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Stasenko A, Kaestner E, Arienzo D, Schadler AJ, Helm JL, Shih JJ, Ben-Haim S, McDonald CR. Preoperative white matter network organization and memory decline after epilepsy surgery. J Neurosurg 2023; 139:1576-1587. [PMID: 37178024 PMCID: PMC10640663 DOI: 10.3171/2023.4.jns23347] [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: 02/23/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Risk for memory decline is a common concern for individuals with temporal lobe epilepsy (TLE) undergoing surgery. Global and local network abnormalities are well documented in TLE. However, it is less known whether network abnormalities predict postsurgical memory decline. The authors examined the role of preoperative global and local white matter network organization and risk of postoperative memory decline in TLE. METHODS One hundred one individuals with TLE (n = 51 with left TLE and 50 with right TLE) underwent preoperative T1-weighted MRI, diffusion MRI, and neuropsychological memory testing in a prospective longitudinal study. Fifty-six age- and sex-matched controls completed the same protocol. Forty-four patients (22 with left TLE and 22 with right TLE) subsequently underwent temporal lobe surgery and postoperative memory testing. Preoperative structural connectomes were generated via diffusion tractography and analyzed using measures of global and local (i.e., medial temporal lobe [MTL]) network organization. Global metrics measured network integration and specialization. The local metric was calculated as an asymmetry of the mean local efficiency between the ipsilateral and contralateral MTLs (i.e., MTL network asymmetry). RESULTS Higher preoperative global network integration and specialization were associated with higher preoperative verbal memory function in patients with left TLE. Higher preoperative global network integration and specialization, as well as greater leftward MTL network asymmetry, predicted greater postoperative verbal memory decline for patients with left TLE. No significant effects were observed in right TLE. Accounting for preoperative memory score and hippocampal volume asymmetry, MTL network asymmetry uniquely explained 25%-33% of the variance in verbal memory decline for left TLE and outperformed hippocampal volume asymmetry and global network metrics. MTL network asymmetry alone produced good diagnostic classification of memory decline in left TLE (i.e., an area under the receiver operating characteristic curve of 0.80-0.84 and correct classification of 65%-76% of cases with cross-validation). CONCLUSIONS These preliminary data suggest that global white matter network disruption contributes to verbal memory impairment preoperatively and predicts postsurgical verbal memory outcomes in left TLE. However, a leftward asymmetry of MTL white matter network organization may confer the highest risk for verbal memory decline. Although this requires replication in a larger sample, the authors demonstrate the importance of characterizing preoperative local white matter network properties within the to-be-operated hemisphere and the reserve capacity of the contralateral MTL network, which may eventually be useful in presurgical planning.
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Affiliation(s)
- Alena Stasenko
- Center for Multimodal Imaging and Genetics, University of California, San Diego, California
- Departments of Psychiatry, San Diego State University, San Diego, California
| | - Erik Kaestner
- Center for Multimodal Imaging and Genetics, University of California, San Diego, California
- Departments of Psychiatry, San Diego State University, San Diego, California
| | - Donatello Arienzo
- Center for Multimodal Imaging and Genetics, University of California, San Diego, California
- Departments of Psychiatry, San Diego State University, San Diego, California
| | - Adam J. Schadler
- Center for Multimodal Imaging and Genetics, University of California, San Diego, California
- Departments of Psychiatry, San Diego State University, San Diego, California
| | - Jonathan L. Helm
- Department of Psychology, San Diego State University, San Diego, California
| | - Jerry J. Shih
- Neurosciences, University of California, San Diego, California
| | | | - Carrie R. McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, California
- Departments of Psychiatry, San Diego State University, San Diego, California
- Radiation Medicine & Applied Sciences, University of California, San Diego, California
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Zhu J, Qiu W, Wei F, Wang Y, Wang Q, Ma W, Xiong H, Cui Y, Li X, Xu R, Lin Y. Reactive A1 Astrocyte-Targeted Nucleic Acid Nanoantiepileptic Drug Downregulating Adenosine Kinase to Rescue Endogenous Antiepileptic Pathway. ACS APPLIED MATERIALS & INTERFACES 2023. [PMID: 37334941 DOI: 10.1021/acsami.3c03455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Resistance to traditional antiepileptic drugs is a major challenge in chronic epilepsy treatment. MicroRNA-based gene therapy is a promising alternative but has demonstrated limited efficacy due to poor blood-brain barrier permeability, cellular uptake, and targeting efficiency. Adenosine is an endogenous antiseizure agent deficient in the epileptic brain due to elevated adenosine kinase (ADK) activity in reactive A1 astrocytes. We designed a nucleic acid nanoantiepileptic drug (tFNA-ADKASO@AS1) based on a tetrahedral framework nucleic acid (tFNA), carrying an antisense oligonucleotide targeting ADK (ADKASO) and A1 astrocyte-targeted peptide (AS1). This tFNA-ADKASO@AS1 construct effectively reduced brain ADK, increased brain adenosine, mitigated aberrant mossy fiber sprouting, and reduced the recurrent spontaneous epileptic spike frequency in a mouse model of chronic temporal lobe epilepsy. Further, the treatment did not induce any neurotoxicity or major organ damage. This work provides proof-of-concept for a novel antiepileptic drug delivery strategy and for endogenous adenosine as a promising target for gene-based modulation.
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Affiliation(s)
- Jianwei Zhu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Wenqiao Qiu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Fan Wei
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yangyang Wang
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China
| | - Wenjuan Ma
- State Key Laboratory of Oral Diseases National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
- Sichuan Provincial Engineering Research Center of Oral Biomaterials, Chengdu, Sichuan 610041, China
| | - Huan Xiong
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yan Cui
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Xinda Li
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Ruxiang Xu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yunfeng Lin
- State Key Laboratory of Oral Diseases National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
- Sichuan Provincial Engineering Research Center of Oral Biomaterials, Chengdu, Sichuan 610041, China
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Garcia-Ramos C, Adluru N, Chu DY, Nair V, Adluru A, Nencka A, Maganti R, Mathis J, Conant LL, Alexander AL, Prabhakaran V, Binder JR, Meyerand ME, Hermann B, Struck AF. Multi-shell connectome DWI-based graph theory measures for the prediction of temporal lobe epilepsy and cognition. Cereb Cortex 2023; 33:8056-8065. [PMID: 37067514 PMCID: PMC10267614 DOI: 10.1093/cercor/bhad098] [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: 11/11/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common epilepsy syndrome that empirically represents a network disorder, which makes graph theory (GT) a practical approach to understand it. Multi-shell diffusion-weighted imaging (DWI) was obtained from 89 TLE and 50 controls. GT measures extracted from harmonized DWI matrices were used as factors in a support vector machine (SVM) analysis to discriminate between groups, and in a k-means algorithm to find intrinsic structural phenotypes within TLE. SVM was able to predict group membership (mean accuracy = 0.70, area under the curve (AUC) = 0.747, Brier score (BS) = 0.264) using 10-fold cross-validation. In addition, k-means clustering identified 2 TLE clusters: 1 similar to controls, and 1 dissimilar. Clusters were significantly different in their distribution of cognitive phenotypes, with the Dissimilar cluster containing the majority of TLE with cognitive impairment (χ2 = 6.641, P = 0.036). In addition, cluster membership showed significant correlations between GT measures and clinical variables. Given that SVM classification seemed driven by the Dissimilar cluster, SVM analysis was repeated to classify Dissimilar versus Similar + Controls with a mean accuracy of 0.91 (AUC = 0.957, BS = 0.189). Altogether, the pattern of results shows that GT measures based on connectome DWI could be significant factors in the search for clinical and neurobehavioral biomarkers in TLE.
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Affiliation(s)
- Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
| | - Nagesh Adluru
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705, United States
| | - Daniel Y Chu
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Veena Nair
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Anusha Adluru
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Andrew Nencka
- Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Rama Maganti
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
| | - Jedidiah Mathis
- Department of Neurology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53705, United States
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI 53705-2275, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, United States
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Milwaukee, WI 53226, United States
| | - Mary E Meyerand
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI 53705-2275, United States
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Medical Foundation Centennial Building, 1685 Highland Ave, Madison, WI 53705-2281, United States
- William S. Middleton VA Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States
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Xie K, Royer J, Larivière S, Rodriguez-Cruces R, Frässle S, Cabalo DG, Ngo A, DeKraker J, Auer H, Tavakol S, Weng Y, Abdallah C, Horwood L, Frauscher B, Caciagli L, Bernasconi A, Bernasconi N, Zhang Z, Concha L, Bernhardt BC. Atypical connectome topography and signal flow in temporal lobe epilepsy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.23.541934. [PMID: 37292996 PMCID: PMC10245853 DOI: 10.1101/2023.05.23.541934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Temporal lobe epilepsy (TLE) is one of the most common pharmaco-resistant epilepsies in adults. While hippocampal pathology is the hallmark of this condition, emerging evidence indicates that brain alterations extend beyond the mesiotemporal epicenter and affect macroscale brain function and cognition. We studied macroscale functional reorganization in TLE, explored structural substrates, and examined cognitive associations. We investigated a multisite cohort of 95 patients with pharmaco-resistant TLE and 95 healthy controls using state-of-the-art multimodal 3T magnetic resonance imaging (MRI). We quantified macroscale functional topographic organization using connectome dimensionality reduction techniques and estimated directional functional flow using generative models of effective connectivity. We observed atypical functional topographies in patients with TLE relative to controls, manifesting as reduced functional differentiation between sensory/motor networks and transmodal systems such as the default mode network, with peak alterations in bilateral temporal and ventromedial prefrontal cortices. TLE-related topographic changes were consistent in all three included sites and reflected reductions in hierarchical flow patterns between cortical systems. Integration of parallel multimodal MRI data indicated that these findings were independent of TLE-related cortical grey matter atrophy, but mediated by microstructural alterations in the superficial white matter immediately beneath the cortex. The magnitude of functional perturbations was robustly associated with behavioral markers of memory function. Overall, this work provides converging evidence for macroscale functional imbalances, contributing microstructural alterations, and their associations with cognitive dysfunction in TLE.
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Affiliation(s)
- Ke Xie
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Raul Rodriguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Stefan Frässle
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Donna Gift Cabalo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Alexander Ngo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jordan DeKraker
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Hans Auer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Shahin Tavakol
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Yifei Weng
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chifaou Abdallah
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Linda Horwood
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Lorenzo Caciagli
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Luis Concha
- Brain Connectivity Laboratory, Institute of Neurobiology, Universidad Nacional Autónoma de Mexico (UNAM), Mexico
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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5
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Stasenko A, Kaestner E, Arienzo D, Schadler A, Reyes A, Shih JJ, Helm JL, Połczyńska M, McDonald CR. Bilingualism and Structural Network Organization in Temporal Lobe Epilepsy: Resilience in Neurologic Disease. Neurology 2023; 100:e1887-e1899. [PMID: 36854619 PMCID: PMC10159767 DOI: 10.1212/wnl.0000000000207087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/06/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is growing evidence that bilingualism can induce neuroplasticity and modulate neural efficiency, resulting in greater resistance to neurologic disease. However, whether bilingualism is beneficial to neural health in the presence of epilepsy is unknown. We tested whether bilingual individuals with temporal lobe epilepsy (TLE) have improved whole-brain structural white matter network organization. METHODS Healthy controls and individuals with TLE recruited from 2 specialized epilepsy centers completed diffusion-weighted MRI and neuropsychological testing as part of an observational cohort study. Whole-brain connectomes were generated via diffusion tractography and analyzed using graph theory. Global analyses compared network integration (path length) and specialization (transitivity) in TLE vs controls and in a 2 (left vs right TLE) × 2 (bilingual vs monolingual) model. Local analyses compared mean local efficiency of predefined frontal-executive and language (i.e., perisylvian) subnetworks. Exploratory correlations examined associations between network organization and neuropsychological performance. RESULTS A total of 29 bilingual and 88 monolingual individuals with TLE matched on several demographic and clinical variables and 81 age-matched healthy controls were included. Globally, a significant interaction between language status and side of seizure onset revealed higher network organization in bilinguals compared with monolinguals but only in left TLE (LTLE). Locally, bilinguals with LTLE showed higher efficiency in frontal-executive but not in perisylvian networks compared with LTLE monolinguals. Improved whole-brain network organization was associated with better executive function performance in bilingual but not monolingual LTLE. DISCUSSION Higher white matter network organization in bilingual individuals with LTLE suggests a neuromodulatory effect of bilingualism on whole-brain connectivity in epilepsy, providing evidence for neural reserve. This may reflect attenuation of or compensation for epilepsy-related dysfunction of the left hemisphere, potentially driven by increased efficiency of frontal-executive networks that mediate dual-language control. This highlights a potential role of bilingualism as a protective factor in epilepsy, motivating further research across neurologic disorders to define mechanisms and develop interventions.
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Affiliation(s)
- Alena Stasenko
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Erik Kaestner
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Donatello Arienzo
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Adam Schadler
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Anny Reyes
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Jerry J Shih
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Jonathan L Helm
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Monika Połczyńska
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Carrie R McDonald
- From the Center for Multimodal Imaging and Genetics (A. Stasenko, E.K., D.A., A. Schadler, A.R., C.R.M.), Department of Psychiatry (A. Stasenko, E.K., D.A., A. Schadler, C.R.M.), Department of Radiation Medicine & Applied Sciences (A.R., C.R.M.), and Department of Neurosciences (J.J.S.), University of California, San Diego; Department of Psychology (J.L.H.), San Diego State University, CA; and Department of Psychiatry and Biobehavioral Sciences (M.P.), David Geffen School of Medicine at UCLA, University of California, Los Angeles.
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Chu DY, Adluru N, Nair VA, Adluru A, Choi T, Kessler-Jones A, Dabbs K, Hou J, Hermann B, Prabhakaran V, Ahmed R. Application of data harmonization and tract-based spatial statistics reveals white matter structural abnormalities in pediatric patients with focal cortical dysplasia. Epilepsy Behav 2023; 142:109190. [PMID: 37011527 PMCID: PMC10371876 DOI: 10.1016/j.yebeh.2023.109190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 04/05/2023]
Abstract
Our study assessed diffusion tensor imaging (DTI) metrics of fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) in pediatric subjects with epilepsy secondary to Focal Cortical Dysplasia (FCD) to improve our understanding of structural network changes associated with FCD related epilepsy. We utilized a data harmonization (DH) approach to minimize confounding effects induced by MRI protocol differences. We also assessed correlations between DTI metrics and neurocognitive measures of the fluid reasoning index (FRI), verbal comprehension index (VCI), and visuospatial index (VSI). Data (n = 51) from 23 FCD patients and 28 typically developing controls (TD) scanned clinically on either 1.5T, 3T, or 3T-wide-bore MRI were retrospectively analyzed. Tract-based spatial statistics (TBSS) with threshold-free cluster enhancement and permutation testing with 100,000 permutations were used for statistical analysis. To account for imaging protocol differences, we employed non-parametric data harmonization prior to permutation testing. Our analysis demonstrates that DH effectively removed MRI protocol-based differences typical in clinical acquisitions while preserving group differences in DTI metrics between FCD and TD subjects. Furthermore, DH strengthened the association between DTI metrics and neurocognitive indices. Fractional anisotropy, MD, and RD metrics showed stronger correlation with FRI and VSI than VCI. Our results demonstrate that DH is an integral step to reduce the confounding effect of MRI protocol differences during the analysis of white matter tracts and highlights biological differences between FCD and healthy control subjects. Characterization of white matter changes associated with FCD-related epilepsy may better inform prognosis and treatment approaches.
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Affiliation(s)
- Daniel Y Chu
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Nagesh Adluru
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Waisman Center, University of Wisconsin, Madison, WI, USA
| | - Veena A Nair
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Anusha Adluru
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Timothy Choi
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Alanna Kessler-Jones
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Waisman Center, University of Wisconsin, Madison, WI, USA
| | - Kevin Dabbs
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jiancheng Hou
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Bruce Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Raheel Ahmed
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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Struck AF, Garcia-Ramos C, Nair VA, Prabhakaran V, Dabbs K, Boly M, Conant LL, Binder JR, Meyerand ME, Hermann BP. The presence, nature and network characteristics of behavioural phenotypes in temporal lobe epilepsy. Brain Commun 2023; 5:fcad095. [PMID: 37038499 PMCID: PMC10082555 DOI: 10.1093/braincomms/fcad095] [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: 08/22/2022] [Revised: 01/25/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023] Open
Abstract
The relationship between temporal lobe epilepsy and psychopathology has had a long and contentious history with diverse views regarding the presence, nature and severity of emotional-behavioural problems in this patient population. To address these controversies, we take a new person-centred approach through the application of unsupervised machine learning techniques to identify underlying latent groups or behavioural phenotypes. Addressed are the distinct psychopathological profiles, their linked frequency, patterns and severity and the disruptions in morphological and network properties that underlie the identified latent groups. A total of 114 patients and 83 controls from the Epilepsy Connectome Project were administered the Achenbach System of Empirically Based Assessment inventory from which six Diagnostic and Statistical Manual of Mental Disorders-oriented scales were analysed by unsupervised machine learning analytics to identify latent patient groups. Identified clusters were contrasted to controls as well as to each other in order to characterize their association with sociodemographic, clinical epilepsy and morphological and functional imaging network features. The concurrent validity of the behavioural phenotypes was examined through other measures of behaviour and quality of life. Patients overall exhibited significantly higher (abnormal) scores compared with controls. However, cluster analysis identified three latent groups: (i) unaffected, with no scale elevations compared with controls (Cluster 1, 37%); (ii) mild symptomatology characterized by significant elevations across several Diagnostic and Statistical Manual of Mental Disorders-oriented scales compared with controls (Cluster 2, 42%); and (iii) severe symptomatology with significant elevations across all scales compared with controls and the other temporal lobe epilepsy behaviour phenotype groups (Cluster 3, 21%). Concurrent validity of the behavioural phenotype grouping was demonstrated through identical stepwise links to abnormalities on independent measures including the National Institutes of Health Toolbox Emotion Battery and quality of life metrics. There were significant associations between cluster membership and sociodemographic (handedness and education), cognition (processing speed), clinical epilepsy (presence and lifetime number of tonic-clonic seizures) and neuroimaging characteristics (cortical volume and thickness and global graph theory metrics of morphology and resting-state functional MRI). Increasingly dispersed volumetric abnormalities and widespread disruptions in underlying network properties were associated with the most abnormal behavioural phenotype. Psychopathology in these patients is characterized by a series of discrete latent groups that harbour accompanying sociodemographic, clinical and neuroimaging correlates. The underlying neurobiological patterns suggest that the degree of psychopathology is linked to increasingly dispersed abnormal brain networks. Similar to cognition, machine learning approaches support a novel developing taxonomy of the comorbidities of epilepsy.
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Affiliation(s)
- Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
- Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705, USA
| | - Camille Garcia-Ramos
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Vivek Prabhakaran
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Melanie Boly
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Mary E Meyerand
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53726, USA
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Stasenko A, Kaestner E, Arienzo D, Schadler AJ, Helm JL, Shih J, Ben-Haim S, McDonald CR. White matter network organization predicts memory decline after epilepsy surgery. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.14.524071. [PMID: 36711617 PMCID: PMC9882113 DOI: 10.1101/2023.01.14.524071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The authors have withdrawn their manuscript owing to a substantial change in data analysis and findings/conclusions. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
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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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Wang M, Cheng X, Shi Q, Xu B, Hou X, Zhao H, Gui Q, Wu G, Dong X, Xu Q, Shen M, Cheng Q, Xue S, Feng H, Ding Z. Brain diffusion tensor imaging reveals altered connections and networks in epilepsy patients. Front Hum Neurosci 2023; 17:1142408. [PMID: 37033907 PMCID: PMC10073437 DOI: 10.3389/fnhum.2023.1142408] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Accumulating evidence shows that epilepsy is a disease caused by brain network dysfunction. This study explored changes in brain network structure in epilepsy patients based on graph analysis of diffusion tensor imaging data. Methods The brain structure networks of 42 healthy control individuals and 26 epilepsy patients were constructed. Using graph theory analysis, global and local network topology parameters of the brain structure network were calculated, and changes in global and local characteristics of the brain network in epilepsy patients were quantitatively analyzed. Results Compared with the healthy control group, the epilepsy patient group showed lower global efficiency, local efficiency, clustering coefficient, and a longer shortest path length. Both healthy control individuals and epilepsy patients showed small-world attributes, with no significant difference between groups. The epilepsy patient group showed lower nodal local efficiency and nodal clustering coefficient in the right olfactory cortex and right rectus and lower nodal degree centrality in the right olfactory cortex and the left paracentral lobular compared with the healthy control group. In addition, the epilepsy patient group showed a smaller fiber number of edges in specific regions of the frontal lobe, temporal lobe, and default mode network, indicating reduced connection strength. Discussion Epilepsy patients exhibited lower global and local brain network properties as well as reduced white matter fiber connectivity in key brain regions. These findings further support the idea that epilepsy is a brain network disorder.
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Affiliation(s)
- Meixia Wang
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaoyu Cheng
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qianru Shi
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Bo Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaoxia Hou
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Huimin Zhao
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qian Gui
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Guanhui Wu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaofeng Dong
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qinrong Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Mingqiang Shen
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qingzhang Cheng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Shouru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongxuan Feng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- *Correspondence: Hongxuan Feng,
| | - Zhiliang Ding
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- Zhiliang Ding,
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