonomy. Nat Rev Neurol 2021; 17:731-746. [PMID: 34552218 PMCID: PMC8900353 DOI: 10.1038/s41582-021-00555-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this 'lesion model' has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.
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Affiliation(s)
- Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,
| | - Aaron F. Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Robyn M. Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anny Reyes
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Erik Kaestner
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R. McDonald
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
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Klinzing JG, Tashiro L, Ruf S, Wolff M, Born J, Ngo HVV. Auditory stimulation during sleep suppresses spike activity in benign epilepsy with centrotemporal spikes. Cell Rep Med 2021; 2:100432. [PMID: 34841286 PMCID: PMC8606903 DOI: 10.1016/j.xcrm.2021.100432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/12/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
Benign epilepsy with centrotemporal spikes (BECTS) is a common form of childhood epilepsy linked to diverse cognitive abnormalities. The electroencephalogram of patients shows focal interictal epileptic spikes, particularly during non-rapid eye movement (NonREM) sleep. Spike formation involves thalamocortical networks, which also contribute to the generation of sleep slow oscillations (SOs) and spindles. Motivated by evidence that SO-spindle activity can be controlled through closed-loop auditory stimulation, here, we show in seven patients that auditory stimulation also reduces spike rates in BECTS. Stimulation during NonREM sleep decreases spike rates, with most robust reductions when tones are presented 1.5 to 3.5 s after spikes. Stimulation further reduces the amplitude of spikes closely following tones. Sleep spindles are negatively correlated with spike rates, suggesting that tone-evoked spindle activity mediates the spike suppression. We hypothesize spindle-related refractoriness in thalamocortical circuits as a potential mechanism. Our results open an avenue for the non-pharmacological treatment of BECTS. Spikes in BECTS epilepsy and sleep spindles may share thalamocortical generation Auditory stimulation during sleep evokes sleep spindles and suppresses spikes Stimulation may reduce spiking by inducing thalamocortical refractoriness
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Affiliation(s)
- Jens G Klinzing
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany.,Centre for Integrative Neuroscience, University of Tübingen, 72076 Tübingen, Germany.,Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08540, USA
| | - Lilian Tashiro
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany
| | - Susanne Ruf
- University Children's Hospital Tübingen, 72076 Tübingen, Germany
| | - Markus Wolff
- Department of Pediatric Neurology, Vivantes Hospital Neukölln, 12351 Berlin, Germany
| | - Jan Born
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany.,Centre for Integrative Neuroscience, University of Tübingen, 72076 Tübingen, Germany
| | - Hong-Viet V Ngo
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany.,Department of Psychology, University of Lübeck, 23562 Lübeck, Germany
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Timofeev I. Just a sound: A non-pharmacological treatment approach in epilepsy. Cell Rep Med 2021; 2:100451. [PMID: 34841296 PMCID: PMC8607007 DOI: 10.1016/j.xcrm.2021.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Benign epilepsy with centro-temporal spikes is typically not treated by antiepileptic drugs, but it leads to cognitive disfunctions. In this issue, Klinzing et al.1 demonstrate that closed-loop auditory stimulation delivered after paroxysmal spikes reduces the total number of paroxysmal spikes.
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Affiliation(s)
- Igor Timofeev
- Faculté de Médecine, Département de Psychiatrie et de Neurosciences, Centre de Recherche CERVO, Université Laval, Québec, QC G1J2G3, Canada
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40
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Zanaboni MP, Varesio C, Pasca L, Foti A, Totaro M, Celario M, Provenzi L, De Giorgis V. Systematic review of executive functions in children with self-limited epilepsy with centrotemporal spikes. Epilepsy Behav 2021; 123:108254. [PMID: 34428616 DOI: 10.1016/j.yebeh.2021.108254] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
Self-limited Epilepsy with Centrotemporal Spikes (ECTS) is a self-limiting childhood epilepsy with an overall good prognosis. The neurocognitive profile of ECTS shows various degrees of neuropsychological impairment, with speech impairment and executive dysfunction being the most prominent. This review aimed to clarify the executive function (EF) profile of children with ECTS and the clinical variables' impact on these abilities. We conducted a systematic review of the relevant literature for articles published up to January 2021. Demographic and clinical characteristics were abstracted from the original records. EF tasks used in the studies were classified according to Diamond's model, which identified four components: working memory, inhibitory control, cognitive flexibility, and higher order EFs. Twenty-three studies were included. Among the included records, 14 studies examined working memory, 15 inhibitory control, 15 flexibility, 4 higher order EFs, and 2 general EFs. Results confirmed the presence of a specific impairment in two abilities: inhibitory control and cognitive flexibility. This review confirms the need to assess each EF both in verbal and visual-spatial tasks. The early detection of children with ECTS at risk of developing neuropsychological impairment could activate interventions and prevent worse school achievement, social functioning, and a poor quality of life. Systematic review registration: PROSPERO: CRD42021245959.
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Affiliation(s)
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Annalisa Foti
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Martina Totaro
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Celario
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
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Niu K, Li Y, Zhang T, Sun J, Sun Y, Shu M, Wang P, Zhang K, Chen Q, Wang X. Impact of Antiepileptic Drugs on Cognition and Neuromagnetic Activity in Childhood Epilepsy With Centrotemporal Spikes: A Magnetoencephalography Study. Front Hum Neurosci 2021; 15:720596. [PMID: 34566605 PMCID: PMC8461317 DOI: 10.3389/fnhum.2021.720596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: Childhood epilepsy with centrotemporal spikes (CECTS), the most common childhood epilepsy, still lacks longitudinal imaging studies involving antiepileptic drugs (AEDs). In order to examine the effect of AEDs on cognition and brain activity. We investigated the neuromagnetic activities and cognitive profile in children with CECTS before and after 1 year of treatment. Methods: Fifteen children with CECTS aged 6–12 years underwent high-sampling magnetoencephalography (MEG) recordings before treatment and at 1 year after treatment, and 12 completed the cognitive assessment (The Wechsler Intelligence Scale for Children). Next, magnetic source location and functional connectivity (FC) were investigated in order to characterize interictal neuromagnetic activity in the seven frequency sub-bands, including: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), gamma (30–80 Hz), ripple (80–250 Hz), and fast ripple (250–500 Hz). Results: After 1 year of treatment, children with CECTS had increased scores on full-scale intelligence quotient, verbal comprehension index (VCI) and perceptual reasoning index (PRI). Alterations of neural activity occurred in specific frequency bands. Source location, in the 30–80 Hz frequency band, was significantly increased in the posterior cingulate cortex (PCC) after treatment. Moreover, FC analysis demonstrated that after treatment, the connectivity between the PCC and the medial frontal cortex (MFC) was enhanced in the 8–12 Hz frequency band. Additionally, the whole-brain network distribution was more dispersed in the 80–250 Hz frequency band. Conclusion: Intrinsic neural activity has frequency-dependent characteristic. AEDs have impact on regional activity and FC of the default mode network (DMN). Normalization of aberrant DMN in children with CECTS after treatment is likely the reason for improvement of cognitive function.
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Affiliation(s)
- Kai Niu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Tingting Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Mingzhu Shu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ke Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- MEG Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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42
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Wang P, Li Y, Sun Y, Sun J, Niu K, Zhang K, Xiang J, Chen Q, Hu Z, Wang X. Altered functional connectivity in newly diagnosed benign epilepsy with unilateral or bilateral centrotemporal spikes: A multi-frequency MEG study. Epilepsy Behav 2021; 124:108276. [PMID: 34547687 DOI: 10.1016/j.yebeh.2021.108276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Rolandic epilepsy (RE) is one of the most common forms of epilepsy syndromes in children. The condition is usually accompanied with either unilateral or bilateral centrotemporal epileptic discharge. Despite the term "benign", many studies have reported that children with benign epilepsy with centrotemporal spikes (BECTS) display a range of pervasive cognitive difficulties. In addition, existing research suggests that unilateral and bilateral centrotemporal spikes may affect cognition through different mechanisms. Consequently, the present study aimed to investigate cognitive impairment and the resting-state network topology of children with benign epilepsy with unilateral centrotemporal spikes (U-BECTS) and with bilateral centrotemporal spikes (B-BECTS). METHODS This study recruited 14 children with U-BECTS and 14 with B-BECTS. Thereafter, cognition was assessed in 28 children with BECTS and 14 healthy controls, using the fourth edition of the Wechsler Intelligence Scale (WISC-IV). Additionally, the functional network of the brain was constructed through magnetoencephalography (MEG) to record the resting-state brain magnetic signals of the brain and by computing virtual sensor waveforms at the source level. Moreover, graph theory (GT) analysis was used to assess the properties of the brain network. RESULTS Children in the B-BECTS group had an earlier onset of epilepsy compared to those in the U-BECTS category. In addition, both the B-BECTS and U-BECTS groups had lower Full Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index (VCI), and Working Memory Index (WMI) scores, compared to the healthy controls although only children in the B-BECTS category had lower Perceptual Reasoning Index (PRI) scores. The results also showed that both BECTS groups had increased frontal cortex connectivity in specific frequency bands. Notably, children with B-BECTS showed a more disorderly and randomized network in the 1-4-Hz and 80-250-Hz frequency bands. Moreover, GT analysis showed that children with B-BECTS had lower clustering coefficient and characteristic path length in the 80-250-Hz frequency bands and higher connection strength in the 4-8-Hz frequency bands. On the other hand, the U-BECTS group had a higher clustering coefficient in the 8-12-Hz frequency bands, compared to the healthy controls. Correlation analysis revealed that there were negative correlations between network parameters, clinical characteristics, and neuropsychological data in the U-BECTS category. CONCLUSION The findings revealed that children with BECTS display a diffuse early cognitive deficit. In addition, resting-state suboptimal network topology may be the mechanism of cognitive impairment in children with BECTS. The study also showed that and children with B-BECTS may be at a higher risk of cognitive impairment.
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Affiliation(s)
- Pengfei Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yihan Li
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yulei Sun
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jingtao Sun
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Kai Niu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ke Zhang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45220, United States
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Stoyell SM, Baxter BS, McLaren J, Kwon H, Chinappen DM, Ostrowski L, Zhu L, Grieco JA, Kramer MA, Morgan AK, Emerton BC, Manoach DS, Chu CJ. Diazepam induced sleep spindle increase correlates with cognitive recovery in a child with epileptic encephalopathy. BMC Neurol 2021; 21:355. [PMID: 34521381 PMCID: PMC8438890 DOI: 10.1186/s12883-021-02376-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Continuous spike and wave of sleep with encephalopathy (CSWS) is a rare and severe developmental electroclinical epileptic encephalopathy characterized by seizures, abundant sleep activated interictal epileptiform discharges, and cognitive regression or deceleration of expected cognitive growth. The cause of the cognitive symptoms is unknown, and efforts to link epileptiform activity to cognitive function have been unrevealing. Converging lines of evidence implicate thalamocortical circuits in these disorders. Sleep spindles are generated and propagated by the same thalamocortical circuits that can generate spikes and, in healthy sleep, support memory consolidation. As such, sleep spindle deficits may provide a physiologically relevant mechanistic biomarker for cognitive dysfunction in epileptic encephalopathies. CASE PRESENTATION We describe the longitudinal course of a child with CSWS with initial cognitive regression followed by dramatic cognitive improvement after treatment. Using validated automated detection algorithms, we analyzed electroencephalograms for epileptiform discharges and sleep spindles alongside contemporaneous neuropsychological evaluations over the course of the patient's disease. We found that sleep spindles increased dramatically with high-dose diazepam treatment, corresponding with marked improvements in cognitive performance. We also found that the sleep spindle rate was anticorrelated to spike rate, consistent with a competitively shared underlying thalamocortical circuitry. CONCLUSIONS Epileptic encephalopathies are challenging electroclinical syndromes characterized by combined seizures and a deceleration or regression in cognitive skills over childhood. This report identifies thalamocortical circuit dysfunction in a case of epileptic encephalopathy and motivates future investigations of sleep spindles as a biomarker of cognitive function and a potential therapeutic target in this challenging disease.
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Affiliation(s)
- S M Stoyell
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - B S Baxter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - J McLaren
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - H Kwon
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - D M Chinappen
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - L Ostrowski
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - L Zhu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J A Grieco
- Massachusetts General Hospital, Psychology Assessment Center, Boston, MA, 02114, USA
| | - M A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA, 02115, USA
| | - A K Morgan
- Massachusetts General Hospital, Psychology Assessment Center, Boston, MA, 02114, USA
| | - B C Emerton
- Massachusetts General Hospital, Psychology Assessment Center, Boston, MA, 02114, USA
| | - D S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - C J Chu
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
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Fang HB, Wang R, Chu LN, Feng YF, Bai RR, Guo FT. Cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes and attention deficit hyperactivity disorder: a prospective study. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:791-796. [PMID: 34511167 DOI: 10.7499/j.issn.1008-8830.2105011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the difference in cognitive impairment between the children with benign childhood epilepsy with centrotemporal spikes (BECT) and attention deficit hyperactivity disorder (ADHD) and those with BECT or ADHD alone. METHODS A prospective study was performed on 80 children with BECT and ADHD, 91 children with BECT, and 70 children with ADHD , who were diagnosed with the diseases for the first time. Seventy children of the same age who underwent physical examination were enrolled as the healthy control group. Event-related potential P300, Wechsler Intelligence Scale for Children, and integrated visual and auditory continuous performance test were used to measure and compare each index between groups. RESULTS Compared with the healthy control group, the BECT+ADHD group, the BECT group, and the ADHD group had a significantly prolonged P300 latency, a significant reduction in the amplitude of P300, and significant reductions in the scores of verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), processing speed index (PSI), full scale intelligence quotient (FSIQ), auditory response control quotient (ARCQ), visual response control quotient, full response control quotient (FRCQ), auditory attention quotient (AAQ), visual attention quotient, and full attention quotient (P<0.05). Compared with the BECT group, the BECT+ADHD group had a significantly prolonged P300 latency, a significant reduction in the amplitude of P300, and significant reductions in the scores of VCI, PRI, WMI, PSI, FSIQ, and FRCQ (P<0.05). Compared with the ADHD group, the BECT+ADHD group had a significantly prolonged P300 latency, a significant reduction in the amplitude of P300, and significant reductions in the scores of VCI, PRI, FSIQ, ARCQ, FRCQ, and AAQ (P<0.05). CONCLUSIONS Compared with the children with BECT or ADHD alone, the children with both BECT and ADHD have basically the same fields of cognitive impairment but a higher degree of cognitive impairment in some fields.
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Affiliation(s)
- Hai-Bo Fang
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Rong Wang
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Lin-Na Chu
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Yan-Fang Feng
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Rong-Rong Bai
- Department of Pediatrics, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
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Dai XJ, Liu H, Yang Y, Wang Y, Wan F. Brain network excitatory/inhibitory imbalance is a biomarker for drug-naive Rolandic epilepsy: A radiomics strategy. Epilepsia 2021; 62:2426-2438. [PMID: 34346086 DOI: 10.1111/epi.17011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Seizure occurs when the balance between excitatory and inhibitory (E/I) inputs to neurons is perturbed, resulting in abnormal electrical activity. This study investigated whether an existing E/I imbalance in neural networks is a useful diagnostic biomarker for Rolandic epilepsy by a resting-state dynamic causal modeling-based support vector machine (rs-DCM-SVM) algorithm. METHODS This multicenter study enrolled a discovery cohort (76 children with Rolandic epilepsy and 76 normal controls [NCs]) and a replication cohort (59 children with Rolandic epilepsy and 60 NCs). Spatial independent component analysis was used to seven canonical neural networks, and a total of 25 regions of interest were selected from these networks. The rs-DCM-SVM classifier was used for individual classification, consensus feature selection, and feature ranking. RESULTS The rs-DCM-SVM classifier showed that the E/I imbalance in brain networks is a useful neuroimaging biomarker for Rolandic epilepsy, with an accuracy of 88.2% and 81.5% and an area under curve of .92 and .83 in the discovery and the replication cohorts, respectively. Consensus brain regions with the highest contributions to the classification were located within the epilepsy-related networks, indicating that this classifier was suitable. Consensus functional connection pairs with the highest contributions to the classification were associated with an excitation network loop and an inhibition network loop. The excitation loop mediated the integration of advanced cognitive networks (subcortex, dorsal attention, default mode, executive control, and salience networks), whereas the inhibition loop was involved in the segregation of sensorimotor and language networks. The two loops showed functional segregation. SIGNIFICANCE Brain E/I imbalance has potential to serve as a biomarker for individual classification in children with Rolandic epilepsy, and might be an important mechanism for causing seizures and cognitive impairment in children with Rolandic epilepsy.
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Affiliation(s)
- Xi-Jian Dai
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China.,Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Yang Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Yongjun Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau, China
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46
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Dai XJ, Yang Y, Wang N, Tao W, Fan J, Wang Y. Reliability and availability of granger causality density in localization of Rolandic focus in BECTS. Brain Imaging Behav 2021; 15:1542-1552. [PMID: 32737823 DOI: 10.1007/s11682-020-00352-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A new method, called granger causality density (GCD), could reflect the directed information flow of the epileptiform activity, which is much closely match with excitatory and inhibitory imbalance theory of epilepsy. Here, we investigated if GCD could effectively localize the Rolandic focus in 50 patients with benign childhood epilepsy with central-temporal spikes (BECTS) from 27 normal children. The BECTS were classified into ictal epileptiform discharges (IEDs; 12 females, 15 males;age, 8.15 ± 1.68 years) and non-IEDs (10 females, 13 males; age, 9.09 ± 1.98 years) subgroups depending on the presence of central-temporal spikes. Multiple correlation-modality analyses (Pearson, across-voxel and across-subject correlations) were used to calculate the couplings between the GCD maps and IEDs-related brain activation map. The individual lateralization coefficient of localize IEDs and multiple regression analysis were used to identify the reliability of the GCD method in localizing the Rolandic focus. In this study, multiple correlation-modality analyses showed that the IEDs-related brain activation map and the GCD maps had highly temporal (coefficient ׀r\= 0.56 ~ 0.65) and spatial (\r\=0.53~0.91) (r\=~ couplings. The proposed GCD method and multiple regression analyses showed consistent findings with the clinical EEG recordings in lateralization of Rolandic focus. Furthermore, the GCD method could reflect the epilepsy-related brain activity during non-IEDs substate. Therefore, the proposed GCD method has the potential to be served as an effective and reliable neuroimaging biomarker to localize the Rolandic focus of BECTS. These findings are critical for clinical early diagnosis, and may promote the progression of treatment and management of pediatric epilepsy.
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Affiliation(s)
- Xi-Jian Dai
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China.
| | - Yang Yang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, 563000, China
| | - Na Wang
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China
| | - Weiqun Tao
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China
| | - Jingyi Fan
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China
| | - Yongjun Wang
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China.
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Ramos IDSS, Coelho CVG, Ribeiro F, Lopes AF. Executive functioning in children with self-limited epilepsy with centrotemporal spikes: a systematic review and meta-analysis. Child Neuropsychol 2021; 28:30-60. [PMID: 34251988 DOI: 10.1080/09297049.2021.1945019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Self-limited epilepsy with centrotemporal spikes (ECTS) is one of the most frequent focal epilepsies amongst children. Because remission usually occurs before 16 years old and patients present infrequent clinical manifestation, ECTS was considered benign for a long time. Despite the reports on cognitive deficits associated with ECTS in the last years, knowledge about the condition's specific executive function domains (inhibitory control, working memory, cognitive flexibility, verbal fluency, and higher-order executive functions) is still lacking. The following systematic review was conducted according to PRISMA guidelines. The PubMed and Scopus databases and gray literature were searched according to the following eligibility criteria: (1) original articles published in peer-review journals; (2) studies that present assessment of children with ECTS; and (3) studies with an available assessment of the executive function of the participants. A total of 43 studies (1179 patients and 1086 healthy controls) met the inclusion criteria. Data from 19 studies were extracted, and meta-analysis methods were used to compare results in the three main executive function domains and verbal fluency. The study quality was measured through the Newcastle-Ottawa Scale (NOS) and the evidence quality with the GRADEpro tool. Results and conclusions: The present systematic review is the first to gather information about executive functioning in children with ECTS. According to the meta-analyses, children with ECTS show weaker performances when compared with a control group in inhibitory control, cognitive flexibility, and verbal fluency. However, because the quality of evidence was classified as very low, caution is needed when interpreting the strength of the results.
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Affiliation(s)
- Inês Duarte Sá Seixas Ramos
- Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Carolina Vanessa Gomes Coelho
- Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal.,CIERL-UMa - Research Centre for Regional and Local Studies, Funchal, Ilha da Madeira, Portugal
| | - Filipa Ribeiro
- Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Ana Filipa Lopes
- Centro de Desenvolvimento da Criança Torrado da Silva do Hospital Garcia de Orta, Almada, Portugal.,Neuropsychological Assessment and Ageing Processes (NAAP-CINEICC-FPCE) da Universidade de Coimbra, Coimbra, Portugal
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Coskun O, Kipoglu O, Karacabey BN, Kilic MA, Simsek Ceran D, Yildiz EP, Aydınlı N, Caliskan M. Evaluation of eating behaviors in childhood epilepsy with centrotemporal spikes: Case-control study. Epilepsy Behav 2021; 120:108029. [PMID: 33992962 DOI: 10.1016/j.yebeh.2021.108029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychosocial and behavioral disorders have been reported in childhood epilepsy with centrotemporal spikes (CECTS). We aimed to identify the symptoms of eating disorders in CECTS. METHODS Patients with CECTS were recruited from the pediatric neurology outpatient clinic between September 2019 and July 2020. The Children's Eating Behaviour Questionnaire (CEBQ) was administered to 39 patients and 31 controls. Patients' scores were compared with those of healthy subjects. RESULTS There was no significant difference between the CEBQ of patients with CECTS and the control group (p > 0.05). There was no significant difference between the BMI of the patients with CECTS and the control group. In the patient group with CECTS, no significant difference was found in terms of CEBQ according to the antiepileptic drug used and EEG findings (p > 0.05). CONCLUSION No difference was found in the eating habits of patients with CECTS compared with the healthy control group.
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Affiliation(s)
- Orhan Coskun
- Department of Pediatric Neurology, Istanbul Medical Faculty, Turkey
| | - Osman Kipoglu
- Department of Pediatric Neurology, Istanbul Medical Faculty, Turkey
| | | | | | | | - Edibe Pembegul Yildiz
- Department of Pediatric Neurology, Istanbul Medical Faculty, Turkey; Istanbul University Institute of Child Health, Istanbul, Turkey.
| | - Nur Aydınlı
- Department of Pediatric Neurology, Istanbul Medical Faculty, Turkey
| | - Mine Caliskan
- Department of Pediatric Neurology, Istanbul Medical Faculty, Turkey; Istanbul University Institute of Child Health, Istanbul, Turkey
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Georgopoulou V, Spruyt K, Garganis K, Kosmidis MH. Altered Sleep-Related Consolidation and Neurocognitive Comorbidity in CECTS. Front Hum Neurosci 2021; 15:563807. [PMID: 34163335 PMCID: PMC8215163 DOI: 10.3389/fnhum.2021.563807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/21/2021] [Indexed: 12/03/2022] Open
Abstract
Our aim is to use neurophysiological sleep-related consolidation (SRC) phenomena to identify putative pathophysiological mechanisms in CECTS linked to diffuse neurocognitive deficits. We argue that there are numerous studies on the association between seizure aspects and neurocognitive functioning but not as many on interictal variables and neurocognitive deficits. We suggest two additional foci. First, the interictal presentation in CECTS and second, neuronal oscillations involved in SRC processes. Existing data on mechanisms through which interictal epileptiform spikes (IES) impact upon SRC indicate that they have the potential to: (a) perturb cross-regional coupling of neuronal oscillations, (b) mimic consolidation processes, (c) alter the precision of the spatiotemporal coupling of oscillations, and (d) variably impact upon SRC performance. Sleep spindles merit systematic study in CECTS in order to clarify: (a) the state of the slow oscillations (SOs) with which they coordinate, (b) the precision of slow oscillation-spindle coupling, and (c) whether their developmental trajectories differ from those of healthy children. We subsequently review studies on the associations between IES load during NREM sleep and SRC performance in childhood epilepsy. We then use sleep consolidation neurophysiological processes and their interplay with IES to help clarify the diffuse neurocognitive deficits that have been empirically documented in CECTS. We claim that studying SRC in CECTS will help to clarify pathophysiological mechanisms toward diverse neurocognitive deficits. Future developments could include close links between the fields of epilepsy and sleep, as well as new therapeutic neurostimulation targets. At the clinical level, children diagnosed with CECTS could benefit from close monitoring with respect to epilepsy, sleep and neurocognitive functions.
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Affiliation(s)
- Victoria Georgopoulou
- 2nd Centre for Educational and Counseling Support of Eastern Thessaloniki, Ministry of Education, Thessaloniki, Greece.,Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Karen Spruyt
- INSERM, Claude Bernard University, School of Medicine, Lyon, France
| | | | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Wu L, Yang X, Zhang K, Wang X, Yang B. Impairment of eye emotion discrimination in benign childhood epilepsy with centrotemporal spikes: A neuropsychological study. Brain Behav 2021; 11:e02154. [PMID: 33942564 PMCID: PMC8213938 DOI: 10.1002/brb3.2154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To explore the characteristics of the impairment of eye emotional recognition and related clinical factors in children with benign childhood epilepsy with centrotemporal spikes (BECT). METHODS The Eye Basic Emotion Discrimination Task and Eye Complex Emotion Discrimination Task were used to study emotion discrimination in 33 recently diagnosed BECT patients and 33 BECT patients after complete remission compared to respective age- and gender-matched comparison participants. RESULTS The scores for discrimination of sadness, fear, and disgust were significantly lower in the newly diagnosed BECT group than in the comparison group (p = .004, p = .019, and p = .044, respectively), while scores for recognizing happiness, anger, and surprise were not significantly different between the two groups (p = .248, p = .586, and p = .540, respectively). Our analysis revealed that the BECT onset age influences the scores for recognition of sadness, fear, and disgust (OR = 1.795, 95% CI: 1.097 to 2.936, p = .020; OR=1.846, 95% CI: 1.124 to 3.034, p = .016; OR = 1.851, 95% CI: 1.131-3.029, p = .014). After remission, the scores for discrimination of happiness, anger, sadness, fear, disgust, and surprise of the BECT group were not significantly different from the comparison group (p = .588, p = .765, p = .752, p = .984, p = .328, and p = .339, respectively). CONCLUSIONS In our study, newly diagnosed BECT patients exhibited emotion discrimination dysfunction, mainly related to sadness, fear, and disgust, and this dysfunction was more severe the younger the age of onset was. However, after BECT remission, the ability to discriminate emotions returned to normal.
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Affiliation(s)
- Lulu Wu
- Department of Neurology, Anhui Provincial Children's Hospital, Hefei, China
| | - Xinyu Yang
- Department of Neurology, Anhui Provincial Children's Hospital, Hefei, China
| | - Kaili Zhang
- Department of Neurology, Anhui Provincial Children's Hospital, Hefei, China
| | - Xiaocui Wang
- Department of Neurology, Anhui Provincial Children's Hospital, Hefei, China
| | - Bin Yang
- Department of Neurology, Anhui Provincial Children's Hospital, Hefei, China
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