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Wang W, Zhou E, Nie Z, Deng Z, Gong Q, Ma S, Kang L, Yao L, Cheng J, Liu Z. Exploring mechanisms of anhedonia in depression through neuroimaging and data-driven approaches. J Affect Disord 2024; 363:409-419. [PMID: 39038623 DOI: 10.1016/j.jad.2024.07.133] [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: 01/15/2024] [Revised: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Anhedonia is a core symptom of depression that is closely related to prognosis and treatment outcomes. However, accurate and efficient treatments for anhedonia are lacking, mandating a deeper understanding of the underlying mechanisms. METHODS A total of 303 patients diagnosed with depression and anhedonia were assessed by the Snaith-Hamilton Pleasure Scale (SHAPS) and magnetic resonance imaging (MRI). The patients were categorized into a low-anhedonia group and a high-anhedonia group using the K-means algorithm. A data-driven approach was used to explore the differences in brain structure and function with different degrees of anhedonia based on MATLAB. A random forest model was used exploratorily to test the predictive ability of differences in brain structure and function on anhedonia in depression. RESULTS Structural and functional differences were apparent in several brain regions of patients with depression and high-level anhedonia, including in the temporal lobe, paracingulate gyrus, superior frontal gyrus, inferior occipital gyrus, right insular gyrus, and superior parietal lobule. And changes in these brain regions were significantly correlated with scores of SHAPS. CONCLUSIONS These brain regions may be useful as biomarkers that provide a more objective assessment of anhedonia in depression, laying the foundation for precision medicine in this treatment-resistant, relatively poor prognosis group.
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Affiliation(s)
- Wei Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Enqi Zhou
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaowen Nie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zipeng Deng
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Simeng Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lijun Kang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Cheng
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China.
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Zhang Q, Hudgins S, Struck AF, Ankeeta A, Javidi SS, Sperling MR, Hermann BP, Tracy JI. Association of Normative and Non-Normative Brain Networks With Cognitive Function in Patients With Temporal Lobe Epilepsy. Neurology 2024; 103:e209800. [PMID: 39250744 PMCID: PMC11385956 DOI: 10.1212/wnl.0000000000209800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite their temporal lobe pathology, a significant subgroup of patients with temporal lobe epilepsy (TLE) is able to maintain normative cognitive functioning. In this study, we identify patients with TLE with intact vs impaired neurocognitive profiles and interrogate for the presence of both normative and highly individual intrinsic connectivity networks (ICNs)-all toward understanding the transition from impaired to intact neurocognitive status. METHODS This retrospective cross-sectional study included patients with TLE and matched healthy controls (HCs) from the Thomas Jefferson Comprehensive Epilepsy Center. Functional MRI data were decomposed using independent component analysis to obtain individualized ICNs. In this article, we calculated the degree of match between individualized ICNs and canonical ICNs (e.g., 17 resting-state networks by Yeo et al.) and divided each participant's ICNs into normative or non-normative status based on the degree of match. RESULTS 100 patients with TLE (mean age 42.0 [SD: 13.7] years, 47 women) and 92 HCs were included in this study. We found that the individualized networks matched to the canonical networks less well in the cognitively impaired (n = 24) compared with the cognitively intact (n = 63) patients with TLE by 2-way mixed-measures analysis of variance (impaired vs intact mean difference [MD] -0.165 [-0.317, -0.013], p = 0.028). The cognitively impaired patients showed significant abnormalities in the profiles of both normative (impaired vs intact MD -0.537 [-0.998, -0.076], p = 0.017, intact vs HC MD -0.221 [-0.536, 0.924], p = 0.220, and impaired vs HC MD -0.759 [-1.200, -0.319], p < 0.001) and non-normative networks (impaired vs intact MD 0.484 [0.030, 0.937], p = 0.033, intact vs HC MD 0.369 [0.059, 0.678], p = 0.014, and impaired vs HC MD 0.853 [0.419, 1.286], p < 0.001) while the intact patients showed abnormalities only in non-normative networks. At the same time, we found that normative networks held a strong, positive association with the neuropsychological measures, with this association negative in non-normative networks. DISCUSSION Our data demonstrated that significant cognitive deficits are associated with the status of both canonical and highly individual ICNs, making clear that the transition from intact to impaired cognitive status is not simply the result of disruption to normative brain networks.
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Affiliation(s)
- Qirui Zhang
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Stacy Hudgins
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Aaron F Struck
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Ankeeta Ankeeta
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Sam S Javidi
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Michael R Sperling
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce P Hermann
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Joseph I Tracy
- From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
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Hermann B, Busch RM, Reyes A, Arrotta K, Fujikawa M, Ives-Deliperi V, Dollman A, Shah U, McDonald CR. A user's guide for the International Classification of Cognitive Disorders in Epilepsy. Epileptic Disord 2024; 26:567-580. [PMID: 39141394 DOI: 10.1002/epd2.20268] [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: 05/09/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
To present the background, rationale, details pertaining to use and essential computational steps, synopsis of findings to date, and future directions for the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE)-an initiative of the ILAE Neuropsychology Task Force. Examined are: (a) the 6 steps leading to the derivation of a cognitive phenotype from neuropsychological test data with an accompanying case example, (b) concise review of all IC-CoDE research to date, (c) summary of identified correlates of IC-CoDE outcomes, and (d) future research and clinical directions for the initiative. The IC-CoDE is computationally uncomplicated with individual or group data and represents a novel approach leading to new insights in the neuropsychology of epilepsy, with applications to diverse datasets internationally informing the reliability and validity of the approach. The IC-CoDE represents a novel approach to the analysis and interpretation of neuropsychological data in epilepsy that offers to advance a global taxonomy of cognitive disorders in epilepsy facilitating international collaboration and big data science.
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Affiliation(s)
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anny Reyes
- University of California-San Diego, San Diego, California, USA
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Reyes A, Hermann BP, Prabhakaran D, Ferguson L, Almane DN, Shih JJ, Iragui‐Madoz VJ, Struck A, Punia V, Jones JE, Busch RM, McDonald CR. Validity of the MoCA as a cognitive screening tool in epilepsy: Are there implications for global care and research? Epilepsia Open 2024; 9:1526-1537. [PMID: 38874380 PMCID: PMC11296095 DOI: 10.1002/epi4.12991] [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: 03/25/2024] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE This study evaluated the diagnostic performance of a widely available cognitive screener, the Montreal cognitive assessment (MoCA), to detect cognitive impairment in older patients (age ≥ 55) with epilepsy residing in the US, using the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) as the gold standard. METHODS Fifty older adults with focal epilepsy completed the MoCA and neuropsychological measures of memory, language, executive function, and processing speed/attention. The IC-CoDE taxonomy divided participants into IC-CoDE Impaired and Intact groups. Sensitivity and specificity across several MoCA cutoffs were examined. Spearman correlations examined relationships between the MoCA total score and clinical and demographic variables and MoCA domain scores and individual neuropsychological tests. RESULTS IC-CoDE impaired patients demonstrated significantly lower scores on the MoCA total, visuospatial/executive, naming, language, delayed recall, and orientation domain scores (Cohen's d range: 0.336-2.77). The recommended MoCA cutoff score < 26 had an overall accuracy of 72%, 88.2% sensitivity, and 63.6% specificity. A MoCA cutoff score < 24 yielded optimal sensitivity (70.6%) and specificity (78.8%), with overall accuracy of 76%. Higher MoCA total scores were associated with greater years of education (p = 0.016) and fewer antiseizure medications (p = 0.049). The MoCA memory domain was associated with several standardized measures of memory, MoCA language domain with category fluency, and MoCA abstraction domain with letter fluency. SIGNIFICANCE This study provides initial validation of the MoCA as a useful screening tool for older adults with epilepsy that can be used to identify patients who may benefit from comprehensive neuropsychological testing. Further, we demonstrate that a lower cutoff (i.e., <24) better captures cognitive impairment in older adults with epilepsy than the generally recommended cutoff and provides evidence for construct overlap between MoCA domains and standard neuropsychological tests. Critically, similar efforts in other regions of the world are needed. PLAIN LANGUAGE SUMMARY The Montreal cognitive assessment (MoCA) can be a helpful tool to screen for cognitive impairment in older adults with epilepsy. We recommend that adults 55 or older with epilepsy who score less than 24 on the MoCA are referred to a neuropsychologist for a comprehensive evaluation to assess any changes in cognitive abilities and mood.
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Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied SciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Bruce P. Hermann
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Divya Prabhakaran
- Department of Radiation Medicine & Applied SciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Lisa Ferguson
- Epilepsy CenterNeurological Institute, Cleveland ClinicClevelandOhioUSA
| | - Dace N. Almane
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Jerry J. Shih
- Department of NeuroscienceUniversity of CaliforniaSan DiegoCaliforniaUSA
| | | | - Aaron Struck
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Vineet Punia
- Epilepsy CenterNeurological Institute, Cleveland ClinicClevelandOhioUSA
- Department of NeurologyCleveland ClinicClevelandOhioUSA
| | - Jana E. Jones
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Robyn M. Busch
- Epilepsy CenterNeurological Institute, Cleveland ClinicClevelandOhioUSA
- Department of NeurologyCleveland ClinicClevelandOhioUSA
| | - Carrie R. McDonald
- Department of Radiation Medicine & Applied SciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
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Murray NWG, Kneebone AC, Graham PL, Wong CH, Savage G, Gillinder L, Fong MWK. The network is more important than the node: stereo-EEG evidence of neurocognitive networks in epilepsy. FRONTIERS IN NETWORK PHYSIOLOGY 2024; 4:1424004. [PMID: 39114571 PMCID: PMC11303167 DOI: 10.3389/fnetp.2024.1424004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/01/2024] [Indexed: 08/10/2024]
Abstract
Introduction Neuropsychological assessment forms an integral part of the presurgical evaluation for patients with medically refractory focal epilepsy. Our understanding of cognitive impairment in epilepsy is based on seminal lesional studies that have demonstrated important structure-function relationships within the brain. However, a growing body of literature demonstrating heterogeneity in the cognitive profiles of patients with focal epilepsy (e.g., temporal lobe epilepsy; TLE) has led researchers to speculate that cognition may be impacted by regions outside the seizure onset zone, such as those involved in the interictal or "irritative" network. Methods Neuropsychological data from 48 patients who underwent stereoelectroencephalography (SEEG) monitoring between 2012 and 2023 were reviewed. Patients were categorized based on the site of seizure onset, as well as their irritative network, to determine the impact of wider network activity on cognition. Neuropsychological data were compared with normative standards (i.e., z = 0), and between groups. Results There were very few distinguishing cognitive features between patients when categorized based purely on the seizure onset zone (i.e., frontal lobe vs. temporal lobe epilepsy). In contrast, patients with localized irritative networks (i.e., frontal or temporal interictal epileptiform discharges [IEDs]) demonstrated more circumscribed profiles of impairment compared with those demonstrating wider irritative networks (i.e., frontotemporal IEDs). Furthermore, the directionality of propagation within the irritative network was found to influence the manifestations of cognitive impairment. Discussion The findings suggest that neuropsychological assessment is sensitive to network activity beyond the site of seizure onset. As such, an overly focal interpretation may not accurately reflect the distribution of the underlying pathology. This has important implications for presurgical work-up in epilepsy, as well as subsequent surgical outcomes.
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Affiliation(s)
- Nicholas W. G. Murray
- School of Psychological Sciences, Macquarie University, Sydney, Australia
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, Australia
| | - Anthony C. Kneebone
- School of Psychology, University of Queensland, Brisbane, Australia
- Department of Neurology and Stroke, Flinders Medical Centre, Adelaide, Australia
| | - Petra L. Graham
- School of Mathematical and Physical Sciences, Macquarie University, Sydney, Australia
| | - Chong H. Wong
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, Australia
| | - Greg Savage
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Lisa Gillinder
- Advanced Epilepsy Unit, The Mater Hospital, Brisbane, Australia
| | - Michael W. K. Fong
- Westmead Comprehensive Epilepsy Centre, The University of Sydney, Sydney, Australia
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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Larivière S, Park BY, Royer J, DeKraker J, Ngo A, Sahlas E, Chen J, Rodríguez-Cruces R, Weng Y, Frauscher B, Liu R, Wang Z, Shafiei G, Mišić B, Bernasconi A, Bernasconi N, Fox MD, Zhang Z, Bernhardt BC. Connectome reorganization associated with temporal lobe pathology and its surgical resection. Brain 2024; 147:2483-2495. [PMID: 38701342 PMCID: PMC11224603 DOI: 10.1093/brain/awae141] [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: 11/20/2023] [Revised: 03/23/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Network neuroscience offers a unique framework to understand the organizational principles of the human brain. Despite recent progress, our understanding of how the brain is modulated by focal lesions remains incomplete. Resection of the temporal lobe is the most effective treatment to control seizures in pharmaco-resistant temporal lobe epilepsy (TLE), making this syndrome a powerful model to study lesional effects on network organization in young and middle-aged adults. Here, we assessed the downstream consequences of a focal lesion and its surgical resection on the brain's structural connectome, and explored how this reorganization relates to clinical variables at the individual patient level. We included adults with pharmaco-resistant TLE (n = 37) who underwent anterior temporal lobectomy between two imaging time points, as well as age- and sex-matched healthy controls who underwent comparable imaging (n = 31). Core to our analysis was the projection of high-dimensional structural connectome data-derived from diffusion MRI tractography from each subject-into lower-dimensional gradients. We then compared connectome gradients in patients relative to controls before surgery, tracked surgically-induced connectome reconfiguration from pre- to postoperative time points, and examined associations to patient-specific clinical and imaging phenotypes. Before surgery, individuals with TLE presented with marked connectome changes in bilateral temporo-parietal regions, reflecting an increased segregation of the ipsilateral anterior temporal lobe from the rest of the brain. Surgery-induced connectome reorganization was localized to this temporo-parietal subnetwork, but primarily involved postoperative integration of contralateral regions with the rest of the brain. Using a partial least-squares analysis, we uncovered a latent clinical imaging signature underlying this pre- to postoperative connectome reorganization, showing that patients who displayed postoperative integration in bilateral fronto-occipital cortices also had greater preoperative ipsilateral hippocampal atrophy, lower seizure frequency and secondarily generalized seizures. Our results bridge the effects of focal brain lesions and their surgical resections with large-scale network reorganization and interindividual clinical variability, thus offering new avenues to examine the fundamental malleability of the human brain.
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Affiliation(s)
- Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard University, Boston, MA 02115, USA
| | - Bo-yong Park
- Department of Data Science, Inha University, Incheon 22212, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon 34126, Republic of Korea
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Jordan DeKraker
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Alexander Ngo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Ella Sahlas
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Judy Chen
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Raúl Rodríguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Yifei Weng
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Birgit Frauscher
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Ruoting Liu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Zhengge Wang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Golia Shafiei
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bratislav Mišić
- Department of Neurology and Neurosurgery, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham and Women’s Hospital, Harvard University, Boston, MA 02115, USA
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - 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
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Cano-López I, Catalán-Aguilar J, Lozano-García A, Hidalgo V, Hampel KG, Tormos-Pons P, Salvador A, Villanueva V, González-Bono E. Cognitive phenotypes in patients with drug-resistant temporal lobe epilepsy: Relationships with cortisol and affectivity. Clin Neuropsychol 2024:1-24. [PMID: 38965831 DOI: 10.1080/13854046.2024.2375605] [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: 04/28/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Drug-resistant temporal lobe epilepsy (TLE) is a neurological disorder characterized by cognitive deficits. This study examined whether patients with TLE and different cognitive phenotypes differ in cortisol levels and affectivity while controlling for demographic and clinical variables. Methods: In this cross-sectional study, 79 adults with TLE underwent neuropsychological evaluation in which memory, language, attention/processing speed, executive function, and affectivity were assessed. Six saliva samples were collected in the afternoon to examine the ability of the hypothalamic-pituitary-adrenal (HPA) axis to descend according to the circadian rhythm (C1 to C6). The cortisol area under the curve concerning ground (AUCg) was computed to examine global cortisol secretion. RESULTS Three cognitive phenotypes were identified: memory impairment, generalized impairment, and no impairment. The memory-impairment phenotype showed higher cortisol levels at C4, C5, and C6 than the other groups (p = 0.03, η2 = 0.06), higher cortisol AUCg than the generalized-impairment phenotype (p = 0.004, η2 = 0.14), and a significant reduction in positive affectivity after the evaluation (p = 0.026, η2 = 0.11). Higher cortisol AUCg and reductions in positive affectivity were significant predictors of the memory-impairment phenotype (p < 0.001; Cox and Snell R2 = 0.47). CONCLUSIONS Patients with memory impairment had a slower decline in cortisol levels in the afternoon, which could be interpreted as an inability of the HPA axis to inhibit itself. Thus, chronic stress may influence hippocampus-dependent cognitive function more than other cognitive functions in patients with TLE.
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Affiliation(s)
- Irene Cano-López
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Judit Catalán-Aguilar
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alejandro Lozano-García
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
| | - Vanesa Hidalgo
- Department of Psychology and Sociology, Area of Psychobiology, Social and Human Sciences Center, University of Zaragoza, Teruel, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Paula Tormos-Pons
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alicia Salvador
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Esperanza González-Bono
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
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8
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Liu AA, Barr WB. Overlapping and distinct phenotypic profiles in Alzheimer's disease and late onset epilepsy: a biologically-based approach. Front Neurol 2024; 14:1260523. [PMID: 38545454 PMCID: PMC10965692 DOI: 10.3389/fneur.2023.1260523] [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: 07/18/2023] [Accepted: 12/18/2023] [Indexed: 04/05/2024] Open
Abstract
Due to shared hippocampal dysfunction, patients with Alzheimer's dementia and late-onset epilepsy (LOE) report memory decline. Multiple studies have described the epidemiological, pathological, neurophysiological, and behavioral overlap between Alzheimer's Disease and LOE, implying a bi-directional relationship. We describe the neurobiological decline occurring at different spatial in AD and LOE patients, which may explain why their phenotypes overlap and differ. We provide suggestions for clinical recognition of dual presentation and novel approaches for behavioral testing that reflect an "inside-out," or biologically-based approach to testing memory. New memory and language assessments could detect-and treat-memory impairment in AD and LOE at an earlier, actionable stage.
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Affiliation(s)
- Anli A. Liu
- Langone Medical Center, New York University, New York, NY, United States
- Department of Neurology, School of Medicine, New York University, New York, NY, United States
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY, United States
| | - William B. Barr
- Department of Neurology, School of Medicine, New York University, New York, NY, United States
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Cairós-González M, Verche E, Hernández S, Alonso MÁ. Cognitive flexibility impairment in temporal lobe epilepsy: The impact of epileptic foci lateralization on executive functions. Epilepsy Behav 2024; 151:109587. [PMID: 38159506 DOI: 10.1016/j.yebeh.2023.109587] [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: 07/27/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Temporal Lobe Epilepsy (TLE) has been associated with memory impairments, which are typically linked to hippocampal and mesial temporal cortex lesions. Considering the presence of extensive bidirectional frontotemporal connections, it can be hypothesized that executive dysfunction in TLE is modulated by the lateralization of the epileptic foci. MATERIAL AND METHODS A comprehensive neuropsychological executive functions protocol was administered to 63 participants, including 42 individuals with temporal lobe epilepsy (20 with right-TLE and 22 with left-TLE) and 21 healthy controls aged 20-49. RESULTS The results indicate that TLE patients exhibit poorer executive performance compared to healthy controls in working memory (F(2,60) = 4.18, p <.01), planning (F(2,60) = 4.71, p <.05), set shifting (F(2,60) = 10.1, p <.001), phonetic verbal fluency (F(2,60) = 11.71, p <.01) and semantic verbal fluency (F(2,60) = 9.61, p <.001. No significant differences were found in cognitive inhibition. Furthermore, right-TLE patients showed lower performance than left-TLE in set shifting (F(1,61) = 6.45, p <.05), while no significant differences were observed in working memory, planning, inhibition, and verbal fluency. CONCLUSIONS This research emphasize the importance of considering the lateralization of the temporal lobe focus to achieve a more accurate neuropsychological characterization. The cognitive differences between left and right TLE patients highlight the need for individualized approaches in their treatment and care.
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Affiliation(s)
- Mariana Cairós-González
- Faculty of Health Sciences, Valencian International University, Pintor Sorolla St., 21, 46002, Valencia, Spain.
| | - Emilio Verche
- Department of Psychobiology and Methodology in Behavioural Sciences, University Complutense de Madrid, Rector Royo Villanova St., 1, 28040, Madrid, Spain
| | - Sergio Hernández
- Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Psychology and Language Therapy, University of La Laguna, Campus de Guajara, 456, 38200, San Cristóbal de La Laguna, Spain
| | - María Ángeles Alonso
- Department of Cognitive Psychology, Social and Organizational Faculty of Psychology and Language Therapy, University of La Laguna, Campus de Guajara, 456, 38200, San Cristóbal de La Laguna, Spain
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Kohli JS, Reyes A, Hopper A, Stasenko A, Menendez N, Tringale KR, Salans M, Karunamuni R, Hattangadi-Gluth JA, McDonald CR. Neuroanatomical profiles of cognitive phenotypes in patients with primary brain tumors. Neurooncol Adv 2024; 6:vdae152. [PMID: 39359697 PMCID: PMC11445899 DOI: 10.1093/noajnl/vdae152] [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] [Indexed: 10/04/2024] Open
Abstract
Background Patients with brain tumors demonstrate heterogeneous patterns of cognitive impairment, likely related to multifactorial etiologies and variable tumor-specific factors. Cognitive phenotyping offers a patient-centered approach to parsing heterogeneity by classifying individuals based on patterns of impairment. The aim of this study was to investigate the neuroanatomical patterns associated with each phenotype to gain a better understanding of the mechanisms underlying impairments. Methods Patients with primary brain tumors were recruited for a prospective, observational study. Patients were cognitively phenotyped using latent profile analysis in a prior study, revealing 3 distinct groups: generalized, isolated verbal memory, and minimal impairment. Whole brain cortical thickness (CT), fractional anisotropy, and mean diffusivity (MD) were compared across phenotypes, and associations between imaging metrics and cognitive scores were explored. Results Neurocognitive, structural MRI, and diffusion MRI data were available for 82 participants at baseline. Compared to the minimal impairment group, the generalized impairment group showed a widespread, bi-hemispheric pattern of decreased CT (P-value range: .004-.049), while the verbal memory impairment group showed decreased CT (P-value range: .006-.049) and increased MD (P-value range: .015-.045) bilaterally in the temporal lobes. In the verbal memory impairment group only, increased parahippocampal MD was associated with lower verbal memory scores (P-values < .01). Conclusions Cognitive phenotypes in patients with brain tumors showed unique patterns of brain pathology, suggesting different underlying mechanisms of their impairment profiles. These distinct patterns highlight the biological relevance of our phenotyping approach and help to identify areas of structural and microstructural vulnerability that could inform treatment decisions.
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Affiliation(s)
- Jiwandeep S Kohli
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Anny Reyes
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Austin Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Alena Stasenko
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Natalia Menendez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Kathryn R Tringale
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Mia Salans
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
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Li Y, Liu P, Lin Q, Zhou D, An D. Postoperative seizure and memory outcome of temporal lobe epilepsy with hippocampal sclerosis: A systematic review. Epilepsia 2023; 64:2845-2860. [PMID: 37611927 DOI: 10.1111/epi.17757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
We conducted a systematic review and meta-analysis to evaluate postoperative seizure and memory outcomes of temporal lobe epilepsy with different hippocampal sclerosis (HS) subtypes classified by International League Against Epilepsy (ILAE) Consensus Guidelines in 2013. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Library from January 1, 2013 to August 6, 2023. Observational studies reporting seizure and memory outcomes among different HS subtypes were included. We used the Newcastle-Ottawa scale to assess the risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to grade the quality of evidence. Seizure freedom and improved outcome (Engel 1 or ILAE class 1-2) ≥1 year after surgery were defined as the primary and secondary seizure outcome. A random-effects meta-analysis by DerSimonian and Laird method was performed to obtain pooled risk ratio (RRs) with 95% confidence interval (CIs). The memory impairment was narratively reviewed because of various evaluation tools. Fifteen cohort studies with 2485 patients were eligible for the meta-analysis of seizure outcome. Six cohorts with detailed information on postoperative memory outcome were included. The pooled RRs of seizure freedom, with moderate to substantial heterogeneity, were .98 (95% CI = .84-1.15) between HS type 2 and type 1, 1.11 (95% CI = .82-1.52) between type 3 and type 1, and .80 (95% CI = .62-1.03) between the no-HS and HS groups. No significant difference of improved outcome was found between different subtypes (p > .05). The quality of evidence was deemed to be low to very low according to GRADE. The long-term seizure outcome (≥5 years after surgery) and memory impairment remained controversial.
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Affiliation(s)
- Yuming Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Peiwen Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuxing Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Sarkis RA. Update in Progress: Cognitive Phenotypes in Temporal Lobe Epilepsy. Epilepsy Curr 2023; 23:363-365. [PMID: 38269342 PMCID: PMC10805095 DOI: 10.1177/15357597231211446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Moving Towards a Taxonomy of Cognitive Impairments in Epilepsy: Application of Latent Profile Analysis to 1178 Patients With Temporal Lobe Epilepsy Reyes A, Hermann BP, Busch RM, Drane DL, Barr WB, Hamberger MJ, Roesch SC, McDonald CR. Brain Commun . 2022;4(6):fcac289. doi:10.1093/braincomms/fcac289 In efforts to understand the cognitive heterogeneity within and across epilepsy syndromes, cognitive phenotyping has been proposed as a new taxonomy aimed at developing a harmonized approach to cognitive classification in epilepsy. Data- and clinically driven approaches have been previously used with variability in the phenotypes derived across studies. In our study, we utilize latent profile analysis to test several models of phenotypes in a large multicentre sample of patients with temporal lobe epilepsy and evaluate their demographic and clinical profiles. For the first time, we examine the added value of replacing missing data and examine factors that may be contributing to missingness. A sample of 1178 participants met the inclusion criteria for the study, which included a diagnosis of temporal lobe epilepsy and the availability of comprehensive neuropsychological data. Models with two to five classes were examined using latent profile analysis and the optimal model was selected based on fit indices, posterior probabilities and proportion of sample sizes. The models were also examined with imputed data to investigate the impact of missing data on model selection. Based on the fit indices, posterior probability and distinctiveness of the latent classes, a three-class solution was the optimal solution. This three-class solution comprised a group of patients with multidomain impairments, a group with impairments predominantly in language and a group with no impairments. Overall, the multidomain group demonstrated a worse clinical profile and comprised a greater proportion of patients with mesial temporal sclerosis, a longer disease duration and a higher number of anti-seizure medications. The four-class and five-class solutions demonstrated the lowest probabilities of a group membership. Analyses with imputed data demonstrated that the four-class solution was the optimal solution; however, there was a weak agreement between the missing and imputed data sets for the four-Class solutions (κ = 0.288, P < 0.001). This study represents the first to use latent profile analysis to test and compare multiple models of cognitive phenotypes in temporal lobe epilepsy and to determine the impact of missing data on model fit. We found that the three-phenotype model was the most meaningful based on several fit indices and produced phenotypes with unique demographic and clinical profiles. Our findings demonstrate that latent profile analysis is a rigorous method to identify phenotypes in large, heterogeneous epilepsy samples. Furthermore, this study highlights the importance of examining the impact of missing data in phenotyping methods. Our latent profile analysis-derived phenotypes can inform future studies aimed at identifying cognitive phenotypes in other neurological disorders.
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Affiliation(s)
- Rani A Sarkis
- Epilepsy Division, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School
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Baggio M, Danieli A, Crescentini C, Duma GM, Da Rold M, Baldini S, Pascoli E, Antoniazzi L, Vestri A, Fabbro F, Bonanni P. Neuropsychological Functioning in Bilateral versus Unilateral Temporal Lobe Epilepsy. Brain Sci 2023; 13:1526. [PMID: 38002486 PMCID: PMC10669306 DOI: 10.3390/brainsci13111526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Although relatively specific anatomo-electro-clinical features of temporal lobe epilepsy (TLE) with bilateral ictal involvement (bitemporal epilepsy-BTLE) have been described, differentiating between BTLE and unilateral TLE (UTLE) remains challenging. Surgery is often the treatment of choice for drug-resistant UTLE, whereas its use is more controversial in BTLE. It is currently unclear whether neuropsychological assessment can contribute to the differential diagnosis. We retrospectively reviewed the neuropsychological evaluation of 46 consecutive patients with refractory TLE. Eighteen patients were diagnosed with BTLE on the basis of ictal electro-clinical data, in particular a video EEG recording of at least one seizure simultaneously involving the two temporal lobes without the possibility of lateralizing its onset or at least two different seizures independently arising from the two temporal lobes. Twenty-eight patients were classified as UTLE. Presurgery evaluation data were used in this study. Compared with UTLE, BTLE was associated with a lower intelligence quotient (IQ) and more severe impairment in long-term memory, the latter remaining significant even after controlling for IQ. No significant differences were found between right and left UTLE. In conclusion, BTLE and UTLE are associated with relatively distinct neuropsychological profiles, further supporting their classification as different disorders within the TLE spectrum.
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Affiliation(s)
- Martina Baggio
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100 Udine, Italy
| | - Gian Marco Duma
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Martina Da Rold
- Aulss 2 Marca Trevigiana, Piazzale Dell’Ospedale, 1, 31100 Treviso, Italy
| | - Sara Baldini
- Clinical Unit of Neurology, Department of Medical Sciences, University Hospital and Health Services of Trieste, University of Trieste, 34129 Trieste, Italy
| | - Eric Pascoli
- Department of Medicine—DAME, University of Udine, 33100 Udine, Italy
| | - Lisa Antoniazzi
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Alec Vestri
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
| | - Franco Fabbro
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100 Udine, Italy
- PERCRO Perceptual Robotics Laboratory, Scuola Superiore Sant’Anna, 56010 Pisa, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS E. Medea, Via Costa Alta 37, 31015 Conegliano, Italy; (M.B.); (A.D.); (A.V.); (P.B.)
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Reyes A, Schneider ALC, Kucharska-Newton AM, Gottesman RF, Johnson EL, McDonald CR. Cognitive phenotypes in late-onset epilepsy: results from the atherosclerosis risk in communities study. Front Neurol 2023; 14:1230368. [PMID: 37745655 PMCID: PMC10513940 DOI: 10.3389/fneur.2023.1230368] [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: 05/28/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Cognitive phenotyping is a widely used approach to characterize the heterogeneity of deficits in patients with a range of neurological disorders but has only recently been applied to patients with epilepsy. In this study, we identify cognitive phenotypes in older adults with late-onset epilepsy (LOE) and examine their demographic, clinical, and vascular profiles. Further, we examine whether specific phenotypes pose an increased risk for progressive cognitive decline. Methods Participants were part of the Atherosclerosis Risk in Communities Study (ARIC), a prospective longitudinal community-based cohort study of 15,792 individuals initially enrolled in 1987-1989. LOE was identified from linked Centers for Medicare and Medicaid Services claims data. Ninety-one participants with LOE completed comprehensive testing either prior to or after seizure onset as part of a larger cohort in the ARIC Neurocognitive Study in either 2011-2013 or 2016-2017 (follow-up mean = 4.9 years). Cognitive phenotypes in individuals with LOE were derived by calculating test-level impairments for each participant (i.e., ≤1 SD below cognitively normal participants on measures of language, memory, and executive function/processing speed); and then assigning participants to phenotypes if they were impaired on at least two tests within a domain. The total number of impaired domains was used to determine the cognitive phenotypes (i.e., Minimal/No Impairment, Single Domain, or Multidomain). Results At our baseline (Visit 5), 36.3% met criteria for Minimal/No Impairment, 35% for Single Domain Impairment (with executive functioning/ processing speed impaired in 53.6%), and 28.7% for Multidomain Impairment. The Minimal/No Impairment group had higher education and occupational complexity. There were no differences in clinical or vascular risk factors across phenotypes. Of those participants with longitudinal data (Visit 6; n = 24), 62.5% declined (i.e., progressed to a more impaired phenotype) and 37.5% remained stable. Those who remained stable were more highly educated compared to those that declined. Discussion Our results demonstrate the presence of identifiable cognitive phenotypes in older adults with LOE. These results also highlight the high prevalence of cognitive impairments across domains, with deficits in executive function/processing speed the most common isolated impairment. We also demonstrate that higher education was associated with a Minimal/No Impairment phenotype and lower risk for cognitive decline over time.
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Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Andrea L. C. Schneider
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Anna M. Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD, United States
| | - Emily L. Johnson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carrie R. McDonald
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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Ballerini A, Arienzo D, Stasenko A, Schadler A, Vaudano AE, Meletti S, Kaestner E, McDonald CR. Spatial patterns of gray and white matter compromise relate to age of seizure onset in temporal lobe epilepsy. Neuroimage Clin 2023; 39:103473. [PMID: 37531834 PMCID: PMC10415805 DOI: 10.1016/j.nicl.2023.103473] [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: 04/29/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Temporal Lobe Epilepsy (TLE) is frequently a neurodevelopmental disorder, involving subcortical volume loss, cortical atrophy, and white matter (WM) disruption. However, few studies have addressed how these pathological changes in TLE relate to one another. In this study, we investigate spatial patterns of gray and white matter degeneration in TLE and evaluate the hypothesis that the relationship among these patterns varies as a function of the age at which seizures begin. METHODS Eighty-two patients with TLE and 59 healthy controls were enrolled. T1-weighted images were used to obtain hippocampal volumes and cortical thickness estimates. Diffusion-weighted imaging was used to obtain fractional anisotropy (FA) and mean diffusivity (MD) of the superficial WM (SWM) and deep WM tracts. Analysis of covariance was used to examine patterns of WM and gray matter alterations in TLE relative to controls, controlling for age and sex. Sliding window correlations were then performed to examine the relationships between SWM degeneration, cortical thinning, and hippocampal atrophy across ages of seizure onset. RESULTS Cortical thinning in TLE followed a widespread, bilateral pattern that was pronounced in posterior centroparietal regions, whereas SWM and deep WM loss occurred mostly in ipsilateral, temporolimbic regions compared to controls. Window correlations revealed a relationship between hippocampal volume loss and whole brain SWM disruption in patients who developed epilepsy during childhood. On the other hand, in patients with adult-onset TLE, co-occurring cortical and SWM alterations were observed in the medial temporal lobe ipsilateral to the seizure focus. SIGNIFICANCE Our results suggest that although cortical, hippocampal and WM alterations appear spatially discordant at the group level, the relationship among these features depends on the age at which seizures begin. Whereas neurodevelopmental aspects of TLE may result in co-occurring WM and hippocampal degeneration near the epileptogenic zone, the onset of seizures in adulthood may set off a cascade of SWM microstructural loss and cortical atrophy of a neurodegenerative nature.
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Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Department of Psychiatry, University of California, San Diego, USA
| | - Donatello Arienzo
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Alena Stasenko
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Adam Schadler
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Italy
| | - Erik Kaestner
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California, San Diego, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, USA; Department of Radiation Medicine & Applied Sciences, University of California, San Diego, USA.
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Ballerini A, Talami F, Molinari MA, Micalizzi E, Scolastico S, Biagioli N, Orlandi N, Pugnaghi M, Giovannini G, Meletti S, Vaudano AE. Exploring the relationship between amygdala subnuclei volumes and cognitive performance in left-lateralized temporal lobe epilepsy with and without hippocampal sclerosis. Epilepsy Behav 2023; 145:109342. [PMID: 37422935 DOI: 10.1016/j.yebeh.2023.109342] [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: 05/04/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Cognitive disruption is a debilitating comorbidity in Temporal Lobe Epilepsy (TLE). Despite recent advances, the amygdala is often neglected in studies that explore cognition in TLE. Amygdala subnuclei are differently engaged in TLE with hippocampal sclerosis (TLE-HS) compared to non-lesional TLE (TLE-MRIneg), with predominant atrophy in the first and increased volume in the latter. Herein, we aim to explore the relationship between the volumes of the amygdala and its substructures with respect to cognitive performances in a population of left-lateralized TLE with and without HS. Twenty-nine TLEs were recruited (14 TLE-HS; 15 TLE-MRIneg). After investigating the differences in the subcortical amygdalae and hippocampal volumes compared to a matched healthy control population, we explored the associations between the subnuclei of the amygdala and the hippocampal subfields with the cognitive scores in TLE patients, according to their etiology. In TLE-HS, a reduced volume of the basolateral and cortical amygdala complexes joined with whole hippocampal atrophy, was related to poorer scores in verbal memory tasks, while in TLE-MRIneg, poorer performances in attention and processing speed tasks were associated with a generalized amygdala enlargement, particularly of the basolateral and central complexes. The present findings extend our knowledge of amygdala involvement in cognition and suggest structural amygdala abnormalities as useful disease biomarkers in TLE.
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Affiliation(s)
- Alice Ballerini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Talami
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Italian National Research Council (CNR), Institute of Neuroscience, Parma, Italy
| | | | - Elisa Micalizzi
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy; Neurophysiology Unit, Epilepsy Center, IRCCS San Martino Hospital, Genoa, Italy
| | - Simona Scolastico
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
| | - Niccolò Biagioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
| | - Niccolò Orlandi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
| | | | | | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy.
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McDonald CR, Busch RM, Reyes A, Arrotta K, Barr W, Block C, Hessen E, Loring DW, Drane DL, Hamberger MJ, Wilson SJ, Baxendale S, Hermann BP. Development and application of the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE): Initial results from a multi-center study of adults with temporal lobe epilepsy. Neuropsychology 2023; 37:301-314. [PMID: 35084879 PMCID: PMC9325925 DOI: 10.1037/neu0000792] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
[Correction Notice: An Erratum for this article was reported online in Neuropsychology on Sep 15 2022 (see record 2023-01997-001). In the original article, there was an error in Figure 2. In the box at the top left of the figure, the fourth explanation incorrectly stated, "Generalized impairment = At least one test < -1.0 or -1.5SD in three or more domains." The correct wording is "Generalized impairment = At least two tests < -1.0 or -1.5SD in each of three or more domains." All versions of this article have been corrected.] Objective: To describe the development and application of a consensus-based, empirically driven approach to cognitive diagnostics in epilepsy research-The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) and to assess the ability of the IC-CoDE to produce definable and stable cognitive phenotypes in a large, multi-center temporal lobe epilepsy (TLE) patient sample. METHOD Neuropsychological data were available for a diverse cohort of 2,485 patients with TLE across seven epilepsy centers. Patterns of impairment were determined based on commonly used tests within five cognitive domains (language, memory, executive functioning, attention/processing speed, and visuospatial ability) using two impairment thresholds (≤1.0 and ≤1.5 standard deviations below the normative mean). Cognitive phenotypes were derived across samples using the IC-CoDE and compared to distributions of phenotypes reported in existing studies. RESULTS Impairment rates were highest on tests of language, followed by memory, executive functioning, attention/processing speed, and visuospatial ability. Application of the IC-CoDE using varying operational definitions of impairment (≤ 1.0 and ≤ 1.5 SD) produced cognitive phenotypes with the following distribution: cognitively intact (30%-50%), single-domain (26%-29%), bi-domain (14%-19%), and generalized (10%-22%) impairment. Application of the ≤ 1.5 cutoff produced a distribution of phenotypes that was consistent across cohorts and approximated the distribution produced using data-driven approaches in prior studies. CONCLUSIONS The IC-CoDE is the first iteration of a classification system for harmonizing cognitive diagnostics in epilepsy research that can be applied across neuropsychological tests and TLE cohorts. This proof-of-principle study in TLE offers a promising path for enhancing research collaborations globally and accelerating scientific discoveries in epilepsy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Reyes A, Salinas L, Hermann BP, Baxendale S, Busch RM, Barr WB, McDonald CR. Establishing the cross-cultural applicability of a harmonized approach to cognitive diagnostics in epilepsy: Initial results of the International Classification of Cognitive Disorders in Epilepsy in a Spanish-speaking sample. Epilepsia 2023; 64:728-741. [PMID: 36625416 PMCID: PMC10394710 DOI: 10.1111/epi.17501] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate the cross-cultural application of the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) to a cohort of Spanish-speaking patients with temporal lobe epilepsy (TLE) living in the United States. METHODS Eighty-four Spanish-speaking patients with TLE completed neuropsychological measures of memory, language, executive function, visuospatial functioning, and attention/processing speed as part of the Neuropsychological Screening Battery for Hispanics. The contribution of demographic and clinical variables to cognitive performance was evaluated. A sensitivity analysis was conducted by examining the base rates of impairment across several impairment thresholds. The IC-CoDE taxonomy was then applied, and the base rate of cognitive phenotypes for each cutoff was calculated. The distribution of phenotypes was compared to the published IC-CoDE taxonomy data, which utilized a large, multicenter cohort of English-speaking patients with TLE. RESULTS Across the different impairment cutoffs, memory was the most impaired cognitive domain, with impairments in list learning ranging from 50% to 78%. Application of the IC-CoDE taxonomy utilizing a -1.5-SD cutoff revealed an intact cognitive profile in 47.6% of patients, single-domain impairment in 23.8% of patients, bidomain impairment in 14.3% of patients, and generalized impairment in 14.3% of the sample. This distribution was comparable to the phenotype distribution observed in the IC-CoDE validation sample. SIGNIFICANCE We demonstrate a similar pattern and distribution of cognitive phenotypes in a Spanish-speaking epilepsy cohort compared to an English-speaking sample. This suggests stability in the underlying phenotypes associated with TLE and applicability of the IC-CoDE for guiding cognitive diagnostics in epilepsy research that can be applied to culturally and linguistically diverse samples.
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Affiliation(s)
- Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Lilian Salinas
- New York University Langone Comprehensive Epilepsy Center, New York, NY, USA
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health USA
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology
| | - Robyn M. Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - William B. Barr
- New York University Langone Comprehensive Epilepsy Center, New York, NY, USA
- Departments of Neurology and Psychiatry, NYU-Langone Medical Center and NYU School of Medicine, New York, NY, USA
| | - Carrie R. McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
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Matias-Guiu JA, Herrera E, González-Nosti M, Krishnan K, Delgado-Alonso C, Díez-Cirarda M, Yus M, Martínez-Petit Á, Pagán J, Matías-Guiu J, Ayala JL, Busch R, Hermann BP. Development of criteria for cognitive dysfunction in post-COVID syndrome: the IC-CoDi-COVID approach. Psychiatry Res 2023; 319:115006. [PMID: 36521337 DOI: 10.1016/j.psychres.2022.115006] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/27/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND We aimed to develop objective criteria for cognitive dysfunction associated with the post-COVID syndrome. METHODS Four hundred and four patients with post-COVID syndrome from two centers were evaluated with comprehensive neuropsychological batteries. The International Classification for Cognitive Disorders in Epilepsy (IC-CoDE) framework was adapted and implemented. A healthy control group of 145 participants and a complementary data-driven approach based on unsupervised machine-learning clustering algorithms were also used to evaluate the optimal classification and cutoff points. RESULTS According to the developed criteria, 41.2% and 17.3% of the sample were classified as having at least one cognitive domain impaired using -1 and -1.5 standard deviations as cutoff points. Attention/processing speed was the most frequently impaired domain. There were no differences in base rates of cognitive impairment between the two centers. Clustering analysis revealed two clusters, although with an important overlap (silhouette index 0.18-0.19). Cognitive impairment was associated with younger age and lower education levels, but not hospitalization. CONCLUSIONS We propose a harmonization of the criteria to define and classify cognitive impairment in the post-COVID syndrome. These criteria may be extrapolated to other neuropsychological batteries and settings, contributing to the diagnosis of cognitive deficits after COVID-19 and facilitating multicenter studies to guide biomarker investigation and therapies.
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Affiliation(s)
- Jordi A Matias-Guiu
- Department of Neurology, Hospital Clínico San Carlos. Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain.
| | - Elena Herrera
- Faculty of Psychology, University of Oviedo, Oviedo, Spain
| | | | - Kamini Krishnan
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Cristina Delgado-Alonso
- Department of Neurology, Hospital Clínico San Carlos. Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - María Díez-Cirarda
- Department of Neurology, Hospital Clínico San Carlos. Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Yus
- Department of Radiology, Clinico San Carlos. Health Research Institute "San Carlos" (IdISCC). Universidad Complutense de Madrid, Madrid, Spain
| | - Álvaro Martínez-Petit
- Department of Electronic Engineering, Universidad Politécnica de Madrid, Madrid, Spain
| | - Josué Pagán
- Department of Electronic Engineering, Universidad Politécnica de Madrid, Madrid, Spain; Center for Computational Simulation, Universidad Politécnica de Madrid, Campus de Montegancedo, Boadilla del Monte, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clínico San Carlos. Health Research Institute "San Carlos" (IdISCC), Universidad Complutense de Madrid, Madrid, Spain
| | - José Luis Ayala
- Center for Computational Simulation, Universidad Politécnica de Madrid, Campus de Montegancedo, Boadilla del Monte, Madrid, Spain; Department of Automatic Architecture and Automation, Universidad Complutense, Madrid, Spain
| | - Robyn Busch
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce P Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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20
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Duma GM, Danieli A, Mattar MG, Baggio M, Vettorel A, Bonanni P, Mento G. Resting state network dynamic reconfiguration and neuropsychological functioning in temporal lobe epilepsy: An HD-EEG investigation. Cortex 2022; 157:1-13. [PMID: 36257103 DOI: 10.1016/j.cortex.2022.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/07/2022] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
Temporal lobe epilepsy (TLE) is nowadays considered a network disorder impacting several cognitive domains. In this work we investigated dynamic network reconfiguration differences in patients with unilateral TLE compared to a healthy control group, focusing on two connectivity indices: flexibility and integration. We apply these indices for the first time to high-density EEG source-based functional connectivity. We observed that patients with TLE exhibited significantly lower flexibility than healthy controls in the Control, Default Mode and Attentive Dorsal networks, expressed in the delta, theta and alpha bands. In addition, patients with TLE displayed greater integration values across the majority of the resting state networks, especially in the delta, theta and gamma bands. Relevantly, a higher integration index in the Control, Attentive Dorsal and Visual networks in the delta band was correlated with lower performance in visual attention and executive functions. Moreover, a greater integration index in the gamma band of the Control, Somatomotor and Temporoparietal networks was related to lower long-term memory performance. These results suggest that patients with TLE display dysregulated network reconfiguration, with lower flexibility in the brain areas related to cognitive control and attention, together with excessive inter-network communication (integration index). Finally, the correlation between network integration and the reduced cognitive performance suggests a potential mechanism underlying specific alterations in neuropsychological profile of patients with TLE.
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Affiliation(s)
- Gian Marco Duma
- Institut de Neurosciences des Systèmes, Aix-Marseille Université, Marseille, France; IRCCS E. Medea Scientific Institute, Epilepsy Unit, Conegliano, Treviso, Italy.
| | - Alberto Danieli
- IRCCS E. Medea Scientific Institute, Epilepsy Unit, Conegliano, Treviso, Italy
| | - Marcelo G Mattar
- Department of Cognitive Science, University of California, San Diego, San Diego, CA, USA
| | - Martina Baggio
- IRCCS E. Medea Scientific Institute, Epilepsy Unit, Conegliano, Treviso, Italy
| | - Airis Vettorel
- IRCCS E. Medea Scientific Institute, Epilepsy Unit, Conegliano, Treviso, Italy
| | - Paolo Bonanni
- IRCCS E. Medea Scientific Institute, Epilepsy Unit, Conegliano, Treviso, Italy
| | - Giovanni Mento
- Department of General Psychology, University of Padova, Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
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21
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Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Hermann B, Byars A, Austin J. Characterizing Sleep Phenotypes in Children With Newly Diagnosed Epilepsy. Pediatr Neurol 2022; 137:34-40. [PMID: 36215818 PMCID: PMC9970008 DOI: 10.1016/j.pediatrneurol.2022.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with epilepsy frequently have sleep, behavior, and cognitive problems at the time of or before the epilepsy diagnosis. The primary goal of this study was to determine if specific sleep disturbance phenotypes exist in a large cohort of children with new-onset epilepsy and if these phenotypes are associated with specific cognitive and behavioral signatures. METHODS A total of354 children with new-onset epilepsy, aged six to 16 years, were recruited within six weeks of initial seizure onset. Each child underwent evaluation of their sleep along with self, parent, and teacher ratings of emotional-behavioral status. Two-step clustering using sleep disturbance (Sleep Behavior Questionnaire), naps, and sleep latency was employed to determine phenotype clusters. RESULTS Analysis showed three distinct sleep disturbance phenotypes-minimal sleep disturbance, moderate sleep disturbance, and severe sleep disturbance phenotypes. Children who fell into the minimal sleep disturbance phenotype had an older age of onset with the best cognitive performance compared with the other phenotypes and the lowest levels of emotional-behavioral problems. In contrast, children who fell into the severe sleep disturbance phenotype had the youngest age of onset of epilepsy with poor cognitive performance and highest levels of emotional-behavioral problems. CONCLUSIONS This study indicates that there are indeed specific sleep disturbance phenotypes that are apparent in children with newly diagnosed epilepsy and are associated with specific comorbidities. Future research should determine if these phenotypic groups persist over time and are predictive of long-term difficulties, as these subgroups may benefit from targeted therapy and intervention.
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Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
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22
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Reyes A, Hermann BP, Busch RM, Drane DL, Barr WB, Hamberger MJ, Roesch SC, McDonald CR. Moving towards a taxonomy of cognitive impairments in epilepsy: application of latent profile analysis to 1178 patients with temporal lobe epilepsy. Brain Commun 2022; 4:fcac289. [PMID: 36447559 PMCID: PMC9692194 DOI: 10.1093/braincomms/fcac289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/07/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
In efforts to understand the cognitive heterogeneity within and across epilepsy syndromes, cognitive phenotyping has been proposed as a new taxonomy aimed at developing a harmonized approach to cognitive classification in epilepsy. Data- and clinically driven approaches have been previously used with variability in the phenotypes derived across studies. In our study, we utilize latent profile analysis to test several models of phenotypes in a large multicentre sample of patients with temporal lobe epilepsy and evaluate their demographic and clinical profiles. For the first time, we examine the added value of replacing missing data and examine factors that may be contributing to missingness. A sample of 1178 participants met the inclusion criteria for the study, which included a diagnosis of temporal lobe epilepsy and the availability of comprehensive neuropsychological data. Models with two to five classes were examined using latent profile analysis and the optimal model was selected based on fit indices, posterior probabilities and proportion of sample sizes. The models were also examined with imputed data to investigate the impact of missing data on model selection. Based on the fit indices, posterior probability and distinctiveness of the latent classes, a three-class solution was the optimal solution. This three-class solution comprised a group of patients with multidomain impairments, a group with impairments predominantly in language and a group with no impairments. Overall, the multidomain group demonstrated a worse clinical profile and comprised a greater proportion of patients with mesial temporal sclerosis, a longer disease duration and a higher number of anti-seizure medications. The four-class and five-class solutions demonstrated the lowest probabilities of a group membership. Analyses with imputed data demonstrated that the four-class solution was the optimal solution; however, there was a weak agreement between the missing and imputed data sets for the four-Class solutions (κ = 0.288, P < 0.001). This study represents the first to use latent profile analysis to test and compare multiple models of cognitive phenotypes in temporal lobe epilepsy and to determine the impact of missing data on model fit. We found that the three-phenotype model was the most meaningful based on several fit indices and produced phenotypes with unique demographic and clinical profiles. Our findings demonstrate that latent profile analysis is a rigorous method to identify phenotypes in large, heterogeneous epilepsy samples. Furthermore, this study highlights the importance of examining the impact of missing data in phenotyping methods. Our latent profile analysis-derived phenotypes can inform future studies aimed at identifying cognitive phenotypes in other neurological disorders.
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Affiliation(s)
- Anny Reyes
- Center for Multimodal Imaging and Genetics, University of CaliforniaSan Diego, La Jolla, CA 92093, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Neurology, University of Washington, Seattle, WA 98195, USA
| | - William B Barr
- Department of Neurology, NYU-Langone Medical Center and NYU School of Medicine, New York, NY 10016, USA
- Department of Psychiatry, NYU-Langone Medical Center and NYU School of Medicine, New York, NY 10016, USA
| | - Marla J Hamberger
- Department of Neurology, Columbia University, New York, NY 10027, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92093, USA
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23
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Vilà-Balló A, De la Cruz-Puebla M, López-Barroso D, Miró J, Sala-Padró J, Cucurell D, Falip M, Rodríguez-Fornells A. Reward-based decision-making in mesial temporal lobe epilepsy patients with unilateral hippocampal sclerosis pre- and post-surgery. Neuroimage Clin 2022; 36:103251. [PMID: 36510413 PMCID: PMC9668642 DOI: 10.1016/j.nicl.2022.103251] [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: 04/09/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Correct functioning of the reward processing system is critical for optimizing decision-making as well as preventing the development of addictions and/or neuropsychiatric symptoms such as depression, apathy, and anhedonia. Consequently, patients with mesial temporal lobe epilepsy due to unilateral hippocampal sclerosis (mTLE-UHS) represent an excellent opportunity to study the brain networks involved in this system. OBJECTIVE The aim of the current study was to evaluate decision-making and the electrophysiological correlates of feedback processing in a sample of mTLE-UHS patients, compared to healthy controls. In addition, we assessed the impact of mesial temporal lobe surgical resection on these processes, as well as general, neuropsychological functioning. METHOD 17 mTLE-UHS patients and 17 matched healthy controls completed: [1] a computerized version of the Game of Dice Task, [2] a Standard Iowa Gambling Task, and [3] a modified ERP version of a probabilistic gambling task coupled with multichannel electroencephalography. Neuropsychological scores were also obtained both pre- and post-surgery. RESULTS Behavioral analyses showed a pattern of increased risk for the mTLE-UHS group in decision-making under ambiguity compared to the control group. A decrease in the amplitude of the Feedback Related Negativity (FRN), a weaker effect of valence on delta power, and a general reduction of delta and theta power in the mTLE-UHS group, as compared to the control group, were also found. The beta-gamma activity associated with the delivery of positive reward was similar in both groups. Behavioral performance and electrophysiological measures did not worsen post-surgery. CONCLUSIONS Patients with mTLE-UHS showed impairments in decision-making under ambiguity, particularly when they had to make decisions based on the outcomes of their choices, but not in decision-making under risk. No group differences were observed in decision-making when feedbacks were random. These results might be explained by the abnormal feedback processing seen in the EEG activity of patients with mTLE-UHS, and by concomitant impairments in working memory, and memory. These impairments may be linked to the disruption of mesial temporal lobe networks. Finally, feedback processing and decision-making under ambiguity were already affected in mTLE-UHS patients pre-surgery and did not show evidence of clear worsening post-surgery.
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Affiliation(s)
- Adrià Vilà-Balló
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain,Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain,Department of Psychology, Faculty of Education and Psychology, University of Girona, Girona, Spain,Corresponding authors.
| | - Myriam De la Cruz-Puebla
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Department of Cellular Biology, Physiology, and Immunology, Neurosciences Institute, Autonomous University of Barcelona, Barcelona, Spain,Department of Equity in Brain Health, Global Brain Health Institute (GBHI), University of California, San Francisco (UCSF), CA, USA,Department of Internal Medicine, Health Sciences Faculty, Technical University of Ambato, Tungurahua, Ecuador,Dept. of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain,Dept. of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Júlia Miró
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Epilepsy Unit, Neurological Service, Neurology and Genetics Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jacint Sala-Padró
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Dept. of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - David Cucurell
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain,Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Mercè Falip
- Epilepsy Unit, Neurological Service, Neurology and Genetics Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain,Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain
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Abstract
OBJECTIVE Adults with temporal lobe epilepsy (TLE) have been found to have a fairly characteristic pattern of neuropsychological performance, but there is considerably less research and more variability in findings with children. Because the cognitive domains included in most studies with children have been limited, the current study attempted to better characterize the cognitive phenotype of children with TLE using a broader neuropsychological battery. METHODS The study included 59 children with TLE (59% male) age 7 to 16 (M = 12.67; SD = 3.12) who underwent comprehensive neuropsychological evaluation. Patient results were grouped into cognitive domains (reasoning, language, visuoperceptual, verbal memory, executive function, and motor function) based upon their test performance. These factor scores were subjected to Ward's hierarchical clustering method with squared Euclidean distance. RESULTS Cluster analysis revealed three distinct cognitive profiles: (1) normal functioning (20% of sample); (2) delayed verbal memory and motor weaknesses (61% of the sample); and (3) global impairment (19% of the sample). Cluster 3 had longer epilepsy duration and a higher incidence of hippocampal sclerosis (HS) compared to Cluster 1 (p < .05). There were no significant differences among the three cluster groups on demographic characteristics or remaining clinical characteristics. CONCLUSIONS Children with TLE present with distinct cognitive phenotypes ranging from average performance to global impairment. Results partially support previous hypotheses highlighting the cumulative neurobiological burden on the developing brain in the context of chronic epilepsy and provide a preliminary framework for the cognitive domains most vulnerable to the TLE disease process.
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25
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Schraegle WA, Babajani-Feremi A. Global network alterations of the cognitive phenotypes in pediatric temporal lobe epilepsy. Epilepsy Behav 2022; 135:108891. [PMID: 36049247 DOI: 10.1016/j.yebeh.2022.108891] [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: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE An emerging literature suggests that the neuropsychological sequelae of pediatric temporal lobe epilepsy (TLE) are characterized by a continuum of cognitive phenotypes that range in type and severity. The goal of the present investigation was to better characterize the neuropsychological networks that underlie these phenotypes. METHODS The study included 59 patients with TLE who were empirically categorized into three cognitive phenotypes (normal, focal, and generalized impairment). Nine neuropsychological measures representing multiple cognitive domains (i.e., reasoning, language, visouperception, memory, and executive function) were examined by graph theory to characterize the global network properties of the cognitive phenotypes. RESULTS Across the cognitive phenotype groups (i.e., normal, focal, generalized impaired) the following findings emerged: (1) the adjacency matrices demonstrated different patterns of association between cognitive measures within the neuropsychological network; (2) global measures including global efficiency (GE) and average clustering coefficient (aCC) showed a stepwise increase across the range of impaired pediatric TLE phenotypes; however, modularity (M) demonstrated the opposite pattern. IMPRESSIONS Cognitive networks in pediatric TLE demonstrate stepwise perturbation in underlying neuropsychological networks. Graph theory offers a novel approach to examine cognitive abnormalities in pediatric TLE that may be applied to other pediatric epilepsies.
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Affiliation(s)
- William A Schraegle
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA; Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA.
| | - Abbas Babajani-Feremi
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA; Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, TX, USA; Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA; Department of Neurology, University of Florida, Gainesville, FL, USA
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26
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Garcia-Ramos C, Nair V, Maganti R, Mathis J, Conant LL, Prabhakaran V, Binder JR, Meyerand B, Hermann B, Struck AF. Network phenotypes and their clinical significance in temporal lobe epilepsy using machine learning applications to morphological and functional graph theory metrics. Sci Rep 2022; 12:14407. [PMID: 36002603 PMCID: PMC9402557 DOI: 10.1038/s41598-022-18495-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/12/2022] [Indexed: 02/08/2023] Open
Abstract
Machine learning analyses were performed on graph theory (GT) metrics extracted from brain functional and morphological data from temporal lobe epilepsy (TLE) patients in order to identify intrinsic network phenotypes and characterize their clinical significance. Participants were 97 TLE and 36 healthy controls from the Epilepsy Connectome Project. Each imaging modality (i.e., Resting-state functional Magnetic Resonance Imaging (RS-fMRI), and structural MRI) rendered 2 clusters: one comparable to controls and one deviating from controls. Participants were minimally overlapping across the identified clusters, suggesting that an abnormal functional GT phenotype did not necessarily mean an abnormal morphological GT phenotype for the same subject. Morphological clusters were associated with a significant difference in the estimated lifetime number of generalized tonic-clonic seizures and functional cluster membership was associated with age. Furthermore, controls exhibited significant correlations between functional GT metrics and cognition, while for TLE participants morphological GT metrics were linked to cognition, suggesting a dissociation between higher cognitive abilities and GT-derived network measures. Overall, these findings demonstrate the existence of clinically meaningful minimally overlapping phenotypes of morphological and functional GT networks. Functional network properties may underlie variance in cognition in healthy brains, but in the pathological state of epilepsy the cognitive limits might be primarily related to structural cerebral network properties.
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Affiliation(s)
- Camille Garcia-Ramos
- grid.14003.360000 0001 2167 3675Department of Medical Physics, University of Wisconsin-Madison, Madison, USA ,grid.14003.360000 0001 2167 3675Department of Neurology, University of Wisconsin-Madison, Madison, USA
| | - Veena Nair
- grid.14003.360000 0001 2167 3675Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Rama Maganti
- grid.14003.360000 0001 2167 3675Department of Neurology, University of Wisconsin-Madison, Madison, USA
| | - Jedidiah Mathis
- grid.30760.320000 0001 2111 8460Department of Neurology, Medical College of Wisconsin, Milwaukee, USA
| | - Lisa L. Conant
- grid.14003.360000 0001 2167 3675Department of Neurology, University of Wisconsin-Madison, Madison, USA
| | - Vivek Prabhakaran
- grid.14003.360000 0001 2167 3675Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Jeffrey R. Binder
- grid.30760.320000 0001 2111 8460Department of Neurology, Medical College of Wisconsin, Milwaukee, USA
| | - Beth Meyerand
- grid.14003.360000 0001 2167 3675Department of Medical Physics, University of Wisconsin-Madison, Madison, USA
| | - Bruce Hermann
- grid.14003.360000 0001 2167 3675Department of Neurology, University of Wisconsin-Madison, Madison, USA
| | - Aaron F. Struck
- grid.14003.360000 0001 2167 3675Department of Neurology, University of Wisconsin-Madison, Madison, USA ,grid.417123.20000 0004 0420 6882William S Middleton VA Hospital, Madison, WI USA
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Grote A, Heiland DH, Taube J, Helmstaedter C, Ravi VM, Will P, Hattingen E, Schüre JR, Witt JA, Reimers A, Elger C, Schramm J, Becker AJ, Delev D. 'Hippocampal innate inflammatory gliosis only' in pharmacoresistant temporal lobe epilepsy. Brain 2022; 146:549-560. [PMID: 35978480 PMCID: PMC9924906 DOI: 10.1093/brain/awac293] [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: 01/04/2022] [Revised: 07/03/2022] [Accepted: 07/31/2022] [Indexed: 11/12/2022] Open
Abstract
Drug-resistant mesial-temporal lobe epilepsy is a devastating disease with seizure onset in the hippocampal formation. A fraction of hippocampi samples from epilepsy-surgical procedures reveals a peculiar histological pattern referred to as 'gliosis only' with unresolved pathogenesis and enigmatic sequelae. Here, we hypothesize that 'gliosis only' represents a particular syndrome defined by distinct clinical and molecular characteristics. We curated an in-depth multiparameter integration of systematic clinical, neuropsychological as well as neuropathological analysis from a consecutive cohort of 627 patients, who underwent hippocampectomy for drug-resistant temporal lobe epilepsy. All patients underwent either classic anterior temporal lobectomy or selective amygdalohippocampectomy. On the basis of their neuropathological exam, patients with hippocampus sclerosis and 'gliosis only' were characterized and compared within the whole cohort and within a subset of matched pairs. Integrated transcriptional analysis was performed to address molecular differences between both groups. 'Gliosis only' revealed demographics, clinical and neuropsychological outcome fundamentally different from hippocampus sclerosis. 'Gliosis only' patients had a significantly later seizure onset (16.3 versus 12.2 years, P = 0.005) and worse neuropsychological outcome after surgery compared to patients with hippocampus sclerosis. Epilepsy was less amendable by surgery in 'gliosis only' patients, resulting in a significantly worse rate of seizure freedom after surgery in this subgroup (43% versus 68%, P = 0.0001, odds ratio = 2.8, confidence interval 1.7-4.7). This finding remained significant after multivariate and matched-pairs analysis. The 'gliosis only' group demonstrated pronounced astrogliosis and lack of significant neuronal degeneration in contrast to characteristic segmental neuron loss and fibrillary astrogliosis in hippocampus sclerosis. RNA-sequencing of gliosis only patients deciphered a distinct transcriptional programme that resembles an innate inflammatory response of reactive astrocytes. Our data indicate a new temporal lobe epilepsy syndrome for which we suggest the term 'Innate inflammatory gliosis only'. 'Innate inflammatory gliosis only' is characterized by a diffuse gliosis pattern lacking restricted hippocampal focality and is poorly controllable by surgery. Thus, 'innate inflammatory gliosis only' patients need to be clearly identified by presurgical examination paradigms of pharmacoresistant temporal lobe epilepsy patients; surgical treatment of this subgroup should be considered with great precaution. 'Innate inflammatory gliosis only' requires innovative pharmacotreatment strategies.
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Affiliation(s)
- Alexander Grote
- Correspondence to: Alexander Grote UKGM—Klinik für Neurochirurgie Baldingerstraße 35033 Marburg, Germany E-mail:
| | | | - Julia Taube
- Clinic for Epileptology, University Hospital of Bonn, 53127 Bonn, Germany
| | | | - Vidhya M Ravi
- Clinic for Neurosurgery, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Paulina Will
- Clinic for Neurosurgery, University Medical Center Freiburg, 79106 Freiburg, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Hospital of Goethe University Frankfurt, 60528 Frankfurt am Main, Germany
| | - Jan-Rüdiger Schüre
- Department of Neuroradiology, Hospital of Goethe University Frankfurt, 60528 Frankfurt am Main, Germany
| | | | - Annika Reimers
- Institute of Neuropathology, Section for Translational Epilepsy Research, University Hospital of Bonn, 53127 Bonn, Germany
| | - Christian Elger
- Clinic for Neurology and Competence Center for Epilepsy, Beta Klinik Bonn GmbH, 53227 Bonn, Germany
| | - Johannes Schramm
- Medical Faculty, University Medical Center Bonn, 53127 Bonn, Germany
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Arrotta K, Reyes A, Kaestner E, McDonald CR, Hermann BP, Barr WB, Sarmey N, Sundar S, Kondylis E, Najm I, Bingaman W, Busch RM. Cognitive phenotypes in frontal lobe epilepsy. Epilepsia 2022; 63:1671-1681. [PMID: 35429174 PMCID: PMC9545860 DOI: 10.1111/epi.17260] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neuropsychological profiles are heterogeneous both across and within epilepsy syndromes, but especially in frontal lobe epilepsy (FLE), which has complex semiology and epileptogenicity. This study aimed to characterize the cognitive heterogeneity within FLE by identifying cognitive phenotypes and determining their demographic and clinical characteristics. METHOD One hundred and six patients (age 16-66; 44% female) with FLE completed comprehensive neuropsychological testing, including measures within five cognitive domains: language, attention, executive function, processing speed, and verbal/visual learning. Patients were categorized into one of four phenotypes based on the number of impaired domains. Patterns of domain impairment and clinical and demographic characteristics were examined across phenotypes. RESULTS Twenty-five percent of patients met criteria for the Generalized Phenotype (impairment in at least four domains), 20% met criteria for the Tri-Domain Phenotype (impairment in three domains), 36% met criteria for the Domain-Specific Phenotype (impairment in one or two domains), and 19% met criteria for the Intact Phenotype (no impairment). Language was the most common domain-specific impairment, followed by attention, executive function, and processing speed. In contrast, learning was the least impacted cognitive domain. The Generalized Phenotype had fewer years of education compared to the Intact Phenotype, but otherwise, there was no differentiation between phenotypes in demographic and clinical variables. However, qualitative analysis suggested that the Generalized and Tri-Domain Phenotypes had a more widespread area of epileptogenicity, whereas the Intact Phenotype most frequently had seizures limited to the lateral frontal region. SIGNIFICANCE This study identified four cognitive phenotypes in FLE that were largely indistinguishable in clinical and demographic features, aside from education and extent of epileptogenic zone. These findings enhance our appreciation of the cognitive heterogeneity within FLE and provide additional support for the development and use of cognitive taxonomies in epilepsy.
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Affiliation(s)
- Kayela Arrotta
- Epilepsy CenterNeurological InstituteCleveland ClinicClevelandOhioUSA
- Department of NeurologyNeurological InstituteCleveland ClinicClevelandOhioUSA
| | - Anny Reyes
- San Diego Joint Doctoral Program in Clinical PsychologySan Diego State University/University of CaliforniaSan DiegoCaliforniaUSA
- Center for Multimodal Imaging and GeneticsUniversity of CaliforniaSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Erik Kaestner
- Center for Multimodal Imaging and GeneticsUniversity of CaliforniaSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Carrie R. McDonald
- San Diego Joint Doctoral Program in Clinical PsychologySan Diego State University/University of CaliforniaSan DiegoCaliforniaUSA
- Center for Multimodal Imaging and GeneticsUniversity of CaliforniaSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Bruce P. Hermann
- Department of NeurologySchool of Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - William B. Barr
- Department of NeurologyNYU Grossman School of MedicineNew York CityNew YorkUSA
| | - Nehaw Sarmey
- Department of NeurosurgeryNeurological InstituteCleveland ClinicClevelandOhioUSA
| | - Swetha Sundar
- Department of NeurosurgeryNeurological InstituteCleveland ClinicClevelandOhioUSA
| | - Efstathios Kondylis
- Department of NeurosurgeryNeurological InstituteCleveland ClinicClevelandOhioUSA
| | - Imad Najm
- Epilepsy CenterNeurological InstituteCleveland ClinicClevelandOhioUSA
- Department of NeurologyNeurological InstituteCleveland ClinicClevelandOhioUSA
| | - William Bingaman
- Epilepsy CenterNeurological InstituteCleveland ClinicClevelandOhioUSA
- Department of NeurosurgeryNeurological InstituteCleveland ClinicClevelandOhioUSA
| | - Robyn M. Busch
- Epilepsy CenterNeurological InstituteCleveland ClinicClevelandOhioUSA
- Department of NeurologyNeurological InstituteCleveland ClinicClevelandOhioUSA
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Exploring the Semantic Structure of WMS-IV Verbal Paired Associates using the Hub-and-Spoke Model. J Int Neuropsychol Soc 2022; 28:494-502. [PMID: 34024287 DOI: 10.1017/s1355617721000709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study aimed to identify a well-fitting and theoretically justified item-level latent factor structure for the Wechsler Memory Scales (WMS)-IV verbal paired associates (VerbalPA) subtest to facilitate the ease and accuracy of score interpretations for patients with lateralized temporal lobe epilepsy (TLE). METHODS Archival data were used from 250 heterogeneous neurosciences patients who were administered the WMS-IV as part of a standard neuropsychological assessment. Three theoretically motivated models for the latent structure of VerbalPA were tested using confirmatory factor analysis. The first model, based on cognitive principles of semantic processing from hub-and-spoke theory, tested whether performance is related to specific semantic features of target words. The second, motivated by the Cattell-Horn-Carroll (CHC) model of cognitive abilities, investigated whether the associative properties of items influence performance. A third, Hybrid model tested whether performance is related to both semantic and associative properties of items. The best-fitting model was tested for diagnostic group effects contrasting the heterogeneous neuroscience patients with subsets of left and right TLE (n = 51, n = 26, respectively) patients. RESULTS The Hybrid model was found to have the best fit. Patients with left TLE scored significantly less well than the heterogeneous neurosciences sample on selected semantic factor scores, although the effect size was small. CONCLUSIONS Future editions of the WMS may consider implementing a semantic scoring structure for the VerbalPA to facilitate test score interpretation. Additionally, these results suggest that principles of hub-and-spoke theory may be integrated into CHC cognitive ability taxonomy.
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Rayner G, Antoniou M, Jackson G, Tailby C. Compromised future thinking: another cognitive cost of temporal lobe epilepsy. Brain Commun 2022; 4:fcac062. [PMID: 35356031 PMCID: PMC8963290 DOI: 10.1093/braincomms/fcac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
The ability to mentally travel forward through time allows humans to envisage a diverse array of possible events taking place in the future, helping us to choose which pathway to take in life. In epilepsy, we assume that patients use this cognitive ability when deciding between various treatment options, but this assumption has not been robustly tested. The temporal lobes are key contributors to this 'future thinking' and its building blocks include cognitive functions commonly impaired in temporal lobe epilepsy such as memory and language, giving rise to a hypothesis that 'future thinking' is impaired in this patient cohort. Participants were 68 adults: 37 with neurosurgically-naïve, unilateral temporal lobe epilepsy (51% right lateralized) and 31 healthy controls of similar age, sex and intellectual ability to the participants with epilepsy. Future thinking was measured using an imagined experiences task validated in other neurological populations. Tools well-established in temporal lobe epilepsy were used to measure potential cognitive correlates of future thinking. Analysis of variance revealed significantly impoverished future thinking in both left and right temporal lobe epilepsy relative to controls (P = 0.001, η p 2=0.206), with no difference between temporal lobe epilepsy groups (P > 0.05). Future thinking deficits in left temporal lobe epilepsy were paralleled by deficits in scene construction, whereas impoverished future thinking in right temporal lobe epilepsy occurred in the setting of intact scene construction. Deficits in future thinking were associated with reductions in lexical access and episodic autobiographic memory in both epilepsy groups. In sum, future thinking is compromised in both left and right temporal lobe epilepsy. The deficit in left temporal lobe epilepsy is largely explainable by dysfunction in verbal cognitive processes including scene construction. While the basis of the deficits observed with right temporal foci shares features with that of left temporal lobe epilepsy, their intact scene construction raises questions about the role of the left and right temporal lobes in future thinking and scene construction and the relationship between these two constructs, including whether right temporal lobe might play a specific role in future thinking in terms of creative processing. Clinicians should take impaired future thinking into account when counselling temporal lobe epilepsy patients about various treatment options, as they may struggle to vividly imagine what different outcomes might mean for their future selves.
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Affiliation(s)
- Genevieve Rayner
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, VIC, Australia
| | - Mariana Antoniou
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Graeme Jackson
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Chris Tailby
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, VIC, Australia
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31
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Schraegle WA, Tillman R, Ailion A, Babajani-Feremi A, Titus JB, DeLeon RC, Clarke D, Hermann BP. Behavioral phenotypes of pediatric temporal lobe epilepsy. Epilepsia 2022; 63:1177-1188. [PMID: 35174484 DOI: 10.1111/epi.17193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A broad spectrum of emotional-behavioral problems have been reported in pediatric temporal lobe epilepsy (TLE), but with considerable variability in their presence and nature of expression, which hampers precise identification and treatment. The present study aimed to empirically identify latent patterns or behavioral phenotypes and their correlates. METHODS Data included parental ratings of emotional-behavioral status on the Behavior Assessment System for Children, 2nd Edition (BASC-2) of 81 children (mean age = 11.79, standard deviation [SD] = 3.93) with TLE. The nine clinical subscales were subjected to unsupervised machine learning to identify behavioral subgroups. To explore concurrent validity and the underlying composition of the identified clusters, we examined demographic factors, seizure characteristics, psychosocial factors, neuropsychological performance, psychiatric status, and health-related quality of life (HRQoL). RESULTS Three behavioral phenotypes were identified, which included no behavioral concerns (Cluster 1, 43% of sample), externalizing problems (Cluster 2, 41% of sample), and internalizing problems (Cluster 3, 16% of sample). Behavioral phenotypes were characterized by important differences across clinical seizure variables, psychosocial/familial factors, everyday executive functioning, and HRQoL. Cluster 2 was associated with younger child age, lower maternal education, and higher rate of single-parent households. Cluster 3 was associated with older age at epilepsy onset and higher rates of hippocampal sclerosis and parental psychiatric history. Both Cluster 2 and 3 demonstrated elevated family stress. Concurrent validity was demonstrated through the association of psychiatric (i.e., rate of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) disorders and psychotropic medication) and parent-rated HRQoL variables. SIGNIFICANCE Youth with TLE present with three distinct behavioral phenotypes that correspond with important clinical and sociodemographic markers. The current findings demonstrate the variability of behavioral presentations in youth with TLE and provide a preliminary framework for screening and targeting intervention to enhance support for youth with TLE and their families.
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Affiliation(s)
- William A Schraegle
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Rachael Tillman
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Alyssa Ailion
- Department of Neurology and Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Abbas Babajani-Feremi
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Jeffrey B Titus
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA
| | - Rosario C DeLeon
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Dave Clarke
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Guo R, Zhao Y, Jin H, Jian J, Wang H, Jin S, Ren H. Abnormal hubs in global network as neuroimaging biomarker in right temporal lobe epilepsy at rest. Front Psychiatry 2022; 13:981728. [PMID: 35966487 PMCID: PMC9363580 DOI: 10.3389/fpsyt.2022.981728] [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: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
While abnormal neuroimaging features have been reported in patients suffering from right temporal lobe epilepsy (rTLE), the value of altered degree centrality (DC) as a diagnostic biomarker for rTLE has yet to be established. As such, the present study was designed to examine DC abnormalities in rTLE patients in order to gauge the diagnostic utility of these neuroimaging features. In total, 68 patients with rTLE and 73 healthy controls (HCs) participated in this study. Imaging data were analyzed using DC and receiver operating characteristic (ROC) methods. Ultimately, rTLE patients were found to exhibit reduced right caudate DC and increased left middle temporal gyrus, superior parietal gyrus, superior frontal gyrus, right precuneus, frontal gyrus Inferior gyrus, middle-superior frontal gyrus, and inferior parietal gyrus DC relative to HC. ROC analyses indicated that DC values in the right caudate nucleus could be used to differentiate between rTLE patients and HCs with a high degree of sensitivity and specificity. Together, these results thus suggest that rTLE is associated with abnormal DC values in the right caudate nucleus, underscoring the relevance of further studies of the underlying pathophysiology of this debilitating condition.
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Affiliation(s)
- Ruimin Guo
- Department of Medical Imaging, Tianyou Hospital of Wuhan University of Science and Technology, Wuhan, China.,Key Laboratory of Occupational Hazards and Identification, Wuhan University of Science and Technology, Wuhan, China
| | - Yunfei Zhao
- Department of Neurosurgery, Tianyou Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Honghua Jin
- Department of Medical Imaging, Tianyou Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Jihua Jian
- Department of Medical Imaging, Tianyou Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Haibo Wang
- Department of Medical Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shengxi Jin
- Department of Neurosurgery, Tianyou Hospital of Wuhan University of Science and Technology, Wuhan, China
| | - Hongwei Ren
- Department of Medical Imaging, Tianyou Hospital of Wuhan University of Science and Technology, Wuhan, China
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Samson S, Denos M. Neuropsychology of temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:519-529. [PMID: 35964990 DOI: 10.1016/b978-0-12-823493-8.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter focuses on the neuropsychology of adults with temporal lobe epilepsy (TLE). First, a thorough description of the brain-behavior relationship characterizing focal TLE with and without hippocampal sclerosis is presented. Then, the aim and the specificity of the NPA in the care of epilepsy are described. Considering the high frequency of medically intractable TLE that can be treated by surgery, an assessment carried out in the context of pre- and postoperative evaluation is presented and discussed in light of insights from functional neuroimaging findings. Finally, we propose concluding remarks about the place of neuropsychology in the care of epilepsy in improving our understanding of the cognitive and emotional phenotypes associated with TLE.
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Affiliation(s)
- Séverine Samson
- Department of Psychology, University of Lille, Lille, France; Epilepsy Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France.
| | - Marisa Denos
- Rehabilitation Unit, Neurosciences Department, Hôpital de la Pitié-Salpêtrière, Paris, France
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34
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Bolocan M, Iacob CI, Avram E. Working Memory and Language Contribution to Verbal Learning and Memory in Drug-Resistant Unilateral Focal Temporal Lobe Epilepsy. Front Neurol 2021; 12:780086. [PMID: 34956061 PMCID: PMC8692669 DOI: 10.3389/fneur.2021.780086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to investigate the working memory (WM) and language separate contributions to verbal learning and memory in patients with unilateral drug-resistant temporal lobe epilepsy (drTLE); additionally, we explored the mediating role of WM on the relationship between the number of antiepileptic drugs (AEDs) and short-term verbal memory. We retrospectively enrolled 70 patients with left (LTLE; n = 44) and right (RTLE; n = 26) drTLE. About 40 similar (age and education) healthy controls were used to determine impairments of groups at WM, language (naming and verbal fluency), and verbal learning and memory (five trials list-learning, story memory-immediate recall). To disentangle the effect of learning from the short-term memory, we separately analyzed performances at the first trial, last trial, and delayed-recall list-learning measures, in addition to the total learning capacity (the sum of the five trials). Correlation and regression analyses were used to assess the contribution of potential predictors while controlling for main clinical and demographic variables, and ascertain the mediating role of WM. All patients were impaired at WM and story memory, whereas only LTLE showed language and verbal learning deficits. In RTLE, language was the unique predictor for the most verbal learning performances, whereas WM predicted the results at story memory. In LTLE, WM was the sole predictor for short-term verbal learning (list-learning capacity; trial 1) and mediated the interaction between AED number and the performance at these measures, whereas language predicted the delayed-recall. Finally, WM confounded the performance at short-term memory in both groups, although at different measures. WM is impaired in drTLE and contributes to verbal memory and learning deficits in addition to language, mediating the relationship between AED number and short-term verbal memory in LTLE. Clinicians should consider this overlap when interpreting poor performance at verbal learning and memory in drTLE.
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Affiliation(s)
- Monica Bolocan
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Claudia I Iacob
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Eugen Avram
- Laboratory of Health Psychology and Clinical Neuropsychology, Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
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35
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Missing links: The functional unification of language and memory (L∪M). Neurosci Biobehav Rev 2021; 133:104489. [PMID: 34929226 DOI: 10.1016/j.neubiorev.2021.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/14/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
The field of neurocognition is currently undergoing a significant change of perspective. Traditional neurocognitive models evolved into an integrative and dynamic vision of cognitive functioning. Dynamic integration assumes an interaction between cognitive domains traditionally considered to be distinct. Language and declarative memory are regarded as separate functions supported by different neural systems. However, they also share anatomical structures (notably, the inferior frontal gyrus, the supplementary motor area, the superior and middle temporal gyrus, and the hippocampal complex) and cognitive processes (such as semantic and working memory) that merge to endorse our quintessential daily lives. We propose a new model, "L∪M" (i.e., Language/union/Memory), that considers these two functions interactively. We fractionated language and declarative memory into three fundamental dimensions or systems ("Receiver-Transmitter", "Controller-Manager" and "Transformer-Associative" Systems), that communicate reciprocally. We formalized their interactions at the brain level with a connectivity-based approach. This new taxonomy overcomes the modular view of cognitive functioning and reconciles functional specialization with plasticity in neurological disorders.
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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: 65] [Impact Index Per Article: 21.7] [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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Lee HM, Fadaie F, Gill R, Caldairou B, Sziklas V, Crane J, Hong SJ, Bernhardt BC, Bernasconi A, Bernasconi N. Decomposing MRI phenotypic heterogeneity in epilepsy: a step towards personalized classification. Brain 2021; 145:897-908. [PMID: 34849619 DOI: 10.1093/brain/awab425] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
In drug-resistant temporal lobe epilepsy (TLE), precise predictions of drug response, surgical outcome, and cognitive dysfunction at an individual level remain challenging. A possible explanation may lie in the dominant "one-size-fits-all" group-level analytical approaches that does not allow parsing inter-individual variations along the disease spectrum. Conversely, analyzing inter-patient heterogeneity is increasingly recognized as a step towards person-centered care. Here, we utilized unsupervised machine learning to estimate latent relations (or disease factors) from 3 T multimodal MRI features (cortical thickness, hippocampal volume, FLAIR, T1/FLAIR, diffusion parameters) representing whole-brain patterns of structural pathology in 82 TLE patients. We assessed the specificity of our approach against age- and sex-matched healthy individuals and a cohort of frontal lobe epilepsy patients with histologically-verified focal cortical dysplasia. We identified four latent disease factors variably co-expressed within each patient and characterized by ipsilateral hippocampal microstructural alterations, loss of myelin and atrophy (Factor-1), bilateral paralimbic and hippocampal gliosis (Factor-2), bilateral neocortical atrophy (Factor-3), bilateral white matter microstructural alterations (Factor-4). Bootstrap analysis and parameter variations supported high stability and robustness of these factors. Moreover, they were not expressed in healthy controls and only negligibly in disease controls, supporting specificity. Supervised classifiers trained on latent disease factors could predict patient-specific drug-response in 76 ± 3% and postsurgical seizure outcome in 88 ± 2%, outperforming classifiers that did not operate on latent factor information. Latent factor models predicted inter-patient variability in cognitive dysfunction (verbal IQ: r = 0.40 ± 0.03; memory: r = 0.35 ± 0.03; sequential motor tapping: r = 0.36 ± 0.04), again outperforming baseline learners. Data-driven analysis of disease factors provides a novel appraisal of the continuum of interindividual variability, which is likely determined by multiple interacting pathological processes. Incorporating interindividual variability is likely to improve clinical prognostics.
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Affiliation(s)
- Hyo Min Lee
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Fatemeh Fadaie
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Ravnoor Gill
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Benoit Caldairou
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Viviane Sziklas
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Joelle Crane
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Seok-Jun Hong
- Center for Neuroscience Imaging Research Institute for Basic Science, Department of Biomedical Engineering, Sungkyunkwan University Suwon South Korea
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Lab, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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38
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Roger E, Torlay L, Banjac S, Mosca C, Minotti L, Kahane P, Baciu M. Prediction of the clinical and naming status after anterior temporal lobe resection in patients with epilepsy. Epilepsy Behav 2021; 124:108357. [PMID: 34717247 DOI: 10.1016/j.yebeh.2021.108357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 01/20/2023]
Abstract
By assessing the cognitive capital, neuropsychological evaluation (NPE) plays a vital role in the perioperative workup of patients with refractory focal epilepsy. In this retrospective study, we used cutting-edge statistical approaches to examine a group of 47 patients with refractory temporal lobe epilepsy (TLE), who underwent standard anterior temporal lobectomy (ATL). Our objective was to determine whether NPE may represent a robust predictor of the postoperative status, two years after surgery. Specifically, based on pre- and postsurgical neuropsychological data, we estimated the sensitivity of cognitive indicators to predict and to disentangle phenotypes associated with more or less favorable outcomes. Engel (ENG) scores were used to assess clinical outcome, and picture naming (NAM) performance to estimate naming status. Two methods were applied: (a) machine learning (ML) to explore cognitive sensitivity to postoperative outcomes; and (b) graph theory (GT) to assess network properties reflecting favorable vs. less favorable phenotypes after surgery. Specific neuropsychological indices assessing language, memory, and executive functions can globally predict outcomes. Interestingly, preoperative cognitive networks associated with poor postsurgical outcome already exhibit an atypical, highly modular and less densely interconnected configuration. We provide statistical and clinical tools to anticipate the condition after surgery and achieve a more personalized clinical management. Our results also shed light on possible mechanisms put in place for cognitive adaptation after acute injury of central nervous system in relation with surgery.
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Affiliation(s)
- Elise Roger
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France.
| | - Laurent Torlay
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - Sonja Banjac
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
| | - Chrystèle Mosca
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Lorella Minotti
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Philippe Kahane
- Univ. Grenoble Alpes, Grenoble Institute of Neuroscience, Synchronisation et modulation des réseaux neuronaux dans l'épilepsie' & Neurology Department, 38000 Grenoble, France
| | - Monica Baciu
- Univ. Grenoble Alpes, CNRS LPNC UMR 5105, 38000 Grenoble, France
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39
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Mikula B, Lencsés A, Borbély C, Demeter G. Emotion recognition and theory of mind after temporal lobe epilepsy surgery: A systematic review. Seizure 2021; 93:63-74. [PMID: 34710833 DOI: 10.1016/j.seizure.2021.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 01/14/2023] Open
Abstract
In order to navigate in our complex social world successfully, it is crucial to maintain and practice cognitive skills that are dedicated to adaptive social functioning. Emerging evidence suggests that besides deficits in declarative memory, executive functions, and language, impairments in social cognition (SC, e.g., emotion recognition, theory of mind) are also present in temporal lobe epilepsy (TLE). The organic and psycho-social consequences of epilepsy surgery might have additional implications regarding this deficit. Here we qualitatively synthesize longitudinal and cross-sectional findings on SC after TLE surgery. A literature search using PubMed and Scopus identified 275 potential articles. Studies were eligible if they (1) included patients with a diagnosis of TLE, (2) included a healthy comparison group, (3) reported original research, (4) were published in peer-reviewed journals and in English language, (5) reported the intervention of epilepsy surgery. Articles that (1) were case studies, (2) did not focus on SC abilities, (3) used interviews or self-report questionnaires to examine SC functions were excluded. A total of 16 original studies assessing emotion recognition (ER) and/or theory of mind (ToM) matched our criteria. The literature suggests that neither ER nor ToM abilities change after surgery: post-surgery patients show similar impairment patterns to pre-surgery patients. Nevertheless, individual improvement or decline could be masked by group comparisons and results should be considered in light of methodological heterogeneity among studies.
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Affiliation(s)
- Bernadett Mikula
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Anita Lencsés
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Csaba Borbély
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Gyula Demeter
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary; Rehabilitation Department of Brain Injuries, National Institute of Medical Rehabilitation, Budapest, Hungary
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40
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Gleichgerrcht E, Kellermann TS, Drane DL, Keller SS, McDonald CR, Rorden C, Jensen J, Weber B, Davis KA, Kuzniecky R, Bonilha L. Cortical disconnection in temporal lobe epilepsy. Epilepsy Behav 2021; 123:108231. [PMID: 34371289 PMCID: PMC8478816 DOI: 10.1016/j.yebeh.2021.108231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022]
Abstract
A critical concept in neurology is cortical disconnection, in which seemingly normal gray matter can have reduced function due to loss of white matter (WM) connections. White matter damage has been extensively described in temporal lobe epilepsy (TLE), but the anatomical distribution of cortical disconnection in TLE is not fully characterized. Here, we studied 221 participants (64 left-TLE, 55 right-TLE, 102 controls) from three different epilepsy treatment centers. We employed a group connectometry diffusion imaging tractography approach to identify WM fibers with reduced integrity in TLE. We then assessed the anatomical distribution of the gray matter endpoint projections of abnormal fibers to map the anatomical pattern of disconnections. As expected, left- and right-TLE were associated with multiple WM pathways with reduced integrity, which were associated with extensive cortical disconnection involving predominantly limbic structures. Controlling for medial temporal gray matter atrophy, cortical disconnection of the left cingulum and the thalamus as well as disconnection of the bilateral putamen and the amygdala was associated with lower verbal memory immediate recall. In conclusion, our results support that cortical disconnection is an underappreciated but pervasive phenomenon in TLE, and cortical disconnection of limbic structures beyond the medial temporal regions is related to verbal memory performance.
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Affiliation(s)
- Ezequiel Gleichgerrcht
- Medical University of South Carolina, Charleston, South Carolina, USA
- Corresponding Authors: Ezequiel Gleichgerrcht and Leonardo Bonilha, Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, Phone: 843-876-68622,
| | | | - Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Simon S. Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Carrie R. McDonald
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Chris Rorden
- Department of Psychology & McCausland Center for Brain Imaging, University of South Carolina, Columbia, SC, USA
| | - Jens Jensen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Germany
| | - Kathryn A. Davis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben Kuzniecky
- Department of Neurology, Hofstra University / Northwell, NY, USA
| | - Leonardo Bonilha
- Medical University of South Carolina, Charleston, South Carolina, USA
- Corresponding Authors: Ezequiel Gleichgerrcht and Leonardo Bonilha, Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, Phone: 843-876-68622,
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The Impact of Right Temporal Lobe Epilepsy On Nonverbal Memory: Meta-regression of Stimulus- and Task-related Moderators. Neuropsychol Rev 2021; 32:537-557. [PMID: 34559363 DOI: 10.1007/s11065-021-09514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 05/24/2021] [Indexed: 11/08/2022]
Abstract
Nonverbal memory tests have great potential value for detecting the impact of lateralized pathology and predicting the risk of memory loss following right temporal lobe resection (TLR) for temporal lobe epilepsy (TLE) patients, but this potential has not been realized. Previous reviews suggest that stimulus type moderates the capacity of nonverbal memory tests to detect right-lateralized pathology (i.e., faces > designs), but the roles of other task-related factors have not been systematically explored. We address these limitations using mixed model meta-regression (k = 158) of right-lateralization effects (right worse than left TLE) testing the moderating effects of: 1) stimulus type (designs, faces, spatial), 2) learning format (single trial, repeated trials), 3) testing delay (immediate or long delay), and 4) testing format (recall, recognition) for three patient scenarios: 1) presurgical, 2) postsurgical, and 3) postsurgical change. Stimulus type significantly moderated the size of the right-lateralization effect (faces > designs) for postsurgical patients, test format moderated the size of the right-lateralization effect for presurgical-postsurgical change (recognition > recall) but learning format and test delay had no right-lateralization effect for either sample. For presurgical patients, none of the task-related factors significantly increased right-lateralization effects. This comprehensive review reveals the value of recognition testing in gauging the risk of nonverbal memory decline.
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42
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Doherty C, Kinzy TG, Ferguson L, Altemus J, Hermann BP, Eng C, Najm I, Busch RM. The role of genetic polymorphisms in executive functioning performance in temporal lobe epilepsy. Epilepsy Behav 2021; 121:108088. [PMID: 34102472 PMCID: PMC8238870 DOI: 10.1016/j.yebeh.2021.108088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the role of several genetic polymorphisms (APOE ε4, BDNF Met, and COMT Val) in executive functioning performance in patients with pharmacoresistant temporal lobe epilepsy (TLE). METHODS Ninety-three adults (51 female, mean age = 39 years) with TLE completed executive functioning measures as part of a comprehensive preoperative neuropsychological evaluation, including Trail Making Test (Part B), Wisconsin Card Sorting Test (Conceptual Level Responses and Perseverative Errors), Color Word Interference from the Delis Kaplan Executive Function System, and measures of phonemic and semantic verbal fluency. Genotyping of the APOE, BDNF, and COMT genes was conducted using DNA extracted from peripheral blood or brain tissue (from epilepsy surgery). RESULTS After adjustment for general cognitive ability, COMT Val carriers showed poorer performance on semantic verbal fluency and color word interference than non-carriers, and BDNF Met carriers showed poorer performance on phonemic verbal fluency than those without a Met allele. SIGNIFICANCE Results suggest that COMT and BDNF polymorphisms are associated with performance on several EF measures in patients with TLE, including tasks assessing verbal fluency and response inhibition and account for up to 16% of the variance in test performance. The APOE polymorphism was not significantly associated with any of the executive function measures analyzed.
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Affiliation(s)
- Christine Doherty
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
| | - Tyler G Kinzy
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Ferguson
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Jessica Altemus
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin, Madison, WI, USA.
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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43
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Hermann BP, Struck AF, Dabbs K, Seidenberg M, Jones JE. Behavioral phenotypes of temporal lobe epilepsy. Epilepsia Open 2021; 6:369-380. [PMID: 34033251 PMCID: PMC8166791 DOI: 10.1002/epi4.12488] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/21/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To identity phenotypes of self‐reported symptoms of psychopathology and their correlates in patients with temporal lobe epilepsy (TLE). Method 96 patients with TLE and 82 controls were administered the Symptom Checklist 90‐Revised (SCL‐90‐R) to characterize emotional‐behavioral status. The nine symptom scales of the SCL‐90‐R were analyzed by unsupervised machine learning techniques to identify latent TLE groups. Identified clusters were contrasted to controls to characterize their association with sociodemographic, clinical epilepsy, neuropsychological, psychiatric, and neuroimaging factors. Results TLE patients as a group exhibited significantly higher (abnormal) scores across all SCL‐90‐R scales compared to controls. However, cluster analysis identified three latent groups: (1) unimpaired with no scale elevations compared to controls (Cluster 1, 42% of TLE patients), (2) mild‐to‐moderate symptomatology characterized by significant elevations across several SCL‐90‐R scales compared to controls (Cluster 2, 35% of TLE patients), and (3) marked symptomatology with significant elevations across all scales compared to controls and the other TLE phenotype groups (Cluster 3, 23% of TLE patients). There were significant associations between cluster membership and demographic (education), clinical epilepsy (perceived seizure severity, bitemporal lobe seizure onset), and neuropsychological status (intelligence, memory, executive function), but with minimal structural neuroimaging correlates. Concurrent validity of the behavioral phenotype grouping was demonstrated through association with psychiatric (current and lifetime‐to‐date DSM IV Axis 1 disorders and current treatment) and quality‐of‐life variables. Significance Symptoms of psychopathology in patients with TLE are characterized by a series of discrete phenotypes with accompanying sociodemographic, cognitive, and clinical correlates. Similar to cognition in TLE, machine learning approaches suggest a developing taxonomy of the comorbidities of epilepsy.
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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.,Department of Neurology, William S Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mike Seidenberg
- Department of Psychology, Rosalind Franklin University of Science and Medicine, North Chicago, IL, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Garcia-Ramos C, Struck AF, Cook C, Prabhakaran V, Nair V, Maganti R, Binder JR, Meyerand M, Conant LL, Hermann B. Network topology of the cognitive phenotypes of temporal lobe epilepsy. Cortex 2021; 141:55-65. [PMID: 34029858 DOI: 10.1016/j.cortex.2021.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/04/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The neuropsychological complications of temporal lobe epilepsy are characterized by a spectrum of reproducible cognitive phenotypes that vary in the presence, type and degree of impairment. The nature of the disruptions to the neuropsychological networks that underlie these phenotypes remain to be characterized and represent the subject of this investigation. METHODS Participants included 30 healthy controls and 104 patients with temporal lobe epilepsy who fell into three cognitive phenotypes (intact, focal impairment, generalized impairment). Eighteen neuropsychological measures representing multiple cognitive domains (language, memory, executive function, visuoperception, motor speed) were examined by graph theory techniques within the control and each epilepsy cognitive phenotype group to characterize their global and local network properties. RESULTS Across the control and epilepsy cognitive phenotype groups (intact to focal to generalized impairment), there was: 1) an orderly breakdown in the positive manifold reflected by a stepwise reduction of positive associations among the neuropsychological tests, 2) stepwise abnormal increases in global measures including the normalized clustering coefficient and modularity index, 3) stepwise abnormal decreases in normalized global efficiency, 4) a community structure demonstrating well organized modules within the control group while each epilepsy group showed deviations from controls, and 5) lower strength, compared to controls, across 8 nodes in the focal and generalized impairment groups compared to only 3 nodes in the no-impairment epilepsy group, pointing to the superior integration of local connections in controls. DISCUSSION The cognitive phenotypes of temporal lobe epilepsy are characterized by orderly abnormalities in their underlying neuropsychological networks. These findings inform the network perturbations that underlie the taxonomy of cognitive abnormality in temporal lobe epilepsy and provide a model for examination of similar issues in other focal and generalized epilepsies.
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Affiliation(s)
- Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medical Physics, 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; Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Cole Cook
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Veena Nair
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rama Maganti
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marybeth Meyerand
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Struck AF, Boly M, Hwang G, Nair V, Mathis J, Nencka A, Conant LL, DeYoe EA, Ragahavan M, Prabhakaran V, Binder JR, Meyerand ME, Hermann BP. Regional and global resting-state functional MR connectivity in temporal lobe epilepsy: Results from the Epilepsy Connectome Project. Epilepsy Behav 2021; 117:107841. [PMID: 33611101 PMCID: PMC8035304 DOI: 10.1016/j.yebeh.2021.107841] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 12/28/2022]
Abstract
Temporal lobe epilepsy (TLE) has been conceptualized as focal disease with a discrete neurobiological focus and can respond well to targeted resection or ablation. In contrast, the neuro-cognitive deficits resulting from TLE can be widespread involving regions beyond the primary epileptic network. We hypothesize that this seemingly paradoxical findings can be explained by differences in connectivity between the primary epileptic region which is hyper-connected and its secondary influence on global connectome organization. This hypothesis is tested using regional and global graph theory metrics where we anticipate that regional mesial-temporal hyperconnectivity will be found and correlate with seizure frequency while global networks will be disorganized and be more closely associated with neuro-cognitive deficits. Resting-state fMRI was used to examine temporal lobe regional connectivity and global functional connectivity from 102 patients with TLE and 55 controls. Connectivity matrices were calculated for subcortical volumes and cortical parcellations. Graph theory metrics (global clustering coefficient (GCC), degree, closeness) were compared between groups and in relation to neuropsychological profiles and disease covariates using permutation testing and causal analysis. In TLE there was a decrease in GCC (p = 0.0345) associated with a worse neuropsychological profile (p = 0.0134). There was increased connectivity in the left hippocampus/amygdala (degree p = 0.0103, closeness p = 0.0104) and a decrease in connectivity in the right lateral temporal lobe (degree p = 0.0186, closeness p = 0.0122). A ratio between the hippocampus/amygdala and lateral temporal lobe-temporal lobe connectivity ratio (TLCR) revealed differences between TLE and controls for closeness (left p = 0.00149, right p = 0.0494) and for degree on left p = 0.00169; with trend on right p = 0.0567. Causal analysis suggested that "Epilepsy Activity" (seizure frequency, anti-seizure medications) was associated with increase in TLCR but not in GCC, while cognitive decline was associated with decreased GCC. These findings support the hypothesis that in TLE there is hyperconnectivity in the hippocampus/amygdala and hypoconnectivity in the lateral temporal lobe associated with "Epilepsy Activity." While, global connectome disorganization was associated with worse neuropsychological phenotype.
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Affiliation(s)
- Aaron F Struck
- University of Wisconsin-Madison, Department of Neurology, United States; William S. Middleton Veterans Administration Hospital, Madison, WI, United States.
| | - Melanie Boly
- University of Wisconsin-Madison, Department of Neurology
| | - Gyujoon Hwang
- University of Wisconsin-Madison, Department of Medical Physics
| | - Veena Nair
- University of Wisconsin-Madison, Department of Radiology
| | | | - Andrew Nencka
- Medical College of Wisconsin, Department of Radiology
| | - Lisa L Conant
- Medical College of Wisconsin, Department of Neurology
| | - Edgar A DeYoe
- Medical College of Wisconsin, Department of Radiology
| | | | | | | | - Mary E Meyerand
- University of Wisconsin-Madison, Department of Medical Physics
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DiFrancesco JC, Isella V, Licciardo D, Crivellaro C, Musarra M, Guerra L, Salvadori N, Chipi E, Calvello C, Costa C, Ferrarese C. Temporal lobe dysfunction in late-onset epilepsy of unknown origin. Epilepsy Behav 2021; 117:107839. [PMID: 33611099 DOI: 10.1016/j.yebeh.2021.107839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Epilepsy with onset in the adulthood is an increasing health problem, due to the progressive aging of the worldwide population. Whether the causes remain undetermined, the disease is defined as Late-Onset Epilepsy of Unknown origin (LOEU). The aim of this study was to evaluate the semiological, electroencephalographic, metabolic, and neuropsychological features of LOEU. METHODS We selected patients with late-onset epilepsy (LOE) (≥55 years), whose causes of the disease have been excluded with a deep clinical-instrumental characterization, including brain MRI, EEG, 18F-labeled fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and neuropsychological assessment. RESULTS Twenty-three LOEU cases were retrospectively recruited. Half presented focal-onset seizures (FOS), the others focal to bilateral tonic-clonic seizures (FBTCS). All demonstrated a mild phenotype, with no recurrence of seizures on single antiseizure treatment at prolonged follow-up. Brain MRI scans were normal in 12 patients (52.3%) and showed nonspecific gliosis or mild atrophy in ten (43.5%); hippocampal sclerosis (HS) was observed in one. In 17/23 (73.9%), the EEG showed slow and/or epileptiform activity of the temporal areas. Brain FDG-PET revealed temporal lobe hypometabolism, mostly ipsilateral to EEG abnormal activity, or multifocal temporal and extra-temporal (cortical, subcortical and subtentorial) clusters of hypometabolism. The neuropsychological analysis demonstrated three different profiles: normal (43.5%), with focal deficits (39.1%) or mild multidomain impairment (17.4%). SIGNIFICANCE Late-Onset Epilepsy of Unknown origin can present as FOS or FBTCS, both with good prognosis. The application of metabolic imaging and neurophysiology techniques in these patients points to the dysfunction of the temporal structures, whose role in the pathogenetic process of the disease remains to be clarified.
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Affiliation(s)
- Jacopo C DiFrancesco
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy.
| | - Valeria Isella
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy.
| | - Daniele Licciardo
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy
| | - Cinzia Crivellaro
- Milan Center for Neuroscience (NeuroMI), Italy; Nuclear Medicine Unit, ASST S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Monica Musarra
- Milan Center for Neuroscience (NeuroMI), Italy; Nuclear Medicine Unit, ASST S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Luca Guerra
- Milan Center for Neuroscience (NeuroMI), Italy; Nuclear Medicine Unit, ASST S. Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Nicola Salvadori
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Elena Chipi
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carmen Calvello
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Cinzia Costa
- Neurology Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carlo Ferrarese
- Department of Neurology, ASST S. Gerardo Hospital, University of Milano - Bicocca, Monza, Italy; Milan Center for Neuroscience (NeuroMI), Italy
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Norman M, Wilson SJ, Baxendale S, Barr W, Block C, Busch RM, Fernandez A, Hessen E, Loring DW, McDonald CR, Hermann BP. Addressing neuropsychological diagnostics in adults with epilepsy: Introducing the International Classification of Cognitive Disorders in Epilepsy: The IC CODE Initiative. Epilepsia Open 2021; 6:266-275. [PMID: 34033259 PMCID: PMC8166800 DOI: 10.1002/epi4.12478] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 01/03/2023] Open
Abstract
This paper addresses the absence of an international diagnostic taxonomy for cognitive disorders in patients with epilepsy. Initiated through the 2020 Memorandum of Understanding between the International League Against Epilepsy and the International Neuropsychological Society, neuropsychological representatives from both organizations met to address the problem and consequences of the absence of an international diagnostic taxonomy for cognitive disorders in epilepsy, overview potential solutions, and propose specific solutions going forward. The group concluded that a classification of cognitive disorders in epilepsy, including an overall taxonomy and associated operational criteria, was clearly lacking and sorely needed. This paper reviews the advantages and shortcomings of four existing cognitive diagnostic approaches, including taxonomies derived from the US National Neuropsychology Network, DSM-V Neurocognitive Disorders, the Mild Cognitive Impairment classification from the aging/preclinical dementia literature, and the Research Domain Criteria Initiative. We propose a framework to develop a consensus-based classification system for cognitive disorders in epilepsy that will be international in scope and be applicable for clinical practice and research globally and introduce the International Classification of Cognitive Disorders in Epilepsy (IC-CODE) project.
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Affiliation(s)
- Marc Norman
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Executive Director of the International Neuropsychological Society
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia.,Chair, Diagnostic Methods Commission, International League Against Epilepsy
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - William Barr
- Departments of Neurology and Psychiatry, NYU-Langone Medical Center and NYU Grossman School of Medicine, New York, NY, USA
| | - Cady Block
- Department of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Robyn M Busch
- Epilepsy Center and Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Alberto Fernandez
- Neuropsychology Department, Universidad Nacional de Córdoba & Universidad Católica de Córdoba, Córdoba, Argentina
| | - Erik Hessen
- Departments of Psychology and Neurology, University of Oslo and Akershus University Hospital, Oslo, Norway.,Chair of the European Federation of Psychological Association's Standing Committee on Clinical Neuropsychology
| | - David W Loring
- Department of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R McDonald
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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48
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Reyes A, Kaestner E, Edmonds EC, Christina Macari A, Wang ZI, Drane DL, Punia V, Busch RM, Hermann BP, McDonald CR. Diagnosing cognitive disorders in older adults with epilepsy. Epilepsia 2020; 62:460-471. [PMID: 33258159 DOI: 10.1111/epi.16780] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To characterize the nature and prevalence of cognitive disorders in older adults with temporal lobe epilepsy (TLE) and compare their cognitive profiles to patients with amnestic mild cognitive impairment (ie, aMCI). METHODS Seventy-one older patients with TLE, 77 aMCI, and 69 normal aging controls (NACs), all 55-80 years of age, completed neuropsychological measures of memory, language, executive function, and processing speed. An actuarial neuropsychological method designed to diagnose MCI was applied to individual patients to identify older adults with TLE who met diagnostic criteria for MCI (TLE-MCI). A linear classifier was performed to evaluate how well the diagnostic criteria differentiated patients with TLE-MCI from aMCI. In TLE, the contribution of epilepsy-related and vascular risk factors to cognitive impairment was evaluated using multiple regression. RESULTS Forty-three TLE patients (60%) met criteria for TLE-MCI, demonstrating marked deficits in both memory and language. When patients were analyzed according to age at seizure onset, 63% of those with an early onset (<50 years) versus 56% of those with late onset (≥ 50 years) met criteria for TLE-MCI. A classification model between TLE-MCI and aMCI correctly classified 81.1% (90.6% specificity, 61.3% sensitivity) of the cohort based on neuropsychological scores. Whereas TLE-MCI showed greater deficits in language relative to aMCI, patients with aMCI showed greater rapid forgetting on memory measures. Both epilepsy-related risk factors and the presence of leukoaraiosis on MRI contributed to impairment profiles in TLE-MCI. SIGNIFICANCE Cognitive impairment is a common comorbidity in epilepsy and it presents in a substantial number of older adults with TLE. Although the underlying etiologies are unknown in many patients, the TLE-MCI phenotype may be secondary to an accumulation of epilepsy and vascular risk factors, signal the onset of a neurodegenerative disease, or represent a combination of factors.
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Affiliation(s)
- Anny Reyes
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Emily C Edmonds
- Department of Psychiatry, University of California, San Diego, CA, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Anna Christina Macari
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Zhong Irene Wang
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel L Drane
- Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, University of Washington, Seattle, WA, USA
| | - Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
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49
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Larivière S, Bernasconi A, Bernasconi N, Bernhardt BC. Connectome biomarkers of drug-resistant epilepsy. Epilepsia 2020; 62:6-24. [PMID: 33236784 DOI: 10.1111/epi.16753] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
Abstract
Drug-resistant epilepsy (DRE) considerably affects patient health, cognition, and well-being, and disproportionally contributes to the overall burden of epilepsy. The most common DRE syndromes are temporal lobe epilepsy related to mesiotemporal sclerosis and extratemporal epilepsy related to cortical malformations. Both syndromes have been traditionally considered as "focal," and most patients benefit from brain surgery for long-term seizure control. However, increasing evidence indicates that many DRE patients also present with widespread structural and functional network disruptions. These anomalies have been suggested to relate to cognitive impairment and prognosis, highlighting their importance for patient management. The advent of multimodal neuroimaging and formal methods to quantify complex systems has offered unprecedented ability to profile structural and functional brain networks in DRE patients. Here, we performed a systematic review on existing DRE network biomarker candidates and their contribution to three key application areas: (1) modeling of cognitive impairments, (2) localization of the surgical target, and (3) prediction of clinical and cognitive outcomes after surgery. Although network biomarkers hold promise for a range of clinical applications, translation of neuroimaging biomarkers to the patient's bedside has been challenged by a lack of clinical and prospective studies. We therefore close by highlighting conceptual and methodological strategies to improve the evaluation and accessibility of network biomarkers, and ultimately guide clinically actionable decisions.
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Affiliation(s)
- Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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50
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The association of cognitive phenotypes with postoperative outcomes after epilepsy surgery in patients with temporal lobe epilepsy. Epilepsy Behav 2020; 112:107386. [PMID: 32911298 DOI: 10.1016/j.yebeh.2020.107386] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The concept of cognitive phenotypes has been developed to categorize the heterogeneity of neuropsychological profiles in patients with temporal lobe epilepsy (TLE). This study examines the utility of cognitive phenotypes derived from clinical criteria in the prediction of postoperative outcomes. METHODS Scores from 9 standardized neuropsychological tests were used to sample preoperative performance in 4 core domains (intellectual, memory, language, & executive function) in 445 patients with TLE (206 right: 236 left). Patients were grouped into 3 clinical phenotypes using clinical criteria: 1. intact cognition, 2. isolated memory and/or language impairment, and 3. widespread impairment. Patients who did not meet the criteria for these phenotypes were characterized as having a mixed profile phenotype. RESULTS Approximately half of the sample had intact cognitive function, with one-quarter demonstrating isolated impairments in language and memory function. The remainder demonstrated widespread impairment or a mixed pattern of cognitive impairments. The clinically derived cognitive phenotypes were associated with demographic and clinical characteristics. Patients with widespread cognitive impairments had an earlier onset of seizures than those with other cognitive phenotypes. They also reported higher levels of depression. Higher levels of anxiety were reported in those with isolated memory/language impairments. Phenotypes were not associated with postoperative seizure outcome or postoperative declines in verbal memory or language function, but an intact phenotype was associated with a greater risk of decline in visual learning than right-sided surgery. CONCLUSIONS Distinct cognitive phenotypes in TLE can be identified using clinical criteria and may reflect neurodevelopmental influences and mood in addition to progression of the disease. Phenotype may be a more powerful predictor of postoperative decline in visual memory than laterality of surgery.
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