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Warsi NM, Wong SM, Suresh H, Arski ON, Yan H, Ebden M, Kerr E, Smith ML, Ochi A, Otsubo H, Sharma R, Jain P, Donner EJ, Snead OC, Ibrahim GM. Interictal discharges delay target-directed eye movements and impair attentional set-shifting in children with epilepsy. Epilepsia 2022; 63:2571-2582. [PMID: 35833751 DOI: 10.1111/epi.17365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The theory of transient cognitive impairment in epilepsy posits that lapses in attention result from ephemeral disruption of attentional circuitry by interictal events. Eye movements are intimately associated with human attention and can be monitored in real -time using eye-tracking technologies. Here, we sought to characterize the associations between interictal discharges (IEDs), gaze, and attentional behaviour in children with epilepsy. METHODS Eleven consecutive children undergoing invasive monitoring with stereotactic electrodes for localization-related epilepsy performed an attentional set-shifting task while tandem intracranial electroencephalographic signals and eye-tracking data were recorded. Using an established algorithm, IEDs were detected across all intracranial electrodes on a trial-by-trial basis. Hierarchical mixed-effects modelling was performed to delineate associations between trial reaction time (RT), eye movements, and IEDs. RESULTS Hierarchical mixed-effects modelling revealed that both the presence of an IED (β±SE=72.74±24.21ms, p=0.003) and the frequency of epileptiform events (β±SE=67.54±17.30ms, p<0.001) were associated with prolonged RT on the attentional set-shifting task. IED occurrence at the time of stimulus presentation was associated with delays in gaze initiation toward the visual targets (p=0.017). SIGNIFICANCE The occurrence of epileptiform activity in close temporal association with stimulus presentation is associated with delays in target-directed gaze and prolonged response time, hallmarks of momentary lapses in attention. These findings provide novel insights into the mechanisms of transient impairments in children and support the use of visual tracking as a correlate of higher-order attentional behaviour.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON
| | - Simeon M Wong
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON.,Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Hrishikesh Suresh
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON
| | - Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Han Yan
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON
| | - Mark Ebden
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Elizabeth Kerr
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Mary Lou Smith
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
| | - Ayako Ochi
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - Hiroshi Otsubo
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - Roy Sharma
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - Puneet Jain
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | | | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, ON
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON.,Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, ON
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