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Billaud CHA, Wood AG, Griffiths-King D, Kessler K, Wassmer E, Foley E, Wright SK. Examining cognition and brain networks using magnetoencephalography in paediatric autoimmune encephalitis and acute disseminated encephalomyelitis: a preliminary study. Brain Commun 2024; 6:fcae248. [PMID: 39130516 PMCID: PMC11316206 DOI: 10.1093/braincomms/fcae248] [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: 04/16/2024] [Revised: 06/10/2024] [Accepted: 08/07/2024] [Indexed: 08/13/2024] Open
Abstract
Paediatric autoimmune encephalitis, including acute disseminated encephalomyelitis, are inflammatory brain diseases presenting with cognitive deficits, psychiatric symptoms, seizures, MRI and EEG abnormalities. Despite improvements in disease recognition and early immunotherapy, long-term outcomes in paediatric autoimmune encephalitis remain poor. Our aim was to understand functional connectivity changes that could be associated with negative developmental outcomes across different types of paediatric autoimmune encephalitis using magnetoencephalography. Participants were children diagnosed with paediatric autoimmune encephalitis at least 18 months before testing and typically developing children. All completed magnetoencephalography recording at rest, T1 MRI scans and neuropsychology testing. Brain connectivity (specifically in delta and theta) was estimated with amplitude envelope correlation, and network efficiency was measured using graph measures (global efficiency, local efficiency and modularity). Twelve children with paediatric autoimmune encephalitis (11.2 ± 3.5 years, interquartile range 9 years; 5M:7F) and 12 typically developing controls (10.6 ± 3.2 years, interquartile range 7 years; 8M:4F) participated. Children with paediatric autoimmune encephalitis did not differ from controls in working memory (t(21) = 1.449; P = 0.162; d = 0.605) but had significantly lower processing speed (t(21) = 2.463; P = 0.023; Cohen's d = 1.028). Groups did not differ in theta network topology measures. The paediatric autoimmune encephalitis group had a significantly lower delta local efficiency across all thresholds tested (d = -1.60 at network threshold 14%). Theta modularity was associated with lower working memory (β = -0.781; t(8) = -2.588, P = 0.032); this effect did not survive correction for multiple comparisons (P(corr) = 0.224). Magnetoencephalography was able to capture specific network alterations in paediatric autoimmune encephalitis patients. This preliminary study demonstrates that magnetoencephalography is an appropriate tool for assessing children with paediatric autoimmune encephalitis and could be associated with cognitive outcomes.
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Affiliation(s)
- Charly H A Billaud
- Institute of Health and Neurodevelopment and College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Department of Psychology, School of Social Sciences, Nanyang Technological University, Singapore 639798, Singapore
| | - Amanda G Wood
- Institute of Health and Neurodevelopment and College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- School of Psychology, Deakin University, Melbourne, Victoria 3125, Australia
| | - Daniel Griffiths-King
- Institute of Health and Neurodevelopment and College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Klaus Kessler
- Institute of Health and Neurodevelopment and College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- School of Psychology, University College Dublin, Dublin 4, Ireland
| | - Evangeline Wassmer
- Institute of Health and Neurodevelopment and College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Department of Neurology, Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK
| | - Elaine Foley
- Institute of Health and Neurodevelopment and College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Sukhvir K Wright
- Institute of Health and Neurodevelopment and College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Department of Neurology, Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK
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Eriksson MH, Prentice F, Piper RJ, Wagstyl K, Adler S, Chari A, Booth J, Moeller F, Das K, Eltze C, Cooray G, Perez Caballero A, Menzies L, McTague A, Shavel-Jessop S, Tisdall MM, Cross JH, Martin Sanfilippo P, Baldeweg T. Long-term neuropsychological trajectories in children with epilepsy: does surgery halt decline? Brain 2024; 147:2791-2802. [PMID: 38643018 PMCID: PMC11292899 DOI: 10.1093/brain/awae121] [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: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 04/22/2024] Open
Abstract
Neuropsychological impairments are common in children with drug-resistant epilepsy. It has been proposed that epilepsy surgery might alleviate these impairments by providing seizure freedom; however, findings from prior studies have been inconsistent. We mapped long-term neuropsychological trajectories in children before and after undergoing epilepsy surgery, to measure the impact of disease course and surgery on functioning. We performed a retrospective cohort study of 882 children who had undergone epilepsy surgery at Great Ormond Street Hospital (1990-2018). We extracted patient information and neuropsychological functioning [obtained from IQ tests (domains: full-scale IQ, verbal IQ, performance IQ, working memory and processing speed) and tests of academic attainment (reading, spelling and numeracy)] and investigated changes in functioning using regression analyses. We identified 500 children (248 females) who had undergone epilepsy surgery [median age at surgery = 11.9 years, interquartile range = (7.8, 15.0)] and neuropsychological assessment. These children showed declines in all domains of neuropsychological functioning in the time leading up to surgery (all P-values ≤0.001; e.g. βFSIQ = -1.9, SEFSIQ = 0.3, PFSIQ < 0.001). Children lost on average one to four points per year, depending on the domain considered; 27%-43% declined by ≥10 points from their first to their last preoperative assessment. At the time of presurgical evaluation, most children (46%-60%) scored one or more standard deviations below the mean (<85) on the different neuropsychological domains; 37% of these met the threshold for intellectual disability (full-scale IQ < 70). On a group level, there was no change in performance from pre- to postoperative assessment on any of the domains (all P-values ≥0.128). However, children who became seizure free through surgery showed higher postoperative neuropsychological performance (e.g. rrb-FSIQ = 0.37, P < 0.001). These children continued to demonstrate improvements in neuropsychological functioning over the course of their long-term follow-up (e.g. βFSIQ = 0.9, SEFSIQ = 0.3, PFSIQ = 0.004). Children who had discontinued antiseizure medication treatment at 1-year follow-up showed an 8- to 13-point advantage in postoperative working memory, processing speed and numeracy, and greater improvements in verbal IQ, working memory, reading and spelling (all P-values ≤0.034) over the postoperative period compared with children who were seizure free and still receiving antiseizure medication. In conclusion, by providing seizure freedom and the opportunity for antiseizure medication cessation, epilepsy surgery might not only halt but reverse the downward trajectory that children with drug-resistant epilepsy display in neuropsychological functioning. To halt this decline as soon as possible or, potentially, to prevent it from occurring in the first place, children with focal epilepsy should be considered for epilepsy surgery as early as possible after diagnosis.
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Affiliation(s)
- Maria H Eriksson
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Freya Prentice
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Rory J Piper
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Konrad Wagstyl
- Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Sophie Adler
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Aswin Chari
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - John Booth
- Data Research, Innovation and Virtual Environments Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Friederike Moeller
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Krishna Das
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Christin Eltze
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Gerald Cooray
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Solna 171 77, Sweden
| | - Ana Perez Caballero
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Lara Menzies
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Amy McTague
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Sara Shavel-Jessop
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Martin M Tisdall
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - J Helen Cross
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Young Epilepsy, Lingfield, RH7 6PW, UK
| | - Patricia Martin Sanfilippo
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Torsten Baldeweg
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
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Feys O, De Tiège X. From cryogenic to on-scalp magnetoencephalography for the evaluation of paediatric epilepsy. Dev Med Child Neurol 2024; 66:298-306. [PMID: 37421175 DOI: 10.1111/dmcn.15689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
Magnetoencephalography (MEG) is a neurophysiological technique based on the detection of brain magnetic fields. Whole-head MEG systems typically house a few hundred sensors requiring cryogenic cooling in a rigid one-size-fits-all (commonly adult-sized) helmet to keep a thermal insulation space. This leads to an increased brain-to-sensor distance in children, because of their smaller head circumference, and decreased signal-to-noise ratio. MEG allows detection and localization of interictal and ictal epileptiform discharges, and pathological high frequency oscillations, as a part of the presurgical assessment of children with refractory focal epilepsy, where electroencephalography is not contributive. MEG can also map the eloquent cortex before surgical resection. MEG also provides insights into the physiopathology of both generalized and focal epilepsy. On-scalp recordings based on cryogenic-free sensors have demonstrated their use in the field of childhood focal epilepsy and should become a reference technique for diagnosing epilepsy in the paediatric population. WHAT THIS PAPER ADDS: Magnetoencephalography (MEG) contributes to the diagnosis and understanding of paediatric epilepsy. On-scalp MEG recordings demonstrate some advantages over cryogenic MEG.
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Affiliation(s)
- Odile Feys
- Department of Neurology, Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Bruxelles, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles, Université libre de Bruxelles, ULB Neuroscience Institute, Bruxelles, Belgium
| | - Xavier De Tiège
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles, Université libre de Bruxelles, ULB Neuroscience Institute, Bruxelles, Belgium
- Department of Translational Neuroimaging, Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Bruxelles, Belgium
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De Benedictis A, de Palma L, Rossi-Espagnet MC, Marras CE. Connectome-based approaches in pediatric epilepsy surgery: "State-of-the art" and future perspectives. Epilepsy Behav 2023; 149:109523. [PMID: 37944286 DOI: 10.1016/j.yebeh.2023.109523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option to achieve both seizure freedom and neurocognitive improvement. Although epilepsy is now considered as a brain network disease, the most relevant literature concerning the "connectome-based" epilepsy surgery mainly refers to adults, with a limited number of studies dedicated to the pediatric population. In this review, the Authors summarized the main current available knowledge on the relevance of WM surgical anatomy in epilepsy surgery, the post-surgical modifications of brain structural connectivity and the related clinical impact of such modifications within the pediatric context. In the last part, possible implications and future perspectives of this approach have been discussed, especially concerning the optimization of surgical strategies and the predictive value of the epilepsy network analysis for planning tailored approaches, with the final aim of improving case selection, presurgical planning, intraoperative management, and postoperative results.
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Affiliation(s)
| | - Luca de Palma
- Epilepsy and Movement Disorders Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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