1
|
Phillips KHT, Patterson K, Butler CR, Woodberry E, Ralph MAL, Cope TE. Does epilepsy differentially affect different types of memory? Seizure 2024; 121:217-225. [PMID: 39243667 DOI: 10.1016/j.seizure.2024.08.020] [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: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/09/2024] Open
Abstract
Despite the recognition that epilepsy can substantially disrupt memory, there are few published accounts of whether and how this disruption varies across different types of memory and/or different types of epilepsy. This review explores four main questions: (1) Are working, episodic and semantic memory differentially affected by epilepsy? (2) Do various types of epilepsy, and their treatment, have different, specifiable effects on memory? (3) Are the usual forms of neuropsychological assessments of memory - many or most designed for other conditions - appropriate for patients with epilepsy? (4) How can research on epilepsy contribute to our understanding of the neuroscience of memory? We conclude that widespread and multifactorial problems are seen in working memory in all patient groups, while patients with temporal lobe epilepsy seem particularly prone to episodic memory deficit, and those with frontal lobe epilepsy to executive function deficits that may in turn impair semantic control. Currently, it is difficult to make individual patient predictions about likely memory deficits based on seizure aetiology and type, but it is possible to guide and tailor neuropsychological assessments in an individualised way. We make recommendations for future directions in validating and optimising neuropsychological assessments, and consider how to approach effective shared decision making about the pros and cons of seizure treatment strategies, especially at crucial educational stages such as adolescence.
Collapse
Affiliation(s)
| | - Karalyn Patterson
- Cambridge University Hospitals, Cambridge, UK; MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | | | | | - Matthew A Lambon Ralph
- Cambridge University Hospitals, Cambridge, UK; MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Thomas E Cope
- Cambridge University Hospitals, Cambridge, UK; MRC Cognition and Brain Sciences Unit, Cambridge, UK
| |
Collapse
|
2
|
Adriaenssen DJ, Huuse Farmen A, Glenne Øie M, Winther Skogli E. Impaired executive functioning in children of women with epilepsy. Epilepsy Behav 2024; 156:109864. [PMID: 38795457 DOI: 10.1016/j.yebeh.2024.109864] [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: 03/21/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE While neurodevelopmental symptoms are often seen in children of mothers with epilepsy, research specifically addressing executive function (EF) in this population is limited. This study aims to investigate EF in children of mothers with epilepsy, both with and without fetal exposure to anti-seizure medications, compared to typically developing children whose mothers do not have epilepsy. METHODS We evaluated EF in children aged 8 to 17 years born to mothers with clinically validated diagnoses of epilepsy, using the Behavior Rating Inventory of Executive Function completed by the mothers. The results were then compared to a typically developing control group at the same age living in the same geographic area. RESULTS The results showed significantly higher levels of EF problems in children of mothers with epilepsy who were exposed (p = 0.005, d = 0.63), and unexposed (p = 0.001, d = 0.74) to anti-seizure medications during pregnancy, compared to typically developing children. There was no significant difference in EF problems between the exposed and unexposed groups. These findings remained statistically significant after adjusting for mothers' education levels, and when excluding participants exposed to valproate during pregnancy. SIGNIFICANCE This study highlights the increased risk of EF problems in children of mothers with epilepsy, independent of exposure to anti-seizure medications. Findings underscore the importance of continuous monitoring of EF in these children and highlights the need for further research into the diverse factors affecting EF development in this group.
Collapse
Affiliation(s)
| | | | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Norway; Research Department, Innlandet Hospital Trust, Norway.
| | - Erik Winther Skogli
- Division Mental Health Care, Innlandet Hospital Trust, Norway; Department of Psychology, Inland Norway University of Applied Sciences, Norway.
| |
Collapse
|
3
|
Joplin S, Gascoigne M, Barton B, Webster R, Gill D, Lawson J, Mandalis A, Sabaz M, McLean S, Gonzalez L, Smith ML, Lah S. Repeat testing enhances long-term verbal memory in children with epilepsy. Child Neuropsychol 2024; 30:425-443. [PMID: 37144751 DOI: 10.1080/09297049.2023.2205633] [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: 08/09/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
To (i) determine whether accelerated long-term forgetting (ALF) can be found using standardized verbal memory test materials in children with genetic generalized epilepsy (GGE) and temporal lobe epilepsy (TLE), and (ii) to establish whether ALF is impacted by executive skills and repeat testing over long delays. One hundred and twenty-three children aged 8 to 16, (28 with GGE, 23 with TLE, and 72 typically developing; TD) completed a battery of standardized tests assessing executive functioning and memory for two stories. Stories were recalled immediately and after a 30-min delay. To examine whether repeat testing impacts long-term forgetting, one story was tested via free recall at 1-day and 2-weeks, and the other at 2-weeks only. Recognition was then tested for both stories at 2-weeks. Children with epilepsy recalled fewer story details, both immediately and after 30-min relative to TD children. Compared to TD children, the GGE group, but not the TLE group, showed ALF, having significantly poorer recall of the story tested only at the longest delay. Poor executive skills were significantly correlated with ALF for children with epilepsy. Standard story memory materials can detect ALF in children with epilepsy when administered over long delays. Our findings suggest that (i) ALF is related to poor executive skills in children with epilepsy, and (ii) repeated testing may ameliorate ALF in some children.
Collapse
Affiliation(s)
- Samantha Joplin
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Michael Gascoigne
- School of Psychology and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Belinda Barton
- Faculty of Health, Discipline of Psychology, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Richard Webster
- TY Nelson Department of Neurology, Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Deepak Gill
- TY Nelson Department of Neurology, Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - John Lawson
- Department of Neurology SCHN, School of Women and Children's Health, UNSW, Randwick, NSW, Australia
| | - Anna Mandalis
- Department of Psychology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Mark Sabaz
- Department of Psychology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Samantha McLean
- TY Nelson Department of Neurology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Linda Gonzalez
- Brain and Mind, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mary-Lou Smith
- Department of Psychology, University of Toronto Mississauga and Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Suncica Lah
- School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
4
|
Silva Alves A, Rigoni I, Mégevand P, Lagarde S, Picard F, Seeck M, Vulliémoz S, Roehri N. High-density electroencephalographic functional networks in genetic generalized epilepsy: Preserved whole-brain topology hides local reorganization. Epilepsia 2024; 65:961-973. [PMID: 38306118 DOI: 10.1111/epi.17903] [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: 09/04/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Genetic generalized epilepsy (GGE) accounts for approximately 20% of adult epilepsy cases and is considered a disorder of large brain networks, involving both hemispheres. Most studies have not shown any difference in functional whole-brain network topology when compared to healthy controls. Our objective was to examine whether this preserved global network topology could hide local reorganizations that balance out at the global network level. METHODS We recorded high-density electroencephalograms from 20 patients and 20 controls, and reconstructed the activity of 118 regions. We computed functional connectivity in windows free of interictal epileptiform discharges in broad, delta, theta, alpha, and beta frequency bands, characterized the network topology, and used the Hub Disruption Index (HDI) to quantify the topological reorganization. We examined the generalizability of our results by reproducing a 25-electrode clinical system. RESULTS Our study did not reveal any significant change in whole-brain network topology among GGE patients. However, the HDI was significantly different between patients and controls in all frequency bands except alpha (p < .01, false discovery rate [FDR] corrected, d < -1), and accompanied by an increase in connectivity in the prefrontal regions and default mode network. This reorganization suggests that regions that are important in transferring the information in controls were less so in patients. Inversely, the crucial regions in patients are less so in controls. These findings were also found in delta and theta frequency bands when using 25 electrodes (p < .001, FDR corrected, d < -1). SIGNIFICANCE In GGE patients, the overall network topology is similar to that of healthy controls but presents a balanced local topological reorganization. This reorganization causes the prefrontal areas and default mode network to be more integrated and segregated, which may explain executive impairment associated with GGE. Additionally, the reorganization distinguishes patients from controls even when using 25 electrodes, suggesting its potential use as a diagnostic tool.
Collapse
Affiliation(s)
- André Silva Alves
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Isotta Rigoni
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre Mégevand
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stanislas Lagarde
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Fabienne Picard
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Vulliémoz
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Roehri
- EEG and Epilepsy Unit, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
5
|
Wang X, Huang Y, Chen L, Mai J, Fang D, Mo T, Qi X, Zeng H. A Potential Mechanism of Neurological Impairment in Children With Infantile Spasm: Based on Microanatomic Structure Analysis Employing Voxel-Based Morphometry and Surface-Based Morphometry. Pediatr Neurol 2024; 153:116-124. [PMID: 38367486 DOI: 10.1016/j.pediatrneurol.2023.12.009] [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: 08/03/2022] [Revised: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Infantile epileptic spasms syndrome (IESS) would accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microwould accompany with severe neurological impairment. Our study aimed to explore the potential mechanism by employing voxel-based and surface-based morphometry to detect brain microanatomic structure alteration. METHODS The IESS group had 21 males and 13 females (mean age: 17.7 ± 15.6 months), whereas the healthy controls group had 22 males and 10 females (mean age: 29.4 ± 18.7 months). High-resolution 3D T1WI was performed. Computational Anatomy Toolbox implemented in Statistical Parametric Mapping 12 was used to measure the gray matter and white matter volume, and the cortical thickness separately. Independent sample t test was used to assess between-group differences. IESS group was assessed using the Bayley Scales of Infant Development. RESULTS The IESS group showed a significantly decreased volume of gray matter in right middle temporal gyrus, inferior temporal gyrus, superior temporal gyrus, right fusiform, and bilateral precuneus (P < 0.001). There were no significant between-group differences with respect to white matter volume or cortical thickness (P > 0.001). The results of Bayley Scales of Infant Development showed that the Mental Development Index (MDI) and Psychomotor Development Index scores of children with IESS were almost concentrated in the range of <70. MDI score showed a positive correlation with gray matter reduction area in IESS group. CONCLUSION Children with IESS had impaired cognitive and delayed motor development. And the decreased gray matter in the right temporal lobe, fusiform, and bilateral precuneus could be the potential anatomic basis for impaired function, such as hearing, visual, and language.
Collapse
Affiliation(s)
- Xiaoyu Wang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yuchun Huang
- Department of Radiology, Longhua District Shenzhen People's Hospital, Shenzhen, China
| | - Li Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiahui Mai
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Diangang Fang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Tong Mo
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xinxin Qi
- China Medical University, Shenyang, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China.
| |
Collapse
|
6
|
Dreier JW, Trabjerg BB, Plana-Ripoll O, Skipper N, Agerbo E, Cotsapas C, Berg AT, Christensen J. Epilepsy in childhood and school performance: a nation-wide cohort study. Brain 2024; 147:532-541. [PMID: 38102964 DOI: 10.1093/brain/awad382] [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: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023] Open
Abstract
Childhood epilepsy has been linked to poor academic performance, but large-scale studies are lacking. In this nation-wide study of school-aged children, we examined the association between childhood epilepsy and school performance in standardized tests according to phenotypic and treatment-related characteristics. We performed a matched register-based cohort study of children born in Denmark (1997-2009) who participated in the Danish National School Test Programme between 2010 and 2019. We used population and health registers to identify children with epilepsy and a randomly sampled sex- and age-matched reference cohort without epilepsy (ratio 1:10). Norm-based test scores from language and mathematics reflecting performance as a percentile of the nation-wide distribution of scores (scale 1-100) were used to assess academic performance. Adjusted differences in mean standardized scores between children with and without epilepsy were estimated using linear regression models. Among 582 840 children participating in the School Test Programme, we identified 4659 (0.8%) children with epilepsy (52.8% males) and 46 590 matched reference children. Median age at epilepsy onset was 7.5 years (interquartile range: 4.0-10.6). Childhood epilepsy was associated with poorer school performance overall (mean score = 48.2 versus references = 56.7; adjusted difference = -6.7, 95% CI: -7.4 to -6.0), and worse performance was found in all epilepsy subgroups, including in 3534 children with uncomplicated epilepsy (i.e. no other pre-existing neurologic or intellectual disabilities and no identified possible cause for epilepsy; adjusted difference = -6.0, 95% CI: -6.8 to -5.2). No major variation by sex, age or subject was observed, but larger score differences were seen in children using antiseizure medication at time of testing (e.g. valproate monotherapy, adjusted difference = -9.3, 95% CI: -11.5 to -7.0 and lamotrigine monotherapy, adjusted difference = -13.1, 95% CI: -15.0 to -11.3) and in children with psychiatric comorbidity, especially epilepsy with comorbid intellectual disability (adjusted difference = -27.0, 95% CI: -30.0 to -23.9) and epilepsy with comorbid attention deficit/hyperactivity disorder (adjusted difference = -15.7, 95% CI: -19.0 to -12.4). Children with epilepsy scored significantly lower than their unaffected siblings (adjusted difference = -6.2, 95% CI: -7.1 to -5.4). In conclusion, childhood epilepsy was associated with impaired academic performance throughout schooling, which suggest that there is a widespread need for educational support of children with epilepsy, even when the child has no other comorbidities and when the epilepsy appears well-managed.
Collapse
Affiliation(s)
- Julie W Dreier
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Betina B Trabjerg
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Niels Skipper
- Department of Economics and Business Economics, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Chris Cotsapas
- Department of Neurology, Yale, New Haven, CT 06510, USA
- Department of Genetics, Yale, New Haven, CT 06510, USA
| | - Anne T Berg
- Department of Neurology, Northwestern University - Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jakob Christensen
- Department of Neurology, Affiliated Member of the European Reference Network EpiCARE, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| |
Collapse
|
7
|
Sitnikova E. Behavioral and Cognitive Comorbidities in Genetic Rat Models of Absence Epilepsy (Focusing on GAERS and WAG/Rij Rats). Biomedicines 2024; 12:122. [PMID: 38255227 PMCID: PMC10812980 DOI: 10.3390/biomedicines12010122] [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: 12/12/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Absence epilepsy is a non-convulsive type of epilepsy characterized by the sudden loss of awareness. It is associated with thalamo-cortical impairment, which may cause neuropsychiatric and neurocognitive problems. Rats with spontaneous absence-like seizures are widely used as in vivo genetic models for absence epilepsy; they display behavioral and cognitive problems similar to epilepsy in humans, such as genetic absence epilepsy rats from Strasbourg (GAERS) and Wistar Albino rats from Rijswijk (WAG/Rij). Depression- and anxiety-like behaviors were apparent in GAERS, but no anxiety and depression-like symptoms were found in WAG/Rij rats. Deficits in executive functions and memory impairment in WAG/Rij rats, i.e., cognitive comorbidities, were linked to the severity of epilepsy. Wistar rats can develop spontaneous seizures in adulthood, so caution is advised when using them as a control epileptic strain. This review discusses challenges in the field, such as putative high emotionality in genetically prone rats, sex differences in the expression of cognitive comorbidities, and predictors of cognitive problems or biomarkers of cognitive comorbidities in absence epilepsy, as well as the concept of "the cognitive thalamus". The current knowledge of behavioral and cognitive comorbidities in drug-naive rats with spontaneous absence epilepsy is beneficial for understanding the pathophysiology of absence epilepsy, and for finding new treatment strategies.
Collapse
Affiliation(s)
- Evgenia Sitnikova
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, 5A Butlerova St., Moscow 117485, Russia
| |
Collapse
|
8
|
Andrén K, Larsson D, Asztély F, Zelano J. Adherence to anti-seizure medications in the Swedish Prospective Regional Epilepsy Database and Biobank for Individualized Clinical Treatment (PREDICT). Epilepsy Behav Rep 2023; 24:100631. [PMID: 37965624 PMCID: PMC10641594 DOI: 10.1016/j.ebr.2023.100631] [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: 09/04/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
The aim of this study was to describe the extent of, and risk factors for, non-adherence to anti-seizure medications (ASMs) in adult people with epilepsy (PWE) in Sweden. A cross-sectional multi-centre study was performed of PWEs in western Sweden, with data from medical records, and a questionnaire filled in by the participants including self-reports on how often ASM doses had been forgotten during the past year. Participants were categorized into adherent if they forgot at 0-1 occasion, and non-adherent if they forgot at 2-10 or >10 occasions. Demographic and clinical factors were compared by Chi2- or Fisher's test and a logistic regression model was used to find risk factors for non-adherence. In the cohort of 416 PWE aged median 43, IQR 29-62 years, 398 patients were prescribed ASM treatment at inclusion, and 39 % (n = 154) were in the non-adherent group. Significant factors in the multivariable analysis were: younger age, seizure freedom the past year, valproate treatment and experiencing side effects. The rate of self-reported non-adherence was high, illustrating a need for continuous focus on fundamental aspects of epilepsy care. The identified risk factors could enable quality improvement projects and patient education to be directed to those at risk of non-adherence.
Collapse
Affiliation(s)
- Kerstin Andrén
- Angered Hospital, SV Hospital Group, Box 63, 424 22 Angered, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Blå Stråket 7, 413 45 Gothenburg, Sweden
| | - David Larsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Blå Stråket 7, 413 45 Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Blå Stråket 7, 413 45 Gothenburg, Sweden
- Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Box 100, 405 30 Gothenburg, Sweden
| | - Fredrik Asztély
- Angered Hospital, SV Hospital Group, Box 63, 424 22 Angered, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Blå Stråket 7, 413 45 Gothenburg, Sweden
| | - Johan Zelano
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Blå Stråket 7, 413 45 Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Blå Stråket 7, 413 45 Gothenburg, Sweden
- Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Box 100, 405 30 Gothenburg, Sweden
| |
Collapse
|
9
|
Kiersnowski OC, Winston GP, Caciagli L, Biondetti E, Elbadri M, Buck S, Duncan JS, Thornton JS, Shmueli K, Vos SB. Quantitative susceptibility mapping identifies hippocampal and other subcortical grey matter tissue composition changes in temporal lobe epilepsy. Hum Brain Mapp 2023; 44:5047-5064. [PMID: 37493334 PMCID: PMC10502681 DOI: 10.1002/hbm.26432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is associated with widespread brain alterations. Using quantitative susceptibility mapping (QSM) alongside transverse relaxation rate (R 2 * ), we investigated regional brain susceptibility changes in 36 patients with left-sided (LTLE) or right-sided TLE (RTLE) secondary to hippocampal sclerosis, and 27 healthy controls (HC). We compared three susceptibility calculation methods to ensure image quality. Correlations of susceptibility andR 2 * with age of epilepsy onset, frequency of focal-to-bilateral tonic-clonic seizures (FBTCS), and neuropsychological test scores were examined. Weak-harmonic QSM (WH-QSM) successfully reduced noise and removed residual background field artefacts. Significant susceptibility increases were identified in the left putamen in the RTLE group compared to the LTLE group, the right putamen and right thalamus in the RTLE group compared to HC, and a significant susceptibility decrease in the left hippocampus in LTLE versus HC. LTLE patients who underwent epilepsy surgery showed significantly lower left-versus-right hippocampal susceptibility. SignificantR 2 * changes were found between TLE and HC groups in the amygdala, putamen, thalamus, and in the hippocampus. Specifically, decreased R2 * was found in the left and right hippocampus in LTLE and RTLE, respectively, compared to HC. Susceptibility andR 2 * were significantly correlated with cognitive test scores in the hippocampus, globus pallidus, and thalamus. FBTCS frequency correlated positively with ipsilateral thalamic and contralateral putamen susceptibility and withR 2 * in bilateral globi pallidi. Age of onset was correlated with susceptibility in the hippocampus and putamen, and withR 2 * in the caudate. Susceptibility andR 2 * changes observed in TLE groups suggest selective loss of low-myelinated neurons alongside iron redistribution in the hippocampi, predominantly ipsilaterally, indicating QSM's sensitivity to local pathology. Increased susceptibility andR 2 * in the thalamus and putamen suggest increased iron content and reflect disease severity.
Collapse
Affiliation(s)
- Oliver C. Kiersnowski
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Gavin P. Winston
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- Department of Medicine, Division of NeurologyQueen's UniversityKingstonCanada
| | - Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Emma Biondetti
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
- Department of Neuroscience, Imaging and Clinical SciencesInstitute for Advanced Biomedical Technologies, “D'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Maha Elbadri
- Department of NeurologyQueen Elizabeth HospitalBirminghamUK
| | - Sarah Buck
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUniversity College LondonLondonUK
| | - John S. Thornton
- Neuroradiological Academic UnitUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Karin Shmueli
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Sjoerd B. Vos
- Neuroradiological Academic UnitUCL Queen Square Institute of Neurology, University College LondonLondonUK
- Centre for Microscopy, Characterisation, and AnalysisThe University of Western AustraliaNedlandsAustralia
- Centre for Medical Image Computing, Computer Science departmentUniversity College LondonLondonUK
| |
Collapse
|
10
|
Ballarà Petitbò M, González Alguacil E, Gutiérrez Delicado E, Ortiz Cabrera NV, Duat Rodríguez A, García Peñas JJ, Soto Insuga V. Neuropsychiatric comorbidities and cognition in epilepsy with eyelid myoclonia: A retrospective pediatric case series. Epileptic Disord 2023; 25:758-768. [PMID: 37584565 DOI: 10.1002/epd2.20148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Epilepsy with eyelid myoclonia (EEM) is a rare epileptic syndrome classified within the Genetic Generalized Epilepsies of childhood. It is characterized by a high drug resistance, and little is known about prognostic factors and neurodevelopmental comorbidities. The aim of this study was to describe the clinical features, cognitive profile, and prognostic factors in a series of children with EEM. METHODS This is a retrospective observational study of patients diagnosed with EEM from 2012 to 2022 in a tertiary pediatric hospital. RESULTS Seventeen patients were analyzed (mean age at symptom onset 5.8 years). Neuropsychiatric comorbidities were present in 76.4% (attention deficit hyperactivity disorder 58.8%, behavioral disorder 11.8%, autism spectrum disorder 11.8%, and psychotic outbreaks 11.8%). Neurocognitive assessment was performed in 75%, revealing cognitive impairment in 66.6% (62.5% with borderline intellectual function and 37.5% with -IQ <70-), with predominant difficulties in executive functions, comprehensive language, and motor skills. Cognitive deterioration was observed in one patient in parallel onset with psychotic symptoms. High refractoriness to antiseizure medication (ASM) was observed, with only 23.5% of the patients being seizure-free after a mean follow-up of 7 years. The most effective ASM was valproic acid, and two of them received ketogenic diet with good response. Regarding prognostic factors, psychotic symptoms were associated with a greater number of antiseizure medication (p < .05) implying a more drug-resistant epilepsy. SIGNIFICANCE In our study, we found a high rate of cognitive and psychiatric comorbidities and high refractoriness. These data support the concept of EEM as an intermediate entity between idiopathic generalized epilepsy and epileptic and/or neurodevelopmental encephalopathy. Making a proper diagnosis and management of these comorbidities is necessary to improve prognosis and quality of life in EEM.
Collapse
Affiliation(s)
| | | | - Eva Gutiérrez Delicado
- Video-EEG Monitoring Unit, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | | | - Anna Duat Rodríguez
- Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | | | - Victor Soto Insuga
- Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| |
Collapse
|
11
|
Caciagli L, Ratcliffe C, Xiao F, van Graan LA, Trimmel K, Vollmar C, Centeno M, Duncan JS, Thompson PJ, Baxendale S, Koepp MJ, Wandschneider B. Cognitive phenotype of juvenile absence epilepsy: An investigation of patients and unaffected siblings. Epilepsia 2023; 64:2792-2805. [PMID: 37475704 PMCID: PMC10952612 DOI: 10.1111/epi.17719] [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: 11/24/2022] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE The cognitive profile of juvenile absence epilepsy (JAE) remains largely uncharacterized. This study aimed to: (1) elucidate the neuropsychological profile of JAE; (2) identify familial cognitive traits by investigating unaffected JAE siblings; (3) establish the clinical meaningfulness of JAE-associated cognitive traits; (4) determine whether cognitive traits across the idiopathic generalized epilepsy (IGE) spectrum are shared or syndrome-specific, by comparing JAE to juvenile myoclonic epilepsy (JME); and (5) identify relationships between cognitive abilities and clinical characteristics. METHODS We investigated 123 participants-23 patients with JAE, 16 unaffected siblings of JAE patients, 45 healthy controls, and 39 patients with JME-who underwent a comprehensive neuropsychological test battery including measures within four cognitive domains: attention/psychomotor speed, language, memory, and executive function. We correlated clinical measures with cognitive performance data to decode effects of age at onset and duration of epilepsy. RESULTS Cognitive performance in individuals with JAE was reduced compared to controls across attention/psychomotor speed, language, and executive function domains; those with ongoing seizures additionally showed lower memory scores. Patients with JAE and their unaffected siblings had similar language impairment compared to controls. Individuals with JME had worse response inhibition than those with JAE. Across all patients, those with older age at onset had better attention/psychomotor speed performance. SIGNIFICANCE JAE is associated with wide-ranging cognitive difficulties that encompass domains reliant on frontal lobe processing, including language, attention, and executive function. JAE siblings share impairment with patients on linguistic measures, indicative of a familial trait. Executive function subdomains may be differentially affected across the IGE spectrum. Cognitive abilities are detrimentally modulated by an early age at seizure onset.
Collapse
Affiliation(s)
- Lorenzo Caciagli
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of Neurology, Inselspital, Sleep‐Wake‐Epilepsy‐Center, Bern University HospitalUniversity of BernBernSwitzerland
| | - Corey Ratcliffe
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular, and Integrative BiologyUniversity of LiverpoolLiverpoolUK
- Department of Neuroimaging and Interventional RadiologyNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Fenglai Xiao
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Louis A. van Graan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Karin Trimmel
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Christian Vollmar
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Department of NeurologyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Maria Centeno
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
- Epilepsy Unit, Department of NeurologyHospital Clínic de BarcelonaBarcelonaSpain
| | - John S. Duncan
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Pamela J. Thompson
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Sallie Baxendale
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Matthias J. Koepp
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| | - Britta Wandschneider
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- MRI UnitEpilepsy SocietyBuckinghamshireUK
| |
Collapse
|
12
|
Rubboli G, Beier CP, Selmer KK, Syvertsen M, Shakeshaft A, Collingwood A, Hall A, Andrade DM, Fong CY, Gesche J, Greenberg DA, Hamandi K, Lim KS, Ng CC, Orsini A, Striano P, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK. Variation in prognosis and treatment outcome in juvenile myoclonic epilepsy: a Biology of Juvenile Myoclonic Epilepsy Consortium proposal for a practical definition and stratified medicine classifications. Brain Commun 2023; 5:fcad182. [PMID: 37361715 PMCID: PMC10288558 DOI: 10.1093/braincomms/fcad182] [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: 10/01/2022] [Revised: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Reliable definitions, classifications and prognostic models are the cornerstones of stratified medicine, but none of the current classifications systems in epilepsy address prognostic or outcome issues. Although heterogeneity is widely acknowledged within epilepsy syndromes, the significance of variation in electroclinical features, comorbidities and treatment response, as they relate to diagnostic and prognostic purposes, has not been explored. In this paper, we aim to provide an evidence-based definition of juvenile myoclonic epilepsy showing that with a predefined and limited set of mandatory features, variation in juvenile myoclonic epilepsy phenotype can be exploited for prognostic purposes. Our study is based on clinical data collected by the Biology of Juvenile Myoclonic Epilepsy Consortium augmented by literature data. We review prognosis research on mortality and seizure remission, predictors of antiseizure medication resistance and selected adverse drug events to valproate, levetiracetam and lamotrigine. Based on our analysis, a simplified set of diagnostic criteria for juvenile myoclonic epilepsy includes the following: (i) myoclonic jerks as mandatory seizure type; (ii) a circadian timing for myoclonia not mandatory for the diagnosis of juvenile myoclonic epilepsy; (iii) age of onset ranging from 6 to 40 years; (iv) generalized EEG abnormalities; and (v) intelligence conforming to population distribution. We find sufficient evidence to propose a predictive model of antiseizure medication resistance that emphasises (i) absence seizures as the strongest stratifying factor with regard to antiseizure medication resistance or seizure freedom for both sexes and (ii) sex as a major stratifying factor, revealing elevated odds of antiseizure medication resistance that correlates to self-report of catamenial and stress-related factors including sleep deprivation. In women, there are reduced odds of antiseizure medication resistance associated with EEG-measured or self-reported photosensitivity. In conclusion, by applying a simplified set of criteria to define phenotypic variations of juvenile myoclonic epilepsy, our paper proposes an evidence-based definition and prognostic stratification of juvenile myoclonic epilepsy. Further studies in existing data sets of individual patient data would be helpful to replicate our findings, and prospective studies in inception cohorts will contribute to validate them in real-world practice for juvenile myoclonic epilepsy management.
Collapse
Affiliation(s)
- Guido Rubboli
- Danish Epilepsy Centre, Filadelfia, Dianalund 4293, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - Kaja K Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo 0372, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo 1337, Norway
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo 3004, Norway
| | - Amy Shakeshaft
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Anna Hall
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Danielle M Andrade
- Adult Epilepsy Genetics Program, Krembil Research Institute, University of Toronto, Toronto M5T 0S8, Canada
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - David A Greenberg
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus 43215, USA
| | - Khalid Hamandi
- Department of Neurology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Ching Ching Ng
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa 56126, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Disease Unit, IRCCS Istituto ‘G. Gaslini’, Genova 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova 16132, Italy
| | - Rhys H Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Jana Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
- Motol University Hospital, Prague 150 06, Czech Republic
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto M5G 1X8, Canada
- Departments of Statistical Sciences and Computer Science and Division of Biostatistics, The University of Toronto, Toronto M5G 1Z5, Canada
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| |
Collapse
|
13
|
Daker LI, Sayed SS, Abdelghaffar M, Hamed AH, Aboelnor MI, El-Khatib MES. Could thalamic biochemical changes correlate to cognitive impairment in idiopathic generalized epilepsy? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00638-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Background
The thalamus is crucial in the development of idiopathic generalized epilepsy (IGE), which could lead to cognitive dysfunctions, according to data from neuropsychology and advanced neuroimaging investigations. This research aimed to measure the metabolic changes in the thalamus and to assess if could be contributed to cognitive impairment in IGE patients. Thirty IGE patients and thirty healthy volunteers with matched ages, genders, and educational levels participated in this cross-sectional case–control research. The IGE patients and controls were evaluated neuropsychologically using Intelligence Quotient (IQ) to assess general cognitive ability, Digit span for attention, Wechsler memory scale (WMS) for verbal memory, cube drawing test for visuospatial memory, Trail making test for executive functions, and Controlled Oral Word Association test (COWAT) for verbal fluency and quantitative multi-voxel MR spectroscopy (MRS) measurements of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), NAA/Cr, NAA/Cho and Cho/Cr ratios at 1.5 T scanner. The voxels were located over the right and left thalamus.
Results
The IGE patients showed worse cognitive performance in IQ, attention, executive function, and verbal and visuospatial memory domains compared to the controls. The IGE patients exhibited a significantly decrease NAA in the right thalamus (p = 0.004) and a lower NAA/Cr ratio in the left thalamus (p = 0.01). the mean thalamus NAA level exhibited a positive correlation with CDT (r = 0.45, p = P = 0.01), and WMS-R (r = 0.39, p = 0.03) and a negative correlation with trail-making A test (r = 0.42, P = 0.01).
Conclusions
it was concluded that IGE patients exhibited poor cognition which could be attributed to thalamic neurometabolic changes due to impaired thalamic cortical circuits.
Collapse
|
14
|
Dharan AL, Bowden SC, Peterson A, Lai A, Seneviratne U, Dabscheck G, Nurse E, Loughman A, Parsons N, D'Souza WJ. A cross-sectional investigation of cognition and epileptiform discharges in juvenile absence epilepsy. Epilepsia 2023; 64:742-753. [PMID: 36625418 DOI: 10.1111/epi.17505] [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: 09/25/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Despite the prevalence of cognitive symptoms in the idiopathic generalized epilepsies (IGEs), cognitive dysfunction in juvenile absence epilepsy (JAE), a common yet understudied IGE subtype, remains poorly understood. This descriptive study provides a novel, comprehensive characterization of cognitive functioning in a JAE sample and examines the relationship between cognition and 24-h epileptiform discharge load. METHOD Forty-four individuals diagnosed with JAE underwent cognitive assessment using Woodcock Johnson III Test of Cognitive Abilities with concurrent 24-h ambulatory EEG monitoring. Generalized epileptiform discharges of any length, and prolonged generalized discharges ≥3 s were quantified across wakefulness and sleep. The relationship between standardized cognitive scores and epileptiform discharges was assessed through regression models. RESULTS Cognitive performances in overall intellectual ability, acquired comprehension-knowledge, processing speed, long-term memory storage and retrieval, and executive processes were 0.63-1.07 standard deviation (SD) units lower in the JAE group compared to the population reference mean, adjusted for educational attainment. Prolonged discharges (≥3 s) were recorded in 20 patients (47.6%) from 42 available electroencephalography (EEG) studies and were largely unreported. Duration and number of prolonged discharges were associated with reduced processing speed and long-term memory storage and retrieval. SIGNIFICANCE Cognitive dysfunction is seen in patients with JAE across various cognitive abilities, including those representing more stable processes like general intellect. During 24-h EEG, prolonged epileptiform discharges are common yet underreported in JAE despite treatment, and they show moderate effects on cognitive abilities. If epileptiform burden is a modifiable predictor of cognitive dysfunction, therapeutic interventions should consider quantitative 24-h EEG with routine neuropsychological screening. The growing recognition of the spectrum of neuropsychological comorbidities of IGE highlights the value of multidisciplinary approaches to explore the causes and consequences of cognitive deficits in epilepsy.
Collapse
Affiliation(s)
- Anita L Dharan
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andre Peterson
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Udaya Seneviratne
- Department of Neuroscience, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash Medical Centre Clayton, Melbourne, Victoria, Australia
| | - Gabriel Dabscheck
- Department of Neurology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neurosciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ewan Nurse
- Seer Medical Inc Research, Melbourne, Victoria, Australia
| | - Amy Loughman
- Food & Mood Centre, Institute of Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Nicholas Parsons
- Deakin University, Cognitive Neuroscience Unit, School of Psychology, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
| |
Collapse
|
15
|
Puri V, Kanojia N, Sharma A, Huanbutta K, Dheer D, Sangnim T. Natural product-based pharmacological studies for neurological disorders. Front Pharmacol 2022; 13:1011740. [PMID: 36419628 PMCID: PMC9676372 DOI: 10.3389/fphar.2022.1011740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2023] Open
Abstract
Central nervous system (CNS) disorders and diseases are expected to rise sharply in the coming years, partly because of the world's aging population. Medicines for the treatment of the CNS have not been successfully made. Inadequate knowledge about the brain, pharmacokinetic and dynamic errors in preclinical studies, challenges with clinical trial design, complexity and variety of human brain illnesses, and variations in species are some potential scenarios. Neurodegenerative diseases (NDDs) are multifaceted and lack identifiable etiological components, and the drugs developed to treat them did not meet the requirements of those who anticipated treatments. Therefore, there is a great demand for safe and effective natural therapeutic adjuvants. For the treatment of NDDs and other memory-related problems, many herbal and natural items have been used in the Ayurvedic medical system. Anxiety, depression, Parkinson's, and Alzheimer's diseases (AD), as well as a plethora of other neuropsychiatric disorders, may benefit from the use of plant and food-derived chemicals that have antidepressant or antiepileptic properties. We have summarized the present level of knowledge about natural products based on topological evidence, bioinformatics analysis, and translational research in this review. We have also highlighted some clinical research or investigation that will help us select natural products for the treatment of neurological conditions. In the present review, we have explored the potential efficacy of phytoconstituents against neurological diseases. Various evidence-based studies and extensive recent investigations have been included, which will help pharmacologists reduce the progression of neuronal disease.
Collapse
Affiliation(s)
- Vivek Puri
- Chitkara School of Pharmacy, Chitkara University, Baddi, Himachal Pradesh, India
| | - Neha Kanojia
- Chitkara School of Pharmacy, Chitkara University, Baddi, Himachal Pradesh, India
| | - Ameya Sharma
- Chitkara School of Pharmacy, Chitkara University, Baddi, Himachal Pradesh, India
| | - Kampanart Huanbutta
- School of Pharmacy, Eastern Asia University, Rangsit, Pathum Thani, Thailand
| | - Divya Dheer
- Chitkara School of Pharmacy, Chitkara University, Baddi, Himachal Pradesh, India
| | - Tanikan Sangnim
- Faculty of Pharmaceutical Sciences, Burapha University, Muang, Chon Buri, Thailand
| |
Collapse
|
16
|
Jensen-Willett S, Cunha A, Lobo MA, Harbourne R, Dusing SC, McCoy SW, Koziol NA, Hsu LY, Marcinowski EC, Babik I, An M, Bovaird JA. The Effect of Early-Life Seizures on Cognitive and Motor Development: A Case Series. Pediatr Phys Ther 2022; 34:425-431. [PMID: 35703307 DOI: 10.1097/pep.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This case series documents developmental changes over time and in response to a novel intervention, Sitting Together and Reaching to Play (START-Play), in children with early-life seizures. METHODS Thirteen children with early-life seizures were included from a subset of participants in the START-Play multisite, randomized controlled trial. Seven received 3 months of twice weekly START-Play intervention; 6 continued with usual care early intervention. Bayley Scales of Infant Development-III (Cognitive Composite), Gross Motor Function Measure-66 Item Set, Assessment of Problem-Solving in Play, and reaching assessments were administered at baseline, 3, 6, and 12 months postbaseline. Change scores are reported at 3 and 12 months postbaseline. RESULTS Over time, plateau or decline was noted in standardized cognition measures; motor development improved or was stable. Children receiving START-Play showed positive trends in problem-solving (71.4%) and reaching behaviors (57.2%). CONCLUSIONS Interventions such as START-Play that combine motor and cognitive constructs may benefit children with early-life seizures.
Collapse
Affiliation(s)
- Sandra Jensen-Willett
- Department of Physical Therapy (Dr Willett), Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska; Department of Physical Therapy (Drs Cunha and Lobo), Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware; Department of Physical Therapy (Dr Harbourne), Duquesne University, Pittsburgh, Pennsylvania; Division of Biokinesiology and Physical Therapy (Dr Dusing), University of Southern California, Los Angeles CA; Department of Rehabilitation Medicine (Drs Westcott-McCoy and Hsu), University of Washington, Seattle, Washington; Nebraska Center for Research on Children, Youth, Families and Schools (Drs Koziol and Bovaird), University of Nebraska-Lincoln, Lincoln, Nebraska; College of Human Science and Education (Dr Marcinowski), Louisiana State University, Baton Rouge, Louisiana; Department of Psychological Science (Dr Babik), Boise State University, Boise, Idaho; Department of Physical Therapy (Dr An), Kaya University, Gimhae-si, Gyeongsangnam-do, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Zhang J, Wu D, Yang H, Lu H, Ji Y, Liu H, Zang Z, Lu J, Sun W. Correlations Between Structural Brain Abnormalities, Cognition and Electroclinical Characteristics in Patients With Juvenile Myoclonic Epilepsy. Front Neurol 2022; 13:883078. [PMID: 35651335 PMCID: PMC9149597 DOI: 10.3389/fneur.2022.883078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the structural brain abnormality and its relationship with neuropsychological disorders and electroclinical characteristics in juvenile myoclonic epilepsy (JME) patients. Methods Sixty-seven patients diagnosed with JME and 56 healthy controls were enrolled. All subjects underwent MRI using T1-weighted 3D brain structural images with 1 mm thickness. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) analyses were performed. They also underwent a series of neuropsychological tests to assess cognitive function. The correlation analyses were conducted between structural changes, neuropsychological outcomes, and electroclinical features. Results The gray matter concentration (GMC) was decreased in the bilateral pre-central and post-central gyrus, right anterior cingulate gyrus, left posterior orbital region, bilateral occipital regions, bilateral hippocampus and bilateral caudate nucleus in the JME groups (corrected P < 0.05). The evaluation of gray matter volume (GMV) showed significant decrease respectively in bilateral pre-central and post-central gyrus, left paracentral lobule, left orbital gyrus, left amygdala, left basal ganglia and left thalamus of JME patients (P < 0.05). The cortex thicknesses of the right inferior temporal gyrus, right insular gyrus, and right cingulate gyrus had negative correlations with the disease duration significantly. At the same time, the whole-brain white matter volume was positively associated with the course of the disease (P < 0.05). Patients with persistent abnormal EEG discharges had significantly less whole-brain gray matter volume than JME patients with normal EEG (P = 0.03). Correlation analyses and linear regression analyses showed that, in addition to the gray matter volumes of frontal and parietal lobe, the temporal lobe, as well as the basal ganglia and thalamus, were also significantly correlated with neuropsychological tests' results (P < 0.05). Conclusion The JME patients showed subtle structural abnormalities in multiple brain regions that were not only limited to the frontal lobe but also included the thalamus, basal ganglia, parietal lobe, temporal lobe and some occipital cortex, with significant involvement of the primary somatosensory cortex and primary motor cortex. And we significantly demonstrated a correlation between structural abnormalities and cognitive impairment. In addition, the course of disease and abnormal discharges had a specific negative correlation with the structural changes.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Dan Wu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Haoran Yang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Hongjuan Lu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yichen Ji
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Huixin Liu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zhenxiang Zang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Sun
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| |
Collapse
|
18
|
Caciagli L, Paquola C, He X, Vollmar C, Centeno M, Wandschneider B, Braun U, Trimmel K, Vos SB, Sidhu MK, Thompson PJ, Baxendale S, Winston GP, Duncan JS, Bassett DS, Koepp MJ, Bernhardt BC. Disorganization of language and working memory systems in frontal versus temporal lobe epilepsy. Brain 2022; 146:935-953. [PMID: 35511160 PMCID: PMC9976988 DOI: 10.1093/brain/awac150] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a common comorbidity of epilepsy and adversely impacts people with both frontal lobe (FLE) and temporal lobe (TLE) epilepsy. While its neural substrates have been investigated extensively in TLE, functional imaging studies in FLE are scarce. In this study, we profiled the neural processes underlying cognitive impairment in FLE and directly compared FLE and TLE to establish commonalities and differences. We investigated 172 adult participants (56 with FLE, 64 with TLE and 52 controls) using neuropsychological tests and four functional MRI tasks probing expressive language (verbal fluency, verb generation) and working memory (verbal and visuo-spatial). Patient groups were comparable in disease duration and anti-seizure medication load. We devised a multiscale approach to map brain activation and deactivation during cognition and track reorganization in FLE and TLE. Voxel-based analyses were complemented with profiling of task effects across established motifs of functional brain organization: (i) canonical resting-state functional systems; and (ii) the principal functional connectivity gradient, which encodes a continuous transition of regional connectivity profiles, anchoring lower-level sensory and transmodal brain areas at the opposite ends of a spectrum. We show that cognitive impairment in FLE is associated with reduced activation across attentional and executive systems, as well as reduced deactivation of the default mode system, indicative of a large-scale disorganization of task-related recruitment. The imaging signatures of dysfunction in FLE are broadly similar to those in TLE, but some patterns are syndrome-specific: altered default-mode deactivation is more prominent in FLE, while impaired recruitment of posterior language areas during a task with semantic demands is more marked in TLE. Functional abnormalities in FLE and TLE appear overall modulated by disease load. On balance, our study elucidates neural processes underlying language and working memory impairment in FLE, identifies shared and syndrome-specific alterations in the two most common focal epilepsies and sheds light on system behaviour that may be amenable to future remediation strategies.
Collapse
Affiliation(s)
- Lorenzo Caciagli
- Correspondence to: Lorenzo Caciagli, MD, PhD Department of Bioengineering University of Pennsylvania, 240 Skirkanich Hall 210 South 33rd Street, Philadelphia, PA 19104, USA E-mail: ;
| | - Casey Paquola
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Quebec H3A 2B4, Canada
| | - Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Christian Vollmar
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Maria Centeno
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Epilepsy Unit, Hospital Clínic de Barcelona, IDIBAPS, 08036 Barcelona, Spain
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Urs Braun
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Centre for Medical Image Computing, University College London, London, UK,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Medicine, Division of Neurology, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Dani S Bassett
- Correspondence may also be addressed to: Dani S. Bassett, PhD E-mail:
| | | | | |
Collapse
|
19
|
Prospective Evaluation of Ghrelin and Des-Acyl Ghrelin Plasma Levels in Children with Newly Diagnosed Epilepsy: Evidence for Reduced Ghrelin-to-Des-Acyl Ghrelin Ratio in Generalized Epilepsies. J Pers Med 2022; 12:jpm12040527. [PMID: 35455643 PMCID: PMC9029558 DOI: 10.3390/jpm12040527] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
Children with epilepsy and identified as responders to antiseizure medications (ASMs) were found to present markedly higher ghrelin plasma levels when compared to drug-resistant patients. However, it was undetermined if this phenotype could be influenced by the ASMs. Here, we prospectively investigated total ghrelin and des-acyl ghrelin (DAG) plasma levels by enzyme-linked immunosorbent assay before and after ASM administration. Inclusion criteria were: (i) subject with a suspicion of epilepsy; (ii) age ranging from 0 to 16 years; and (iii) informed consent signed by parents or caregivers. Exclusion criteria were acute or chronic metabolic disorders with occasional convulsions but without epilepsy. Fifty patients were followed over a period of one year in Italian neuropediatric centers. Apart from a few exceptions, the majority of children were responsive to ASMs. No differences were found in total ghrelin and DAG levels before and after the treatment, but total ghrelin levels were significantly lower in children with generalized epilepsy compared to those with combined focal and generalized epilepsy. Moreover, the ghrelin-to-DAG ratio was also markedly lower in generalized epilepsies compared to all the other types of epilepsy. Finally, ghrelin was unchanged by ASMs, including the first (e.g., carbamazepine), second (levetiracetam), and third (lacosamide) generation of anticonvulsants.
Collapse
|
20
|
Rodriguez-Cruces R, Royer J, Larivière S, Bassett DS, Caciagli L, Bernhardt BC. Multimodal connectome biomarkers of cognitive and affective dysfunction in the common epilepsies. Netw Neurosci 2022; 6:320-338. [PMID: 35733426 PMCID: PMC9208009 DOI: 10.1162/netn_a_00237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/02/2022] [Indexed: 11/05/2022] Open
Abstract
Epilepsy is one of the most common chronic neurological conditions, traditionally defined as a disorder of recurrent seizures. Cognitive and affective dysfunction are increasingly recognized as core disease dimensions and can affect patient well-being, sometimes more than the seizures themselves. Connectome-based approaches hold immense promise for revealing mechanisms that contribute to dysfunction and to identify biomarkers. Our review discusses emerging multimodal neuroimaging and connectomics studies that highlight network substrates of cognitive/affective dysfunction in the common epilepsies. We first discuss work in drug-resistant epilepsy syndromes, that is, temporal lobe epilepsy, related to mesiotemporal sclerosis (TLE), and extratemporal epilepsy (ETE), related to malformations of cortical development. While these are traditionally conceptualized as ‘focal’ epilepsies, many patients present with broad structural and functional anomalies. Moreover, the extent of distributed changes contributes to difficulties in multiple cognitive domains as well as affective-behavioral challenges. We also review work in idiopathic generalized epilepsy (IGE), a subset of generalized epilepsy syndromes that involve subcortico-cortical circuits. Overall, neuroimaging and network neuroscience studies point to both shared and syndrome-specific connectome signatures of dysfunction across TLE, ETE, and IGE. Lastly, we point to current gaps in the literature and formulate recommendations for future research. Epilepsy is increasingly recognized as a network disorder characterized by recurrent seizures as well as broad-ranging cognitive difficulties and affective dysfunction. Our manuscript reviews recent literature highlighting brain network substrates of cognitive and affective dysfunction in common epilepsy syndromes, namely temporal lobe epilepsy secondary to mesiotemporal sclerosis, extratemporal epilepsy secondary to malformations of cortical development, and idiopathic generalized epilepsy syndromes arising from subcortico-cortical pathophysiology. We discuss prior work that has indicated both shared and distinct brain network signatures of cognitive and affective dysfunction across the epilepsy spectrum, improves our knowledge of structure-function links and interindividual heterogeneity, and ultimately aids screening and monitoring of therapeutic strategies.
Collapse
Affiliation(s)
- Raul Rodriguez-Cruces
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jessica Royer
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sara Larivière
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Dani S. Bassett
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104 USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom
| | - Boris C. Bernhardt
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
21
|
Gauffin H, Landtblom AM, Vigren P, Frick A, Engström M, McAllister A, Karlsson T. Similar Profile and Magnitude of Cognitive Impairments in Focal and Generalized Epilepsy: A Pilot Study. Front Neurol 2022; 12:746381. [PMID: 35095714 PMCID: PMC8790571 DOI: 10.3389/fneur.2021.746381] [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: 07/28/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Cognitive impairments in epilepsy are not well-understood. In addition, long-term emotional, interpersonal, and social consequences of the underlying disturbances are important to evaluate. Purpose: To compare cognitive function including language in young adults with focal or generalized epilepsy. In addition, quality of life and self-esteem were investigated. Patients and Methods: Young adults with no primary intellectual disability, 17 with focal epilepsy and 11 with generalized epilepsy participated and were compared to 28 healthy controls. Groups were matched on age (mean = 26 years), sex, and education. Participants were administered a battery of neuropsychological tasks and carried out self-ratings of quality of life, self-esteem, and psychological problems. Results: Similar impairments regarding cognitive function were noted in focal and generalized epilepsy. The cognitive domains tested were episodic long-term memory, executive functions, attention, working memory, visuospatial functions, and language. Both epilepsy groups had lower results compared to controls (effect sizes 0.24–1.07). The total number of convulsive seizures was predictive of episodic long-term memory function. Participants with focal epilepsy reported lower quality of life than participants with generalized epilepsy. Lowered self-esteem values were seen in both epilepsy groups and particularly in those with focal epilepsy. Along with measures of cognitive speed and depression, the total number of seizures explained more than 50% of variation in quality of life. Conclusion: Interestingly, similarities rather than differences characterized the widespread cognitive deficits that were seen in focal and generalized epilepsy, ranging from mild to moderate. These similarities were modified by quality of life and self-esteem. This study confirms the notion that epilepsy is a network disorder.
Collapse
Affiliation(s)
- Helena Gauffin
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden
| | - Anne-Marie Landtblom
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.,Neurology Division, Clinic of Medical Specialist, Motala General Hospital, Motala, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Patrick Vigren
- Department of Neurology, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences Linköping University, Linköping, Sweden
| | - Andreas Frick
- The Beijer Laboratory, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.,Department of Medical, Health and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anita McAllister
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Karlsson
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| |
Collapse
|
22
|
Genetic generalized epilepsies in adults - challenging assumptions and dogmas. Nat Rev Neurol 2022; 18:71-83. [PMID: 34837042 DOI: 10.1038/s41582-021-00583-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/16/2023]
Abstract
Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15-20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizures alone. However, in ~20% of patients with GGE, characteristics of more than one syndrome are present. Novel insights into the genetic aetiology, comorbidities and prognosis of the GGE syndromes have emerged and challenge traditional concepts about these conditions. Evidence has shown that the mode of inheritance in GGE is mostly polygenic. Neuropsychological and imaging studies indicate similar abnormalities in unaffected relatives of patients with GGE, supporting the concept that underlying alterations in bilateral frontothalamocortical networks are genetically determined. Contrary to popular belief, first-line anti-seizure medication often fails to provide seizure freedom in combination with good tolerability. Nevertheless, long-term follow-up studies have shown that with advancing age, many patients can discontinue their anti-seizure medication without seizure relapses. Several outcome predictors have been identified, but prognosis across the syndromes is more homogeneous than previously assumed. Overall, overlap in pathophysiology, seizure types, treatment responses and outcomes support the idea that GGEs are not separate nosological entities but represent a neurobiological continuum.
Collapse
|
23
|
Li T, Niu S, Qiu X, Zhai Z, Yang L, Chen L, Zhang XM. Altered Cerebral Blood Flow is Linked to Disease Duration in Patients with Generalized tonic‒clonic Seizures. Neuropsychiatr Dis Treat 2022; 18:2649-2659. [PMID: 36387946 PMCID: PMC9662018 DOI: 10.2147/ndt.s386509] [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: 08/17/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate cerebral blood flow (CBF) characteristics in individuals with generalized tonic‒clonic seizures (GTCS) during the interictal phase using voxel-based analysis of 3D pseudocontinuous arterial spin labeling (PCASL). PATIENTS AND METHODS Patients with GTCS (GTCS group) (during the interictal period) and healthy volunteers (control group) underwent head MR imaging with a 3.0T MR scanner with a 3D PCASL sequence. CBF was compared between the two groups. Spearman correlations of CBF in regions of interest (ROIs) in GTCS patients with the duration of disease and age of onset were analyzed and corrected using the false discovery rate (FDR). RESULTS Twenty patients with GTCS (GTCS group) and twenty healthy volunteers (control group) were recruited for this study. On 3D PCASL, (1) GTCS patients had lower CBF in the brainstem, right cerebellum, right inferior temporal gyrus, parahippocampal gyrus, superior frontal gyrus, middle frontal gyrus, triangular part of inferior frontal gyrus, left temporal pole of superior temporal gyrus and thalamus and had higher CBF in the bilateral superior parietal gyri, precuneus, precentral gyri, postcentral gyri, and left dorsolateral superior frontal gyrus than controls. (2) The CBF of the right temporal pole of the middle temporal gyrus was negatively correlated with the duration of disease (PFDRcorrected<0.05), with a correlation coefficient r of -0.7333 and a PFDRcorrected value of 0.04. CONCLUSION Voxel-based analysis of 3D PCASL imaging can be used to sensitively detect brain perfusion differences in GTCS patients. The decrease in CBF in the right temporal pole of the middle temporal gyrus may be associated with disease onset. These findings may offer new perspectives on the pathogenesis of GTCS and the underlying pathophysiological changes associated with perfusion.
Collapse
Affiliation(s)
- Ting Li
- The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China.,Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Shaowei Niu
- Department of Infection, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Xiang Qiu
- Department of Radiology, Integrated TCM & Western Medicine Hospital Affiliated to Chengdu University of TCM, Chengdu First People's Hospital, Chengdu, People's Republic of China
| | - Zhaohua Zhai
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Lin Yang
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Li Chen
- Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Xiao Ming Zhang
- The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China.,Medical Imaging Key Laboratory of Sichuan Province, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| |
Collapse
|
24
|
Puteikis K, Wolf P, Mameniškienė R. Accelerated long-term forgetting in adult patients with genetic generalized epilepsy. Epilepsia 2021; 63:474-482. [PMID: 34893974 DOI: 10.1111/epi.17144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Accelerated long-term forgetting (ALF) has been demonstrated among children but not adults with genetic generalized epilepsy (GGE). We investigated (1) how forgetting patterns of verbal and visuospatial material differ between patients with GGE and healthy controls (HCs) and (2) whether ALF is associated with ictal or interictal epileptic activity. METHODS Forty-two patients with GGE (39, 92.9% experiencing seizures) were compared to 57 HCs in word, logical story, and Rey-Osterrieth complex figure recall tasks by testing after intervals of 30 min and 4 weeks. Ambulatory electroencephalography (EEG) was performed before testing to detect generalized epileptic activity, and patients were asked to document the number of seizures during the 4-week interval. RESULTS A two-way repeated measures ANOVA indicated that individuals with GGE have different forgetting patterns in comparison to HCs in tasks of word (delay by group interaction F1.5, 142.5 = 4.5, p = .02, η p 2 = .04) and figure (F2, 194 = 15.9, p < .001, η p 2 = .14) but not story (F1.6 151.1 = .5, p = .58, η p 2 = .005) recall. Last learning trial-adjusted scores of word recall were comparable between HCs and patients with epilepsy (PWEs) at 30 min (p = .21) but not at 4 weeks (p = .006). Individuals with GGE performed worse than HCs in figure recall at 30 min and 4 weeks (p < .001), with lower performance after the 4-week interval present only among seizure-positive and EEG-positive individuals (p < .001) during subgroup analysis. Performance on memory tests was unrelated to overall seizure frequency, the number of antiseizure drugs used, and epilepsy duration. SIGNIFICANCE Our study supports the presence of ALF in a task of word recall among adult patients with GGE. The pattern of forgetting visuospatial information suggests greater forgetting of material before the first delay and ongoing deficits among PWEs with epileptic activity. Future studies should confirm our findings and investigate the functional or pathological mechanisms of memory dysfunction in GGE.
Collapse
Affiliation(s)
| | - Peter Wolf
- Center for Neurology, Vilnius University, Vilnius, Lithuania.,Danish Epilepsy Center Filadelfia, Dianalund, Denmark.,Postgraduation Program of Medical Sciences, Santa Catarina Federal University, Florianópolis, Brazil
| | | |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Chen Y, Fallon N, Kreilkamp BAK, Denby C, Bracewell M, Das K, Pegg E, Mohanraj R, Marson AG, Keller SS. Probabilistic mapping of thalamic nuclei and thalamocortical functional connectivity in idiopathic generalised epilepsy. Hum Brain Mapp 2021; 42:5648-5664. [PMID: 34432348 PMCID: PMC8559489 DOI: 10.1002/hbm.25644] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
It is well established that abnormal thalamocortical systems play an important role in the generation and maintenance of primary generalised seizures. However, it is currently unknown which thalamic nuclei and how nuclear‐specific thalamocortical functional connectivity are differentially impacted in patients with medically refractory and non‐refractory idiopathic generalised epilepsy (IGE). In the present study, we performed structural and resting‐state functional magnetic resonance imaging (MRI) in patients with refractory and non‐refractory IGE, segmented the thalamus into constituent nuclear regions using a probabilistic MRI segmentation method and determined thalamocortical functional connectivity using seed‐to‐voxel connectivity analyses. We report significant volume reduction of the left and right anterior thalamic nuclei only in patients with refractory IGE. Compared to healthy controls, patients with refractory and non‐refractory IGE had significant alterations of functional connectivity between the centromedian nucleus and cortex, but only patients with refractory IGE had altered cortical connectivity with the ventral lateral nuclear group. Patients with refractory IGE had significantly increased functional connectivity between the left and right ventral lateral posterior nuclei and cortical regions compared to patients with non‐refractory IGE. Cortical effects were predominantly located in the frontal lobe. Atrophy of the anterior thalamic nuclei and resting‐state functional hyperconnectivity between ventral lateral nuclei and cerebral cortex may be imaging markers of pharmacoresistance in patients with IGE. These structural and functional abnormalities fit well with the known importance of thalamocortical systems in the generation and maintenance of primary generalised seizures, and the increasing recognition of the importance of limbic pathways in IGE.
Collapse
Affiliation(s)
- Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nicholas Fallon
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | | | - Martyn Bracewell
- The Walton Centre NHS Foundation Trust, Liverpool, UK.,Schools of Medical Sciences and Psychology, Bangor University, Bangor, UK
| | - Kumar Das
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily Pegg
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Rajiv Mohanraj
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
27
|
Dharan AL, Bowden SC, Lai A, Peterson ADH, Cheung MWL, Woldman W, D'Souza WJ. Resting-state functional connectivity in the idiopathic generalized epilepsies: A systematic review and meta-analysis of EEG and MEG studies. Epilepsy Behav 2021; 124:108336. [PMID: 34607215 DOI: 10.1016/j.yebeh.2021.108336] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 11/20/2022]
Abstract
For idiopathic generalized epilepsies (IGE), brain network analysis is emerging as a biomarker for potential use in clinical care. To determine whether people with IGE show alterations in resting-state brain connectivity compared to healthy controls, and to quantify these differences, we conducted a systematic review and meta-analysis of EEG and magnetoencephalography (MEG) functional connectivity and network studies. The review was conducted according to PRISMA guidelines. Twenty-two studies were eligible for inclusion. Outcomes from individual studies supported hypotheses for interictal, resting-state brain connectivity alterations in IGE patients compared to healthy controls. In contrast, meta-analysis from six studies of common network metrics clustering coefficient, path length, mean degree and nodal strength showed no significant differences between IGE and control groups (effect sizes ranged from -0.151 -1.78). The null findings of the meta-analysis and the heterogeneity of the included studies highlights the importance of developing standardized, validated methodologies for future research. Network neuroscience has significant potential as both a diagnostic and prognostic biomarker in epilepsy, though individual variability in network dynamics needs to be better understood and accounted for.
Collapse
Affiliation(s)
- Anita L Dharan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia; Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Andre D H Peterson
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Mike W-L Cheung
- Department of Psychology, National University of Singapore, Singapore
| | - Wessel Woldman
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Edgbaston, United Kingdom
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| |
Collapse
|
28
|
Guerrero-Molina MP, Rodriguez-López C, Panadés-de Oliveira L, Uriarte-Pérez de Urabayen D, Garzo-Caldas N, García-Cena CE, Saiz-Díaz RA, Benito-León J, Gonzalez de la Aleja J. Antisaccades and memory-guided saccades in genetic generalized epilepsy and temporal lobe epilepsy. Epilepsy Behav 2021; 123:108236. [PMID: 34419714 DOI: 10.1016/j.yebeh.2021.108236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Oculomotor tasks can be used to measure volitional control of behavior sensitive to frontal dysfunction. This study aimed to examine the saccadic eye movement in Genetic Generalized Epilepsy (GGE) which could correlate with the abnormality of the frontal lobe or the thalamo-frontal network. METHODS Twenty-one patients with GGE were compared with 22 patients with Temporal Lobe Epilepsy (TLE) and 39 healthy controls. Visual-guided saccades, Antisaccades, and Memory-guided saccades as oculomotor tasks were performed using a novel gaze-tracker designed for clinical practice use. RESULTS Patients with epilepsy (either GEE or TLE) had similar latency, accuracy, and velocity in visual-guided saccades and memory-guided saccades. Patients with epilepsy had similar latencies and correct antisaccade number. However, healthy volunteers, matched by age, had faster responses and more accurate results than patients with epilepsy. CONCLUSIONS Our investigations did not reveal differences between TLE and GGE patients' groups in visually guided saccades, antisaccades, and memory-guided saccades, thus suggesting that the frontal cortical mechanisms responsible for them are not explicitly impaired in patients with GGE.
Collapse
Affiliation(s)
| | | | | | | | | | - Cecilia E García-Cena
- Centre for Automation and Robotics, Universidad Politécnica de Madrid, 28012 Madrid, Spain.
| | - Rosa A Saiz-Díaz
- 12th of October University Hospital, Avenida Córdoba S/N, 28041 Madrid, Spain
| | - Julián Benito-León
- 12th of October University Hospital, Avenida Córdoba S/N, 28041 Madrid, Spain
| | | |
Collapse
|
29
|
Sager G, Vatansever Z, Batu U, Çağ Y, Akin Y. Neuropsychiatric comorbidities in genetic/idiopathic generalized epilepsies and their effects on psychosocial outcomes. Epilepsy Behav 2021; 124:108339. [PMID: 34600282 DOI: 10.1016/j.yebeh.2021.108339] [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: 06/30/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Idiopathic/genetic generalized epilepsy (GGE) accounts for 15-20% of all epilepsy cases. Neuropsychiatric comorbidities and disorders, such as attention-deficit hyperactivity disorder (ADHD), academic failure, and poor social competence, are present at a higher rate in patients with epilepsy compared with the general population. In this study, we aimed to determine the frequency of neuropsychiatric comorbidities in GGE subgroups, and to reveal the risk factors in the patient group with neuropsychiatric comorbidities. MATERIAL AND METHOD This hospital-based, cross-sectional study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients with seizure-controlled GGE were invited to a semi-structured interview at the hospital. Variables [photosensitivity, valproic acid (VPA) resistance, timing of the neuropsychiatric comorbidities Attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and low academic performance), seizure control, and timing of the antiepileptic treatment] were statistically analyzed and evaluated in terms of their association with GGE subgroups [Generalized tonic-clonic seizures alone (EGTGS), juvenile myoclonic epilepsy (JME), and juvenile absence epilepsy (JAE)], RESULTS: Total 101 patients with GGE were included in the study and the mean age was 13.94 ± 1.66 years. A total of 12.9% (n = 13) of the patients had EGTGS, 49.5% (n = 50) had JME, and 37.6% (n = 38) had JAE. VPA resistance, photosensitivity, and the presence of neuropsychiatric symptoms before the starting of epilepsy were found to be risk factors in the GGE group with neuropsychiatric comorbidities compared with the group without neuropsychiatric comorbidities (p < 0.001). The subgroups of GGE did not show any relationship with psychiatric disorders, including ADHD, ODD, and low academic performance (neuropsychiatric comorbidities) (p > 0.005). No correlation was found between seizure control and decline in neuropsychiatric symptoms (p > 0.05). CONCLUSION In this study, the onset of psychiatric symptoms prior to the onset of epilepsy, photosensitivity, and VPA resistance were the most important factors affecting neuropsychiatric comorbidities. The JME, JAE, and EGTCS subgroups, early initiation of antiepileptic treatment, and seizure control were found to have no effect on poor psychosocial outcome and neuropsychiatric comorbidities.
Collapse
Affiliation(s)
- Gunes Sager
- Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Zeynep Vatansever
- Department of Child and Adolescent Psychiatry Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Utku Batu
- Department of Pediatrics, Van Education and Research Hospital, Van, Turkey
| | - Yakup Çağ
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Yasemin Akin
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| |
Collapse
|
30
|
Denervaud S, Korff C, Fluss J, Kalser J, Roulet-Perez E, Hagmann P, Lebon S. Structural brain abnormalities in epilepsy with myoclonic atonic seizures. Epilepsy Res 2021; 177:106771. [PMID: 34562678 DOI: 10.1016/j.eplepsyres.2021.106771] [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: 06/01/2021] [Revised: 08/22/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Epilepsy with myoclonic atonic seizure (EMAS) occurs in young children with previously normal to subnormal development. The outcome ranges from seizure freedom with preserved cognitive abilities to refractory epilepsy with intellectual disability (ID). Routine brain imaging typically shows no abnormalities. We aimed to compare the brain morphometry of EMAS patients with healthy subjects several years after epilepsy onset, and to correlate it to epilepsy severity and cognitive findings. METHODS Fourteen EMAS patients (4 females, 5-14 years) and 14 matched healthy controls were included. Patients were classified into three outcome groups (good, intermediate, poor) according to seizure control and cognitive and behavioral functioning. Individual anatomical data (T1-weighted sequence) were processed using the FreeSurfer pipeline. Cortical volume (CV), cortical thickness (CT), local gyrification index (LGI), and subcortical volumes were used for group-comparison and linear regression analyses. RESULTS Morphometric comparison between EMAS patients and healthy controls revealed that patients have 1) reduced CV in frontal, temporal and parietal lobes (p = <.001; 0.009 and 0.024 respectively); 2) reduced CT and LGI in frontal lobes (p = 0.036 and 0.032 respectively); and 3) a neat cerebellar volume reduction (p = 0.011). Neither the number of anti-seizure medication nor the duration of epilepsy was related to cerebellar volume (both p > 0.62). Poor outcome group was associated with lower LGI. Patients in good and intermediate outcome groups had a comparable LGI to their matched healthy controls (p > 0.27 for all lobes). CONCLUSIONS Structural brain differences were detectable in our sample of children with EMAS, mainly located in the frontal lobes and cerebellum. These findings are similar to those found in patients with genetic/idiopathic generalized epilepsies. Outcome groups correlated best with LGI. Whether these anatomical changes reflect genetically determined abnormal neuronal networks or a consequence of sustained epilepsy remains to be solved with prospective longitudinal studies.
Collapse
Affiliation(s)
- Solange Denervaud
- Radiology Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Christian Korff
- Pediatric Neurology Unit, Geneva Children's Hospital, Geneva, Switzerland
| | - Joël Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, Geneva, Switzerland
| | - Judith Kalser
- Pediatric Neurology and Neurorehabilitation Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Eliane Roulet-Perez
- Pediatric Neurology and Neurorehabilitation Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Patric Hagmann
- Radiology Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Sébastien Lebon
- Pediatric Neurology and Neurorehabilitation Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland.
| |
Collapse
|
31
|
Executive Functions and Attention in Childhood Epilepsies: A Neuropsychological Hallmark of Dysfunction? J Int Neuropsychol Soc 2021; 27:673-685. [PMID: 33183389 DOI: 10.1017/s1355617720001125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with epilepsy are at risk for several lifetime problems, in which neuropsychological impairments may represent an impacting factor. We evaluated the neuropsychological functions in children suffering from three main epilepsy categories. Further, we analyzed the longitudinal evolution of the neuropsychological profile over time. METHODS Patients undergoing neuropsychological evaluation at our Department from 2012 to 2018 were identified retrospectively. We selected patients aged 6-16 years and with at least two evaluations. Three epilepsy categories were considered: focal/structural, focal self-limited, and idiopathic generalized. Each evaluation included the same structured assessment of main neuropsychological domains. The effect of the epilepsy category, illness duration, seizure status, and medication was computed in multilevel models. RESULTS We identified 103 patients (focal self-limited = 27; focal/structural = 51; and idiopathic generalized = 25), for 233 evaluations. The majority of deficits were reported in attention and executive functions (>30% of patients); the results were dichotomized to obtain global indexes. Multilevel models showed a trend toward statistical significance of category of epilepsy on the global executive index and of illness duration on global attention index. Illness duration predicted the scores of executive and attention tasks, while category and medication predicted executive task performance. Focal/structural epilepsies mostly affected the executive domain, with deficits persisting over time. By contrast, an ameliorative effect of illness duration for attention was documented in all epilepsies. CONCLUSIONS This study offers lacking information about the evolution of deficits in time, the role of epilepsy category, and possible psychological implications for high-order cognitive skills, central in several social and academic problems.
Collapse
|
32
|
Luca A, Giuliano L, Manna R, D'Agate C, Maira G, Sofia V, Nicoletti A, Zappia M. Impulsivity traits in eyelid myoclonia with absences. Seizure 2021; 91:393-396. [PMID: 34298458 DOI: 10.1016/j.seizure.2021.07.006] [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: 03/07/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Eyelid myoclonia with absences (EMA) shares some clinical characteristics with juvenile myoclonic epilepsy (JME), in which impulsivity traits have been described. Aim of the study was to evaluate whether EMA patients could present a peculiar behavioural profile. METHODS Patients with EMA, JME and healthy controls (HCs) were enrolled. Subjects with intellectual quotient <80 were excluded from the study. All the enrolled subjects underwent the Italian version of the Barratt Impulsiveness Scale (BIS-11) and the three dimensions of impulsivity (motor, attentional-cognitive and nonplanning impulsivity) were considered. RESULTS Seventeen patients with EMA (12 females [70.6%], age 30.8±10 years), 29 patients with JME (17 females [58.6%], age 29.1±9.7 years) and 31 HCs (15 females [48.4%], age 27.6±5.8 years) were enrolled. Both EMA and JME patients presented a borderline significantly higher BIS total score than HCs (p=0.064). EMA patients presented a significantly higher BIS nonplanning subscore than JME patients and HCs (p=0.001). CONCLUSION The study showed the presence of peculiar behavioral characteristics in EMA patients, slightly different from patients with JME.
Collapse
Affiliation(s)
- Antonina Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Roberta Manna
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Concetta D'Agate
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Giulia Maira
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, via Santa Sofia 78, 95123 Catania, Italy.
| |
Collapse
|
33
|
Abstract
Reflex seizures (RS) are epileptic events that are objectively and consistently elicited in response to a specific afferent stimulus or by an activity of the patient. The specific stimulus can be a variety of heterogenous intrinsic or extrinsic factors, ranging from the simple to the complex, such as flashing lights or reading a book. These seizures can take a variety of forms, comprising either general or focal onset, with or without secondary generalization. Reflex epilepsies (RE) are classified as a specific syndrome in which all epileptic seizures are precipitated by sensory stimuli. The few designated RE include idiopathic photosensitive occipital lobe epilepsy, other visual sensitive epilepsies, primary reading epilepsy, and startle epilepsy. RS that occurs within other focal or generalized epilepsy syndromes that are associated with distinct spontaneous seizures are classified by the overarching seizure type. Most patients experience spontaneous seizures along with their provoked events. RS originate from stimulation of functional anatomic networks normally functioning for physiological activities, that overlap or coincide with regions of cortical hyperexcitability. Generalized RS typically occur within the setting of IGEs and should be considered as focal seizures with quick secondary generalization via cortico-cortical or cortico-reticular pathways. In aggregate, activation of a critical neuronal mass, supported and sustained by cortico-subcortical and thalamocortical pathways eventually result in a seizure. Treatment includes antiseizure medication, commonly valproate or levetiracetam, along with lifestyle modifications, and when amenable, surgical intervention. High clinical suspicion and careful history taking must be employed in all epilepsy patients to identify reflex triggers.
Collapse
Affiliation(s)
- Samrina Hanif
- 1Department of Neurology, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| | - Shane T Musick
- 2Department of Neurosurgery, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| |
Collapse
|
34
|
Sitnikova E, Smirnov K. Active avoidance learning in WAG/Rij rats with genetic predisposition to absence epilepsy. Brain Res Bull 2020; 165:198-208. [DOI: 10.1016/j.brainresbull.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
|
35
|
Joplin S, Webster R, Gill D, Barton B, Lawson JA, Mandalis A, Sabaz M, Gascoigne M, Lah S. Accelerated long-term forgetting in children with genetic generalized epilepsy: The temporal trajectory and contribution of executive skills. Epilepsy Behav 2020; 113:107471. [PMID: 33142199 DOI: 10.1016/j.yebeh.2020.107471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Long-term memory, which is critical for social and vocational functioning, is impaired in children with genetic generalized epilepsy (GGE). In this study, we examined the relationship between the temporal pattern of long-term forgetting for visual and verbal materials and executive skills in children with GGE. METHOD Thirty-two children, 17 with GGE and 25 typically developing age-matched controls completed standardized tests of short-term memory (recall after a 30-minute delay), executive skills, and experimental long-term memory tasks (one verbal and one visual) involving recall after one short (30-minute), and two long (1-day, 2-week) delays. RESULTS On the long-term visual memory task, children with GGE performed comparably with typically developing children at a 30-minute delay (p = .298), although obtained lower object placement accuracy score, at 1 day (p = .039) and at 2 weeks (p = .022) relative to typically developing children. On the verbal task, the between-group difference was not significant at any delay. In children with GGE, poorer object placement accuracy at two weeks correlated with lower visuospatial short-term memory (r = -0.624, p = .005) and verbal working memory (r = -0.448, p = .041). CONCLUSIONS This study provided several novel findings. For the first time, accelerated long-term forgetting (ALF) was found in long-term visual memory in children with GGE, despite comparable learning and recall at 30 min. Study results indicated that deficits in long-term visual memory are present after one day, increase over time, and may relate to reduced executive skills. Our findings can be used to inform our understanding of the temporal trajectory of ALF and contribution of executive skills.
Collapse
Affiliation(s)
- Samantha Joplin
- School of Psychology, The University of Sydney, NSW 2006, Australia
| | - Richard Webster
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Deepak Gill
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, The University of Sydney, Australia
| | - John A Lawson
- Department of Neurology, Sydney Children's Hospital, Sydney, Australia
| | - Anna Mandalis
- Department of Psychology, Sydney Children's Hospital, Sydney, Australia
| | - Mark Sabaz
- Department of Psychology, Sydney Children's Hospital, Sydney, Australia
| | - Michael Gascoigne
- School of Psychology, The University of Sydney, NSW 2006, Australia; School of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, NSW 2006, Australia.
| |
Collapse
|
36
|
Helmstaedter C, Sadat-Hossieny Z, Kanner AM, Meador KJ. Cognitive disorders in epilepsy II: Clinical targets, indications and selection of test instruments. Seizure 2020; 83:223-231. [PMID: 33172763 DOI: 10.1016/j.seizure.2020.09.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022] Open
Abstract
This is the second of two narrative reviews on cognitive disorders in epilepsy (companion manuscript: Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations). Its focus is on the clinical targets, indications, and the selection of neuropsychological test instruments. Cognitive assessment has become an essential tool for the diagnosis and outcome control in the clinical management of epilepsy. The diagnostics of basic and higher brain functions can provide valuable information on lateralized and localized brain dysfunctions associated with epilepsy, its underlying pathologies and treatment. In addition to the detection or verification of deficits, neuropsychology reveals the patient's cognitive strengths and, thus, information about the patient reserve capacities for functional restitution and compensation. Neuropsychology is an integral part of diagnostic evaluations mainly in the context of epilepsy surgery to avoid new or additional damage to preexisting neurocognitive impairments. In addition and increasingly, neuropsychology is being used as a tool for monitoring of the disease and its underlying pathologies, and it is suited for the quality and outcome control of pharmacological or other non-invasive medical intervention. This narrative review summarizes the present state of neuropsychological assessments in epilepsy, reveals diagnostic gaps, and shows the great need for education, homogenization, translation and standardization of instruments.
Collapse
Affiliation(s)
- C Helmstaedter
- University Clinic Bonn, Department of Epileptology, Germany.
| | - Z Sadat-Hossieny
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
| | - A M Kanner
- University of Miami Health System, Uhealth Neurology, 1150 NW 14th St #609, Miami, FL 33136, USA
| | - K J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979, CA, 94304, USA
| |
Collapse
|
37
|
Galimberti S, Baldini C, Baratè C, Ricci F, Balducci S, Grassi S, Ferro F, Buda G, Benedetti E, Fazzi R, Baglietto L, Lucenteforte E, Di Paolo A, Petrini M. The CoV-2 outbreak: how hematologists could help to fight Covid-19. Pharmacol Res 2020; 157:104866. [PMID: 32387301 PMCID: PMC7202852 DOI: 10.1016/j.phrs.2020.104866] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 02/08/2023]
Abstract
COVID-19 is a medical emergency, with 20 % of patients presenting with severe clinical manifestations. From the pathogenetic point of view, COVID-19 mimics two other well-known diseases characterized by cytokine storm and hyper-activation of the immune response, with consequent organ damage: acute graft-versus-host disease (aGVHD) and macrophage activation syndrome (MAS). Hematologists are confident with these situations requiring a prompt therapeutic approach for switching off the uncontrolled cytokine release; here, we discuss pros and cons of drugs that are already employed in hematology in the light of their possible application in COVID-19. The most promising drugs might be: Ruxolitinib, a JAK1/2 inhibitor, with a rapid and powerful anti-cytokine effect, tyrosine kinase inhibitors (TKIs), with their good anti-inflammatory properties, and perhaps the anti-Cd26 antibody Begelomab. We also present immunological data from gene expression experiments where TKIs resulted effective anti-inflammatory and pro-immune drugs. A possible combined treatment algorithm for COVID-19 is here proposed.
Collapse
Affiliation(s)
- Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Federica Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Serena Balducci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Susanna Grassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Buda
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|