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Byington CG, Goodman AM, Allendorfer JB, Correia S, LaFrance WC, Szaflarski JP. Decreased uncinate fasciculus integrity in functional seizures following traumatic brain injury. Epilepsia 2024; 65:1060-1071. [PMID: 38294068 DOI: 10.1111/epi.17896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The uncinate fasciculus (UF) has been implicated previously in contributing to the pathophysiology of functional (nonepileptic) seizures (FS). FS are frequently preceded by adverse life events (ALEs) and present with comorbid psychiatric symptoms, yet neurobiological correlates of these factors remain unclear. To address this gap, using advanced diffusion magnetic resonance imaging (dMRI), UF tracts in a large cohort of patients with FS and pre-existing traumatic brain injury (TBI + FS) were compared to those in patients with TBI without FS (TBI-only). We hypothesized that dMRI measures in UF structural connectivity would reveal UF differences when controlling for TBI status. Partial correlation tests assessed the potential relationships with psychiatric symptom severity measures. METHODS Participants with TBI-only (N = 46) and TBI + FS (N = 55) completed a series of symptom questionnaires and MRI scanning. Deterministic tractography via diffusion spectrum imaging (DSI) was implemented in DSI studio (https://dsi-studio.labsolver.org) with q-space diffeomorphic reconstruction (QSDR), streamline production, and manual segmentation to assess bilateral UF integrity. Fractional anisotropy (FA), radial diffusivity (RD), streamline counts, and their respective asymmetry indices (AIs) served as estimates of white matter integrity. RESULTS Compared to TBI-only, TBI + FS participants demonstrated decreased left hemisphere FA and RD asymmetry index (AI) for UF tracts (both p < .05, false discovery rate [FDR] corrected). Additionally, TBI + FS reported higher symptom severity in depression, anxiety, and PTSD measures (all p < .01). Correlation tests comparing UF white matter integrity differences to psychiatric symptom severity failed to reach criteria for significance (all p > .05, FDR corrected). SIGNIFICANCE In a large, well-characterized sample, participants with FS had decreased white matter health after controlling for the history of TBI. Planned follow-up analysis found no evidence to suggest that UF connectivity measures are a feature of group differences in mood or anxiety comorbidities for FS. These findings suggest that frontolimbic structural connectivity may play a role in FS symptomology, after accounting for prior ALEs and comorbid psychopathology severity.
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Affiliation(s)
- Caroline G Byington
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam M Goodman
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane B Allendorfer
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephen Correia
- Departments of Psychiatry and Neurology, Veterans Affairs Providence Healthcare System, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Veterans Affairs Providence Healthcare System, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Jerzy P Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Departments of Neurobiology and Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Szaflarski JP, Allendorfer JB, Begnaud J, Ranuzzi G, Shamshiri E, Verner R. Optimized microburst VNS elicits fMRI responses beyond thalamic-specific response from standard VNS. Ann Clin Transl Neurol 2024. [PMID: 38532258 DOI: 10.1002/acn3.52029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE In parallel to standard vagus nerve stimulation (VNS), microburst stimulation delivery has been developed. We evaluated the fMRI-related signal changes associated with standard and optimized microburst stimulation in a proof-of-concept study (NCT03446664). METHODS Twenty-nine drug-resistant epilepsy patients were prospectively implanted with VNS. Three 3T fMRI scans were collected 2 weeks postimplantation. The maximum tolerated VNS intensity was determined prior to each scan starting at 0.125 mA with 0.125 mA increments. FMRI scans were block-design with alternating 30 sec stimulation [ON] and 30 sec no stimulation [OFF]: Scan 1 utilized standard VNS and Scan 3 optimized microburst parameters to determine target settings. Semi-automated on-site fMRI data processing utilized ON-OFF block modeling to determine VNS-related fMRI activation per stimulation setting. Anatomical thalamic mask was used to derive highest mean thalamic t-value for determination of microburst stimulation parameters. Paired t-tests corrected at P < 0.05 examined differences in fMRI responses to each stimulation type. RESULTS Standard and microburst stimulation intensities at Scans 1 and 3 were similar (P = 0.16). Thalamic fMRI responses were obtained in 28 participants (19 with focal; 9 with generalized seizures). Group activation maps showed standard VNS elicited thalamic activation while optimized microburst VNS showed widespread activation patterns including thalamus. Comparison of stimulation types revealed significantly greater cerebellar, midbrain, and parietal fMRI signal changes in microburst compared to standard VNS. These differences were not associated with seizure responses. INTERPRETATION While standard and optimized microburst VNS elicited thalamic activation, microburst also engaged other brain regions. Relationship between these fMRI activation patterns and clinical response warrants further investigation. CLINICAL TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT03446664).
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Allendorfer JB, Nenert R, Goodman AM, Kakulamarri P, Correia S, Philip NS, LaFrance WC, Szaflarski JP. Brain network entropy, depression, and quality of life in people with traumatic brain injury and seizure disorders. Epilepsia Open 2024. [PMID: 38507279 DOI: 10.1002/epi4.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Traumatic brain injury (TBI) often precedes the onset of epileptic (ES) or psychogenic nonepileptic seizures (PNES) with depression being a common comorbidity. The relationship between depression severity and quality of life (QOL) may be related to resting-state network complexity. We investigated these relationships in adults with TBI-only, TBI + ES, or TBI + PNES using Sample Entropy (SampEn), a measure of physiologic signals complexity. METHODS Adults with TBI-only (n = 60), TBI + ES (n = 21), or TBI + PNES (n = 56) completed the Beck Depression Inventory-II (BDI-II; depression symptom severity) and QOL in Epilepsy (QOLIE-31) assessments and underwent resting-state functional magnetic resonance imaging (rs-fMRI). SampEn values derived from six resting state functional networks were calculated per participant. Effects of group, network, and group-by-network-interactions for SampEn were investigated with a mixed-effects model. We examined relationships between BDI-II, QOL, and SampEn of each of the networks. RESULTS Groups did not differ in age, but there was a higher proportion of women with TBI + PNES (p = 0.040). TBI + ES and TBI-only groups did not differ in BDI-II or QOLIE-31 scores, while the TBI + PNES group scored worse on both measures. The fixed effects of the model revealed significant differences in SampEn values across networks (lower SampEn for the frontoparietal network compared to other networks). The likelihood ratio test for group-by-network-interactions was significant (p = 0.033). BDI-II was significantly negatively associated with Overall QOL scale scores in all groups, and significantly negatively associated with network SampEn values only in the TBI + PNES group. SIGNIFICANCE Only TBI + PNES had significant relationships between depression symptom severity and network SampEn values indicating that the resting state network complexity is related to depression severity in this group but not in TBI + ES or TBI-only. PLAIN LANGUAGE SUMMARY The brain has a complex network of internal connections. How well these connections work may be affected by TBI and seizures and may underlie mental health symptoms including depression; the worse the depression, the worse the quality of life. Our study compared brain organization in people with TBI, people with epilepsy after TBI, and people with nonepileptic seizures after TBI. Only people with nonepileptic seizures after TBI showed a relationship between how organized their brain connections were and how bad was their depression. We need to better understand these relationships to develop more impactful, effective treatments.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam M Goodman
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pranav Kakulamarri
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephen Correia
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - W Curt LaFrance
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Neurology, Brown University, Providence, Rhode Island, USA
- Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Middlebrooks EH, Szaflarski JP, Begnaud J, Thaker A, Henderson K, Bolding M, Sellers JA, Allendorfer JB. Compatibility of standard vagus nerve stimulation and investigational microburst vagus nerve stimulation therapy with functional magnetic resonance imaging. AJNR Am J Neuroradiol 2024:ajnr.A8235. [PMID: 38448165 DOI: 10.3174/ajnr.a8235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
Vagus nerve stimulation devices are conditionally approved in MRI with stimulation turned off and the requirement to modify the stimulation settings may be a barrier to scanning in some radiology practices. There is increasing interest in studying the effects of stimulation during MRI/fMRI. This study evaluated the safety of standard and investigational microburst vagus nerve stimulation therapies during MRI/fMRI. A prospective, multi-center study was conducted in patients with an investigational vagus nerve stimulation device that delivered either standard or investigational microburst vagus nerve stimulation. Thirty participants underwent sequential MRI and fMRI scans encompassing 188 total hours of scan time (62.7 hours with standard vagus nerve stimulation and 125.3 with investigational microburst vagus nerve stimulation). No adverse events were reported with active stimulation during MRI or during 12 months of follow-up. Our results support the safety and standard and investigational microburst vagus nerve stimulation therapy during MRI and fMRI scans.ABBREVIATIONS: VNS = vagus nerve stimulation; µVNS = microburst VNS; DRE = drug-resistant epilepsy; U.S. = United States; FOS = focal onset seizures; PGTC = primary generalized tonic-clonic seizures; IDE = investigational device exemption; SD = standard deviation; EEG = electroencephalogram.
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Affiliation(s)
- Erik H Middlebrooks
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
| | - Jerzy P Szaflarski
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
| | - Jason Begnaud
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
| | - Ashesh Thaker
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
| | - Kenny Henderson
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
| | - Mark Bolding
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
| | - Jill A Sellers
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
| | - Jane B Allendorfer
- From the Department of Neuroradiology, Mayo Clinic College of Medicine, Jacksonville, FL (E.M), Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL (J.S;M.B;J.A;), Neuromodulation Division, LivaNova USA, Houston, TXL (J.B;K.H), Department of Neuroradiology, Denver Health; Department of Radiology, University of Colorado School of Medicine, Denver, CO (A.T), Sellers Communications, LLC, Springfield, MO (J.S)
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Sharma AA, Mackensie Terry D, Popp JL, Szaflarski JP, Martin RC, Nenert R, Kaur M, Brokamp GA, Bolding M, Allendorfer JB. Neuromorphometric associations with mood, cognition, and self-reported exercise levels in epilepsy and healthy individuals. Epilepsy Behav Rep 2023; 25:100643. [PMID: 38264358 PMCID: PMC10803905 DOI: 10.1016/j.ebr.2023.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Regular physical activity may promote beneficial neuroplasticity, e.g., increased hippocampus volume. However, it is unclear whether self-reported physical exercise in leisure (PEL) levels are associated with the brain structure features demonstrated by exercise interventions. This pilot study investigated the relationship between PEL, mood, cognition, and neuromorphometry in patients with idiopathic generalized epilepsy (IGEs) compared to healthy controls (HCs). Seventeen IGEs and 19 age- and sex-matched HCs underwent magnetic resonance imaging (MRI) at 3T. The Baecke Questionnaire of Habitual Physical Activity, Profile of Mood States, and Montreal Cognitive Assessment (MoCA) assessed PEL, mood, and cognition, respectively. Structural MRI data were analyzed by voxel- and surface-based morphometry. IGEs had significantly lower PEL (p < 0.001), poorer mood (p = 0.029), and lower MoCA scores (p = 0.027) than HCs. These group differences were associated with reduced volume, decreased gyrification, and altered surface topology (IGEs < HCs) in frontal, temporal and cerebellar regions involved in executive function, memory retrieval, and emotional regulation, respectively. These preliminary results support the notion that increased PEL may promote neuroplasticity in IGEs, thus emphasizing the role of physical activity in promoting brain health in people with epilepsy.
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Affiliation(s)
- Ayushe A. Sharma
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - D. Mackensie Terry
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - Johanna L. Popp
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - Jerzy P. Szaflarski
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), Department of Neurobiology, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), Department of Neurosurgery, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Roy C. Martin
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Rodolphe Nenert
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - Manmeet Kaur
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Gabrielle A. Brokamp
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - Mark Bolding
- University of Alabama at Birmingham (UAB), Department of Radiology, Birmingham, AL, USA
| | - Jane B. Allendorfer
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), Department of Neurobiology, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
- University of Alabama at Birmingham (UAB), UAB Center for Exercise Medicine, Birmingham, AL, USA
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Sint Jago SC, Bahabry R, Schreiber AM, Homola J, Ngyuen T, Meijia F, Allendorfer JB, Lubin FD. Aerobic exercise alters DNA hydroxymethylation levels in an experimental rodent model of temporal lobe epilepsy. Epilepsy Behav Rep 2023; 25:100642. [PMID: 38323091 PMCID: PMC10844942 DOI: 10.1016/j.ebr.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024] Open
Abstract
The therapeutic potential of aerobic exercise in mitigating seizures and cognitive issues in temporal lobe epilepsy (TLE) is recognized, yet the underlying mechanisms are not well understood. Using a rodent TLE model induced by Kainic acid (KA), we investigated the impact of a single bout of exercise (i.e., acute) or 4 weeks of aerobic exercise (i.e., chronic). Blood was processed for epilepsy-associated serum markers, and DNA methylation (DNAme), and hippocampal area CA3 was assessed for gene expression levels for DNAme-associated enzymes. While acute aerobic exercise did not alter serum Brain-Derived Neurotrophic Factor (BDNF) or Interleukin-6 (IL-6), chronic exercise resulted in an exercise-specific decrease in serum BDNF and an increase in serum IL-6 levels in epileptic rats. Additionally, whole blood DNAme levels, specifically 5-hydroxymethylcytosine (5-hmC), decreased in epileptic animals following chronic exercise. Hippocampal CA3 5-hmC levels and ten-eleven translocation protein (TET1) expression mirrored these changes. Furthermore, immunohistochemistry analysis revealed that most 5-hmC changes in response to chronic exercise were neuron-specific within area CA3 of the hippocampus. Together, these findings suggest that DNAme mechanisms in the rodent model of TLE are responsive to chronic aerobic exercise, with emphasis on neuronal 5-hmC DNAme in the epileptic hippocampus.
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Affiliation(s)
| | - Rudhab Bahabry
- Department of Neurobiology, University of Alabama at Birmingham, United States
| | | | - Julia Homola
- Department of Neurobiology, University of Alabama at Birmingham, United States
| | - Tram Ngyuen
- Department of Neurobiology, University of Alabama at Birmingham, United States
| | - Fernando Meijia
- Department of Neurobiology, University of Alabama at Birmingham, United States
| | - Jane B. Allendorfer
- Department of Neurobiology, University of Alabama at Birmingham, United States
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Farah D. Lubin
- Department of Neurobiology, University of Alabama at Birmingham, United States
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Alexander HB, Allendorfer JB. Working out relationships between physical activity and cognitive function in people with Epilepsy: Response to the commentary by Mulser and Moreau. Epilepsy Behav 2023; 149:109532. [PMID: 37977909 DOI: 10.1016/j.yebeh.2023.109532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Halley B Alexander
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA.
| | - Jane B Allendorfer
- University of Alabama at Birmingham, Departments of Neurology and Neurobiology, Birmingham, AL, USA
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Mitchell BS, Puzzo C, Morgan CJ, Szaflarski JP, Popp JL, Ortiz-Braidot R, Moyana A, Allendorfer JB. Do people with epilepsy want to participate in an exercise intervention randomized controlled trial? - Results of a brief survey and its preliminary application. Epilepsy Behav Rep 2023; 24:100632. [PMID: 38025406 PMCID: PMC10665809 DOI: 10.1016/j.ebr.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/09/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Our goal was to survey people with epilepsy (PWE) about their interest in and factors that may influence willingness and ability to participate in an exercise randomized controlled trial (RCT). A brief survey was administered to 100 PWE asking if they would take part in a hypothetical 6-week exercise intervention RCT. Follow-up questions queried reasons for and against participation and why participation would be difficult. Sixty-nine percent of respondents indicated willingness to participate. The top reason for participation was "to improve overall health with exercise" (n = 49). The top reason for why participation would be difficult was they "do not have a reliable source of transportation" (n = 27). The top reason for not participating was "not interested in research participation" (n = 19). Preliminary results were used to budget for transportation in a prospective RCT (NCT04959019). Of the first 27 PWE enrolled (63 % female; 44 % African American/Black), six (50 % female; 50 % African American/Black) have used the transportation service. The majority of PWE surveyed were interested in participating in an exercise RCT, but some indicated barriers. Accommodating transportation in an ongoing RCT has facilitated recruitment of PWE who would otherwise not be able to participate. Barriers to participation should be accounted for when designing studies.
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Affiliation(s)
- Brandon S. Mitchell
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA
| | - Christian Puzzo
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA
| | - Charity J. Morgan
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL, USA
| | - Jerzy P. Szaflarski
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA
- University of Alabama at Birmingham, Department of Neurobiology, Birmingham, AL, USA
- University of Alabama at Birmingham, UAB Epilepsy Center, Birmingham, AL, USA
| | - Johanna L. Popp
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA
| | | | - Anna Moyana
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA
| | - Jane B. Allendorfer
- University of Alabama at Birmingham, Department of Neurology, Birmingham, AL, USA
- University of Alabama at Birmingham, Department of Neurobiology, Birmingham, AL, USA
- University of Alabama at Birmingham, UAB Epilepsy Center, Birmingham, AL, USA
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Van Patten R, Chan L, Tocco K, Mordecai K, Altalib H, Twamley EW, Gaston TE, Grayson LP, Martin A, Fry S, Goodman A, Allendorfer JB, Correia S, Szaflarski J, LaFrance WC. Improvements in Montreal Cognitive Assessment scores after neurobehavioral therapy in adults with functional (nonepileptic) seizures and traumatic brain injury. J Psychiatr Res 2023; 165:282-289. [PMID: 37549503 DOI: 10.1016/j.jpsychires.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
Cognitive functioning impacts clinical symptoms, treatment response, and quality of life in adults with functional/nonepileptic seizures (FS/NES), but no study to date examines effects of behavioral FS/NES treatment on cognition in these patients. We hypothesized that there would be a reduction in cognitive symptoms in participants with FS/NES and traumatic brain injury (TBI) following neurobehavioral therapy (NBT). We also hypothesized that select seizure-related, medication, subjective cognitive, and mental health symptoms would be negatively correlated with improvements in cognitive performance after NBT. Participants were 37 adults with TBI + FS/NES and 35 adults with TBI only, recruited from medical centers in the northeastern or southeastern U.S. TBI + FS/NES participants completed a 12 session NBT intervention, and TBI without seizures participants were not treated. All participants completed pre-post assessments of cognition (Montreal Cognitive Assessment [MoCA]) and baseline sociodemographic factors and mental health symptoms. Pre-post MoCA scores increased significantly in TBI + FS/NES participants (28/37 [75.7%] improved) but not in TBI comparisons (10/35 [28.6%] improved). Language, memory, and visuospatial/executive functions, but not attention, improved over time in the TBI + FS/NES group. Gains in cognition were concentrated in those TBI + FS/NES participants with likely baseline cognitive impairments (MoCA total score <26), and 9/17 of these participants moved from the "impaired" range at baseline (<26) to the "intact" range at endpoint (≥26). Lastly, participants taking fewer medications and reporting lower subjective cognitive difficulties at baseline showed larger pre-post MoCA total score improvements. Overall, results from this study suggest the potential for positive change in cognition in FS/NES and co-occurring TBI using evidence-based psychotherapy.
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Affiliation(s)
- Ryan Van Patten
- VA Providence Healthcare System, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Lawrence Chan
- VA Providence Healthcare System, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Krista Tocco
- VA Providence Healthcare System, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | | | | | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System and UC San Diego, San Diego, CA, USA
| | - Tyler E Gaston
- University of Alabama Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Amber Martin
- University of Alabama Birmingham, Birmingham, AL, USA
| | - Samantha Fry
- University of Alabama Birmingham, Birmingham, AL, USA
| | - Adam Goodman
- University of Alabama Birmingham, Birmingham, AL, USA
| | | | | | | | - W Curt LaFrance
- VA Providence Healthcare System, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
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10
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Mueller C, Goodman AM, Nenert R, Allendorfer JB, Philip NS, Correia S, Oster RA, LaFrance WC, Szaflarski JP. Repeatability of neurite orientation dispersion and density imaging in patients with traumatic brain injury. J Neuroimaging 2023; 33:802-824. [PMID: 37210714 PMCID: PMC10524628 DOI: 10.1111/jon.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the repeatability of neurite orientation dispersion and density imaging in healthy controls (HCs) and traumatic brain injury (TBI). METHODS Seventeen HCs and 48 TBI patients were scanned twice over 18 weeks with diffusion imaging. Orientation dispersion (ODI), neurite density (NDI), and the fraction of isotropic diffusion (F-ISO) were quantified in regions of interest (ROIs) from a gray matter, subcortical, and white matter atlas and compared using the coefficient of variation for repeated measures (CVrep ), which quantifies the expected percent change on repeated measurement. We used a modified signed likelihood ratio test (M-SLRT) to compare the CVrep between groups in each ROI while correcting for multiple comparisons. RESULTS NDI exhibited excellent repeatability in both groups; the only group difference was found in the fusiform gyrus, where HCs exhibited better repeatability (M-SLRT = 9.463, p = .0021). ODI also had excellent repeatability in both groups, although repeatability was significantly better in HCs in 16 cortical ROIs (p < .0022) and in the bilateral white matter and bilateral cortex (p < .0027). F-ISO exhibited relatively poor repeatability in both groups, with few group differences. CONCLUSION Overall, the repeatability of the NDI, ODI, and F-ISO metrics over an 18-week period is acceptable for assessing the effects of behavioral or pharmacological interventions, though caution is advised when assessing F-ISO changes over time.
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Affiliation(s)
- Christina Mueller
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, AL 35233
| | - Adam M. Goodman
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, AL 35233
| | - Rodolphe Nenert
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, AL 35233
| | - Jane B. Allendorfer
- Departments of Neurology and Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Noah S. Philip
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI
| | - Stephen Correia
- Department of Psychiatry, Butler Hospital / Brown University, Providence, RI
| | - Robert A. Oster
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - W. Curt LaFrance
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI
- Departments of Psychiatry and Neurology, Rhode Island Hospital / Brown University, Providence, RI
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurobiology and Neurosurgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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11
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Verner R, Szaflarski JP, Allendorfer JB, Vonck K, Giannicola G. Modulation of the thalamus by microburst vagus nerve stimulation: a feasibility study protocol. Front Neurol 2023; 14:1169161. [PMID: 37384278 PMCID: PMC10299807 DOI: 10.3389/fneur.2023.1169161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023] Open
Abstract
Vagus nerve stimulation (VNS) was the first device-based therapy for epilepsy, having launched in 1994 in Europe and 1997 in the United States. Since then, significant advances in the understanding of the mechanism of action of VNS and the central neurocircuitry that VNS modulates have impacted how the therapy is practically implemented. However, there has been little change to VNS stimulation parameters since the late 1990s. Short bursts of high frequency stimulation have been of increasing interest to other neuromodulation targets e.g., the spine, and these high frequency bursts elicit unique effects in the central nervous system, especially when applied to the vagus nerve. In the current study, we describe a protocol design that is aimed to assess the impact of high frequency bursts of stimulation, called "Microburst VNS", in subjects with refractory focal and generalized epilepsies treated with this novel stimulation pattern in addition to standard anti-seizure medications. This protocol also employed an investigational, fMRI-guided titration protocol that permits personalized dosing of Microburst VNS among the treated population depending on the thalamic blood-oxygen-level-dependent signal. The study was registered on clinicaltrials.gov (NCT03446664). The first subject was enrolled in 2018 and the final results are expected in 2023.
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Affiliation(s)
- Ryan Verner
- Clinical and Medical Affairs, LivaNova PLC (or a subsidiary), London, United Kingdom
| | - Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Kristl Vonck
- Department of Neurology, 4Brain, Ghent University Hospital, Ghent, Belgium
| | - Gaia Giannicola
- Clinical and Medical Affairs, LivaNova PLC (or a subsidiary), London, United Kingdom
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12
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Alexander HB, Allendorfer JB. The relationship between physical activity and cognitive function in people with epilepsy: A systematic review. Epilepsy Behav 2023; 142:109170. [PMID: 36940504 PMCID: PMC10173358 DOI: 10.1016/j.yebeh.2023.109170] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND This study aimed to systematically review the published literature evaluating the association between physical activity and cognitive function in people with epilepsy (PWE). METHODS A comprehensive search of PubMed, Cochrane, Embase, and PsychInfo was performed on June 20, 2022. Studies were excluded if they were not available in the English language, contained animal data only, did not include any original data, were not peer-reviewed, or did not include PWE as a discrete group. PRISMA guidelines were followed. The GRADE scale was used to assess the risk of bias. RESULTS Six studies were identified with a total of 123 participants. These included one observational study and five interventional studies, only one of which was a randomized controlled trial. In all studies, there was a positive association between physical activity and cognitive function in PWE. Both interventional studies showed improvement in at least one domain of cognitive functioning, though there was heterogeneity in the outcome measures used. CONCLUSIONS There is a potential positive association between physical activity and cognitive function in PWE, but available data is limited by heterogeneity, small sample size, and an overall lack of published studies in this area of research. There is a need for more robust studies to be performed in larger samples of PWE.
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Affiliation(s)
- Halley B Alexander
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA.
| | - Jane B Allendorfer
- University of Alabama at Birmingham, Departments of Neurology and Neurobiology, Birmingham, AL, USA
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13
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Mueller C, Goodman AM, Allendorfer JB, Nenert R, Gaston TE, Grayson LE, Correia S, Philip NS, Curt LaFrance W, Szaflarski JP. White Matter Changes after Neurobehavioral Therapy for Functional Seizures. Ann Neurol 2023. [PMID: 37084040 DOI: 10.1002/ana.26665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE We aimed to prospectively quantify changes in white matter morphology after neurobehavioral therapy (NBT) for functional seizures (FS) using neurite orientation dispersion and density imaging (NODDI). We hypothesized that patients with FS would exhibit white matter plasticity in the uncinate fasciculus, fornix/stria terminalis, cingulum, and corticospinal tract following NBT that would correlate with improvements in affective symptoms, post-concussive symptoms, and quality of life (QOL). METHODS Forty-two patients with traumatic brain injury (TBI) and FS (TBI + FS) underwent NBT and provided pre-/post-intervention neuroimaging and behavioral data; 47 controls with TBI without FS (TBI-only) completed the same measures but did not receive NBT. Changes in neurite density (NDI), orientation dispersion (ODI), and extracellular free water (FW) were compared between groups. RESULTS Significant ODI increases in the left uncinate fasciculus in TBI + FS (mean difference = 0.017, p = 0.039) correlated with improvements in posttraumatic symptoms (r = -0.395, p = 0.013), QOL (r = 0.474, r = 0.002), emotional wellbeing (r = 0.524, p < 0.001), and energy (r = 0.474, p = 0.002). In TBI-only, ODI decreased (mean difference = -0.008, p = 0.047) and FW increased (mean difference = 0.011, p = 0.003) in the right cingulum. FW increases correlated with increased psychological problems (r = 0.383, p = 0.013). In TBI + FS, NBT resulted in FS decreases of 3.5 seizures per week. None of the imaging changes correlated with FS frequency. INTERPRETATION We identified white matter changes after NBT in patients with FS that were associated with improved psychosocial functioning. NODDI could be incorporated into future mechanistic assessments of interventions in patients with FS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Christina Mueller
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, Alabama, 35233
| | - Adam M Goodman
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, Alabama, 35233
| | - Jane B Allendorfer
- Depts of Neurology and Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, Alabama, 35233
| | - Rodolphe Nenert
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, Alabama, 35233
| | - Tyler E Gaston
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, Alabama, 35233
- Birmingham Veterans Affairs Medical Center, 700 19th Street S, Birmingham, Alabama, 35233
| | - Leslie E Grayson
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, Alabama, 35233
| | - Stephen Correia
- College of Public Health, University of Georgia, 100 Hudson Hall, Health Sciences Campus, 102 Spear Road, Athens, Georgia, 30602
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, 830 Chalkstone Avenue, Providence, Rhode Island, 02908
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - W Curt LaFrance
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, 830 Chalkstone Avenue, Providence, Rhode Island, 02908
- Departments of Psychiatry and Neurology, Rhode Island Hospital / Brown University, Potter 3 Neuropsychiatry, 593 Eddy Street, Providence, Rhode Island, 02903
| | - Jerzy P Szaflarski
- Depts of Neurology, Neurobiology, and Neurosurgery, Heersink School of Medicine, University of Alabama at Birmingham, 1719 6th Ave S, Birmingham, Alabama, 35233
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14
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Nair S, Szaflarski JP, Wang Y, Pizarro D, Killen JF, Allendorfer JB. Assessing dynamic brain activity during verbal associative learning using MEG/fMRI co-processing. Neuroimage: Reports 2023. [DOI: 10.1016/j.ynirp.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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15
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Goodman AM, Kakulamarri P, Nenert R, Allendorfer JB, Philip NS, Correia S, LaFrance WC, Szaflarski JP. Relationship between intrinsic network connectivity and psychiatric symptom severity in functional seizures. J Neurol Neurosurg Psychiatry 2023; 94:136-143. [PMID: 36302640 DOI: 10.1136/jnnp-2022-329838] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) may precipitate the onset of functional seizures (FSs). Many patients with FS report at least one prior TBI, and these patients typically present with more severe psychiatric comorbidities. TBI and psychopathology are linked to changes in neural network connectivity, but their combined effects on these networks and relationship to the effects of FS remain unclear. We hypothesised that resting-state functional connectivity (rsFC) would differ between patients with FS and TBI (FS+TBI) compared with TBI without FS (TBI only), with variability only partially explained by the presence of psychopathology. METHODS Patients with FS+TBI (n=52) and TBI only (n=54) were matched for age and sex. All participants completed psychiatric assessments prior to resting-state functional MRI at 3 T. Independent component analysis identified five canonical rsFC networks related to emotion and motor functions. RESULTS Five linear mixed-effects analyses identified clusters of connectivity coefficients that differed between groups within the posterior cingulate of the default mode network, insula and supramarginal gyrus of the executive control network and bilateral anterior cingulate of the salience network (all α=0.05, corrected). Cluster signal extractions revealed decreased contributions to each network for FS+TBI compared to TBI only. Planned secondary analyses demonstrated correlations between signal and severity of mood, anxiety, somatisation and global functioning symptoms. CONCLUSIONS These findings indicate the presence of aberrant connectivity in FS and extend the biopsychosocial network model by demonstrating that common aetiology is linked to both FS and comorbidities, but the overlap in affected networks varies by comorbid symptoms.
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Affiliation(s)
- Adam M Goodman
- Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pranav Kakulamarri
- Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Psychology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rodolphe Nenert
- Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane B Allendorfer
- Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Noah S Philip
- RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island, USA.,Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Stephen Correia
- RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island, USA.,Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - W Curt LaFrance
- RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, Rhode Island, USA.,Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Neurology, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jerzy P Szaflarski
- Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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16
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Kustubayeva AM, Nelson EB, Smith ML, Allendorfer JB, Eliassen JC. Corrigendum: Functional MRI study of feedback-based reinforcement learning in depression. Front Neuroinform 2023; 17:1175847. [PMID: 37025551 PMCID: PMC10070971 DOI: 10.3389/fninf.2023.1175847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 04/08/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fninf.2022.1028121.].
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Affiliation(s)
- Almira M. Kustubayeva
- Center for Cognitive Neuroscience, Department of Physiology, Biophysics, and Neuroscience, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Erik B. Nelson
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Michael L. Smith
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Jane B. Allendorfer
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James C. Eliassen
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Robert Bosch Automotive Steering LLC, Florence, KY, United States
- *Correspondence: James C. Eliassen
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17
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Kustubayeva AM, Nelson EB, Smith ML, Allendorfer JB, Eliassen JC. Functional MRI study of feedback-based reinforcement learning in depression. Front Neuroinform 2022; 16:1028121. [PMID: 36605827 PMCID: PMC9807874 DOI: 10.3389/fninf.2022.1028121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022] Open
Abstract
Reinforcement learning depends upon the integrity of emotional circuitry to establish associations between environmental cues, decisions, and positive or negative outcomes in order to guide behavior through experience. The emotional dysregulation characteristic of major depressive disorder (MDD) may alter activity in frontal and limbic structures that are key to learning. Although reward and decision-making have been examined in MDD, the effects of depression on associative learning is less well studied. We investigated whether depressive symptoms would be related to abnormalities in learning-related brain activity as measured by functional magnetic resonance imaging (fMRI). Also, we explored whether melancholic and atypical features were associated with altered brain activity. We conducted MRI scans on a 4T Varian MRI system in 10 individuals with MDD and 10 healthy subjects. We examined event-related brain activation during feedback-based learning task using Analysis of Functional NeuroImages (AFNI) for image processing and statistical analysis. We observed that MDD patients exhibited reduced activation in visual cortex but increased activation in cingulate and insular regions compared to healthy participants. Also, in relation to features of depressive subtypes, we observed that levels of activation in striatal, thalamic, and precuneus regions were negatively correlated with atypical characteristics. These results suggest that the effects of MDD change the neural circuitry underlying associative learning, and these effects may depend upon subtype features of MDD.
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Affiliation(s)
- Almira M. Kustubayeva
- Center for Cognitive Neuroscience, Department of Physiology, Biophysics, and Neuroscience, Al-Farabi Kazakh National University, Almaty, Kazakhstan,Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Erik B. Nelson
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Michael L. Smith
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States,Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Jane B. Allendorfer
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States,Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James C. Eliassen
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, United States,Robert Bosch Automotive Steering LLC, Florence, KY, United States,*Correspondence: James C. Eliassen,
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18
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Hansen B, Allendorfer JB. Considering social determinants of health in the relationship between physical activity and exercise engagement and cognitive impairment among persons with epilepsy. Front Rehabilit Sci 2022; 3:923856. [PMID: 36188918 PMCID: PMC9397670 DOI: 10.3389/fresc.2022.923856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022]
Abstract
Many persons with epilepsy (PWE) are not as active or physically fit as compared to the general population. This lack of engagement in physical activity has been attributed to a number of factors, few of which take into consideration the social determinants of health (SDH). In this perspective, we highlight how SDH are considered in explaining lower levels of physical activity engagement among PWE, particularly for those experiencing cognitive impairment. We also discuss how these data can be applied in research to yield a greater impact on the quality of life among PWE. Consideration of SDH allows for increased understanding of how cognition can be both a determinant of physical activity and an outcome of environments conducive to physical activity in PWE.
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Affiliation(s)
- Barbara Hansen
- Division of Preventive Medicine, University of Alabama Heersink School of Medicine, Birmingham, AL, United States
| | - Jane B. Allendorfer
- Departments of Neurology and Neurobiology, University of Alabama Heersink School of Medicine, Birmingham, AL, United States
- *Correspondence: Jane B. Allendorfer
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19
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Gross WL, Helfand AI, Swanson SJ, Conant LL, Humphries CJ, Raghavan M, Mueller WM, Busch RM, Allen L, Anderson CT, Carlson CE, Lowe MJ, Langfitt JT, Tivarus ME, Drane DL, Loring DW, Jacobs M, Morgan VL, Allendorfer JB, Szaflarski JP, Bonilha L, Bookheimer S, Grabowski T, Vannest J, Binder JR. Prediction of Naming Outcome With fMRI Language Lateralization in Left Temporal Epilepsy Surgery. Neurology 2022; 98:e2337-e2346. [PMID: 35410903 PMCID: PMC9202528 DOI: 10.1212/wnl.0000000000200552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Naming decline after left temporal lobe epilepsy (TLE) surgery is common and difficult to predict. Preoperative language fMRI may predict naming decline, but this application is still lacking evidence. We performed a large multicenter cohort study of the effectiveness of fMRI in predicting naming deficits after left TLE surgery. METHODS At 10 US epilepsy centers, 81 patients with left TLE were prospectively recruited and given the Boston Naming Test (BNT) before and ≈7 months after anterior temporal lobectomy. An fMRI language laterality index (LI) was measured with an auditory semantic decision-tone decision task contrast. Correlations and a multiple regression model were built with a priori chosen predictors. RESULTS Naming decline occurred in 56% of patients and correlated with fMRI LI (r = -0.41, p < 0.001), age at epilepsy onset (r = -0.30, p = 0.006), age at surgery (r = -0.23, p = 0.039), and years of education (r = 0.24, p = 0.032). Preoperative BNT score and duration of epilepsy were not correlated with naming decline. The regression model explained 31% of the variance, with fMRI contributing 14%, with a 96% sensitivity and 44% specificity for predicting meaningful naming decline. Cross-validation resulted in an average prediction error of 6 points. DISCUSSION An fMRI-based regression model predicted naming outcome after left TLE surgery in a large, prospective multicenter sample, with fMRI as the strongest predictor. These results provide evidence supporting the use of preoperative language fMRI to predict language outcome in patients undergoing left TLE surgery. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that fMRI language lateralization can help in predicting naming decline after left TLE surgery.
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Affiliation(s)
- William Louis Gross
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH.
| | - Alexander I Helfand
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Sara J Swanson
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Lisa L Conant
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Colin J Humphries
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Manoj Raghavan
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Wade M Mueller
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Robyn M Busch
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Linda Allen
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Christopher Todd Anderson
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Chad E Carlson
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Mark J Lowe
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - John T Langfitt
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Madalina E Tivarus
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Daniel L Drane
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - David W Loring
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Monica Jacobs
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Victoria L Morgan
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jane B Allendorfer
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jerzy P Szaflarski
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Leonardo Bonilha
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Susan Bookheimer
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Thomas Grabowski
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jennifer Vannest
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
| | - Jeffrey R Binder
- From the Departments of Neurology (W.L.G., A.H., S.J.S., L.L.C., C.H., M.R., L.A., C.T.A., C.E.C., J.R.B.), Anesthesiology (W.L.G.), and Neurosurgery (W.M.M.), Medical College of Wisconsin, Milwaukee; Departments of Neurology (R.M.B.) and Radiology (M.J.L.), Cleveland Clinic Foundation, OH; Departments of Neurology (J.T.L.) and Imaging Sciences (M.E.T.), University of Rochester, NY; Departments of Neurology (D.L.D., D.W.L.) and Pediatrics (D.L.D.), Emory University, Atlanta, GA; Department of Neurology (D.L.D., T.G.), University of Washington, Seattle; Departments of Psychology (M.J.) and Radiology (V.L.M.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; Department of Neurology (S.B.), University of California, Los Angeles; and Department of Neurology (J.V.), University of Cincinnati, OH
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Szaflarski JP, Allendorfer JB, Goodman AM, Byington CG, Philip NS, Correia S, LaFrance WC. Diagnostic delay in functional seizures is associated with abnormal processing of facial emotions. Epilepsy Behav 2022; 131:108712. [PMID: 35526462 DOI: 10.1016/j.yebeh.2022.108712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In patients with functional seizures (FS), delay in diagnosis (DD) may negatively affect outcomes. Altered brain responses to emotional stimuli have been shown in adults with FS. We hypothesized that DD would be associated with differential fMRI activation in emotion processing circuits. METHODS Fifty-two adults (38 females) with video-EEG confirmed FS prospectively completed assessments related to symptoms of depression (BDI-II), anxiety (BAI), post-traumatic stress disorder (PCL-S), a measure of how their symptoms affect day-to-day life (GAF), and fMRI at 3T with emotional faces task (EFT). During fMRI, subjects indicated "male" or "female" via button press while implicitly processing happy, sad, fearful, and neutral faces. Functional magnetic resonance imaging (FMRI) response to each emotion was modeled and group analyses were performed in AFNI within pre-specified regions-of-interest involved in emotion processing. A median split (507 days) defined short- (s-DD) and long-delay diagnosis (l-DD) groups. Voxelwise regression analyses were also performed to examine linear relationship between DD and emotion processing. FMRI signal was extracted from clusters showing group differences and Spearman's correlations assessed relationships with symptom scores. RESULTS Groups did not differ in FS age of onset, sex distribution, years of education, TBI characteristics, EFT in-scanner or post-test performance, or scores on the GAF, BDI-II, BAI, and PCL-S measures. The s-DD group was younger than l-DD (mean age 32.6 vs. 40.1; p = 0.022) at the time of study participation. After correcting for age, compared to s-DD, the l-DD group showed greater fMRI activation to sad faces in the bilateral posterior cingulate cortex (PCC) and to neutral faces in the right anterior insula. Within-group linear regression revealed that with increasing DD, there was increased fMRI activation to sad faces in the PCC and to happy faces in the right anterior insula/inferior frontal gyrus (AI/IFG). There were positive correlations between PCC response to sad faces and BDI-II scores in the l-DD group (rho = 0.48, p = 0.012) and the combined sample (rho = 0.30, p = 0.029). Increased PCC activation to sad faces in those in the l-DD group was associated with worse symptoms of depression (i.e. higher BDI-II score). CONCLUSIONS Delay in FS diagnosis is associated with fMRI changes in PCC and AI/IFG. As part of the default mode network, PCC is implicated in mood control, self-referencing, and other emotion-relevant processes. In our study, PCC changes are linked to depression. Future studies should assess the effects of interventions on these abnormalities.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Caroline G Byington
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephen Correia
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
| | - W Curt LaFrance
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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21
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Goodman AM, Allendorfer JB, LaFrance WC, Szaflarski JP. Precentral gyrus and insula responses to stress vary with duration to diagnosis in functional seizures. Epilepsia 2022; 63:865-879. [PMID: 35112346 DOI: 10.1111/epi.17179] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study was undertaken to determine whether undiagnosed illness duration (time between functional seizures [FS] onset and diagnosis) is linked to differences in neural response and functional connectivity during processing of stressful experiences. METHODS Forty-nine participants with traumatic brain injury preceding the onset of FS confirmed by video-electroencephalography were recruited prospectively. Participants completed psychiatric symptom assessments before undergoing functional magnetic resonance imaging (fMRI) with an acute psychosocial stress task. Linear mixed effects (LME) analyses identified significant interactions between the factors of group (early vs. delayed diagnosis) and time lag to diagnosis on neural responses to stressful math performance and auditory feedback (corrected α = .05). Functional connectivity analysis utilized clusters from initial LME analyses as seed regions to determine significant interactions between these factors on network functional connectivity. RESULTS Demographic and psychiatric symptom measures were similar between early (n = 25) and delayed (n = 24) groups. Responses to stressful math performance within the left anterior insula and functional connectivity between the anterior insula seed region and a precentral gyrus cluster were significantly negatively correlated with time lag to diagnosis for the early but not the delayed FS diagnosis group. There was no correlation between fMRI findings and psychiatric symptoms. SIGNIFICANCE This study indicates that aberrant left anterior insula activation and its functional connectivity to the precentral gyrus underlie differences in processing of stressful experiences in patients with delayed FS diagnosis. Follow-up comparisons suggest changes are associated with undiagnosed illness duration rather than psychiatric comorbidities and indicate a potential mechanistic association between neuropathophysiology, response to stressful experiences, and functional neuroanatomy in FS.
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Affiliation(s)
- Adam M Goodman
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - W Curt LaFrance
- Providence Veterans Affairs Medical Center, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
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22
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Sharma AA, Goodman AM, Allendorfer JB, Philip NS, Correia S, LaFrance WC, Szaflarski JP. Regional brain atrophy and aberrant cortical folding relate to anxiety and depression in patients with traumatic brain injury and psychogenic nonepileptic seizures. Epilepsia 2022; 63:222-236. [PMID: 34730239 PMCID: PMC8742780 DOI: 10.1111/epi.17109] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/21/2021] [Accepted: 10/15/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Psychogenic nonepileptic seizures (PNES) are characterized by multifocal and global abnormalities in brain function and connectivity. Only a few studies have examined neuroanatomic correlates of PNES. Traumatic brain injury (TBI) is reported in 83% of patients with PNES and may be a key component of PNES pathophysiology. In this study, we included patients with TBI preceding the onset of PNES (TBI-PNES) and TBI without PNES (TBI-only) to identify neuromorphometric abnormalities associated with PNES. METHODS Adults diagnosed with TBI-PNES (n = 62) or TBI-only (n = 59) completed psychological questionnaires and underwent 3-T magnetic resonance imaging. Imaging data were analyzed by voxel- and surface-based morphometry. Voxelwise general linear models computed group differences in gray matter volume, cortical thickness, sulcal depth, fractal dimension (FDf), and gyrification. Statistical models were assessed with permutation-based testing at 5000 iterations with the Threshold-Free Cluster Enhancement toolbox. Logarithmically scaled p-values corrected for multiple comparisons using familywise error were considered significant at p < .05. Post hoc analyses determined the association between structural and psychological measures (p < .05). RESULTS TBI-PNES participants demonstrated atrophy of the left inferior frontal gyrus and the right cerebellum VIII. Relative to TBI-only, TBI-PNES participants had decreased FDf in the right superior parietal gyrus and decreased sulcal depth in the left insular cortex. Significant clusters were positively correlated with global assessment of functioning scores, and demonstrated varying negative associations with measures of anxiety, depression, somatization, and global severity of symptoms. SIGNIFICANCE The diagnosis of PNES was associated with brain atrophy and reduced cortical folding in regions implicated in emotion processing, regulation, and response inhibition. Cortical folds primarily develop during the third trimester of pregnancy and remain relatively constant throughout the remainder of one's life. Thus, the observed aberrations in FDf and sulcal depth could originate early in development. The convergence of environmental, developmental, and neurobiological factors may coalesce to reflect the neuropathophysiological substrate of PNES.
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Affiliation(s)
- Ayushe A. Sharma
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA,Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Adam M. Goodman
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA,University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, USA
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Stephen Correia
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - W. Curt LaFrance
- Department of Neurology, Brown University, Providence, RI, USA,VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA,Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA,Department of Neurosurgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA,University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, USA
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23
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Allendorfer JB, Nenert R, Vannest J, Szaflarski JP. A Pilot Randomized Controlled Trial of Intermittent Theta Burst Stimulation as Stand-Alone Treatment for Post-Stroke Aphasia: Effects on Language and Verbal Functional Magnetic Resonance Imaging (fMRI). Med Sci Monit 2021; 27:e934818. [PMID: 34862359 PMCID: PMC8653428 DOI: 10.12659/msm.934818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/29/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is an ongoing need for facilitating language recovery in chronic post-stroke aphasia. The primary aim of this study (NCT01512264) was to examine if noninvasive intermittent theta burst stimulation (iTBS) applied to the injured left-hemispheric cortex promotes language improvements and fMRI changes in post-stroke aphasia. MATERIAL AND METHODS Participants were randomized to 3 weeks of sham (Tx0) or 1-3 weeks of iTBS (Tx123). We assessed participants who completed the first 2 functional MRI (fMRI) sessions (T1, T2) where they performed 2 overt language fMRI tasks, and examined longitudinal response after 3 months (T3). Language performance and fMRI activation changes, and relationships between these changes were assessed. RESULTS From T1 to T2, both groups showed improvements on the Boston Naming Test (BNT). From T1 to T3, Tx123 improved on the Aphasia Quotient, post-scan word recognition on the verbal paired associates task (VPAT), and perceived communicative ability. Each group exhibited significant activation changes between T1 and T2 for both tasks. Only the Tx123 group exhibited fMRI activation changes between T2 to T3 on the verb-generation task and between T1 and T3 on VPAT. Delayed aphasia symptom improvement for Tx123 was associated with increased left ventral visual stream activation from T1 to T3 (rho=0.74, P=0.0058), and with decreased bilateral supplementary motor area activation related to VPAT encoding from T2 to T3 (rho=-0.80, P=0.0016). CONCLUSIONS Observed iTBS-induced language improvements and associations between delayed fMRI changes and aphasia improvements support the therapeutic and neurorehabilitative potential of iTBS in post-stroke aphasia recovery.
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Affiliation(s)
- Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Vannest
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Szaflarski JP, Nenert R, Allendorfer JB, Martin AN, Amara AW, Griffis JC, Dietz A, Mark VW, Sung VW, Walker HC, Zhou X, Lindsell CJ. Intermittent Theta Burst Stimulation (iTBS) for Treatment of Chronic Post-Stroke Aphasia: Results of a Pilot Randomized, Double-Blind, Sham-Controlled Trial. Med Sci Monit 2021; 27:e931468. [PMID: 34183640 PMCID: PMC8254416 DOI: 10.12659/msm.931468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Research indicates intermittent theta burst stimulation (iTBS) is a potential treatment of post-stroke aphasia. Material/Methods In this double-blind, sham-controlled trial (NCT 01512264) participants were randomized to receive 3 weeks of sham (G0), 1 week of iTBS/2 weeks of sham (G1), 2 weeks of iTBS/1 week of sham (G2), or 3 weeks of iTBS (G3). FMRI localized residual language function in the left hemisphere; iTBS was applied to the maximum fMRI activation in the residual language cortex in the left frontal lobe. FMRI and aphasia testing were conducted pre-treatment, at ≤1 week after completing treatment, and at 3 months follow-up. Results 27/36 participants completed the trial. We compared G0 to each of the individual treatment group and to all iTBS treatment groups combined (G1–3). In individual groups, participants gained (of moderate or large effect sizes; some significant at P<0.05) on the Boston Naming Test (BNT), the Semantic Fluency Test (SFT), and the Aphasia Quotient of the Western Aphasia Battery-Revised (WAB-R AQ). In G1–3, BNT, and SFT improved immediately after treatment, while the WAB-R AQ improved at 3 months. Compared to G0, the other groups showed greater fMRI activation in both hemispheres and non-significant increases in language lateralization to the left hemisphere. Changes in IFG connectivity were noted with iTBS, showing differences between time-points, with some of them correlating with the behavioral measures. Conclusions The results of this pilot trial support the hypothesis that iTBS applied to the ipsilesional hemisphere can improve aphasia and result in cortical plasticity.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber N Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph C Griffis
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aimee Dietz
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Victor W Mark
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor W Sung
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiaohua Zhou
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Allendorfer JB, Nenert R, Nair S, Vannest J, Szaflarski JP. Functional Magnetic Resonance Imaging of Language Following Constraint-Induced Aphasia Therapy Primed with Intermittent Theta Burst Stimulation in 13 Patients with Post-Stroke Aphasia. Med Sci Monit 2021; 27:e930100. [PMID: 33970893 PMCID: PMC8120906 DOI: 10.12659/msm.930100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Aphasia is a debilitating consequence of stroke. This study aimed to investigate the role of functional magnetic resonance imaging (fMRI) activation changes during overt language tasks in promoting language improvements following constraint-induced aphasia therapy (CIAT) primed with intermittent theta burst stimulation (iTBS) in 13 patients with aphasia following ischemic stroke. Material/Methods Participants with post-stroke aphasia participated in CIAT primed with iTBS on 10 consecutive weekdays. They also underwent language testing and fMRI while performing overt language tasks at baseline (N=13), immediately post-treatment (N=13), and after 3 months (N=12). Outcome measures were compared between time points, and relationships between changes in language ability and fMRI activation were examined. Results We observed improvements in naming (p<0.001), aphasia symptoms (p=0.038), apraxia of speech symptoms (p=0.040), perception of everyday communicative ability (p=0.001), and the number of spoken words produced during fMRI (p=0.028). Pre- to post-treatment change in naming was negatively correlated with change in right postcentral gyrus activation related to noun-verb associations (rho=−0.554, p=0.0497). Change in aphasia symptoms from immediately after to 3 months post-treatment was negatively correlated with change in bilateral supplementary motor area activation related to verbal encoding (rho=−0.790, p=0.0022). Conclusions Aphasia improvements coupled with fMRI activation changes over time provide support for treatment-induced neuroplasticity with CIAT primed with iTBS. However, a larger randomized sham-controlled study is warranted to confirm our findings and further our understanding of how iTBS can potentiate beneficial effects of language therapy in post-stroke aphasia.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sangeeta Nair
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Vannest
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
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26
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Popp JL, Szaflarski JP, Kaur M, Martin RC, Brokamp GA, Terry DM, Diggs MD, Allendorfer JB. Relationships between cognitive function, seizure control, and self-reported leisure-time exercise in epilepsy. Epilepsy Behav 2021; 118:107900. [PMID: 33770613 DOI: 10.1016/j.yebeh.2021.107900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 01/16/2023]
Abstract
Exercise may be a strategy for improvement of cognitive deficits commonly present in people with idiopathic generalized epilepsies (IGE). We investigated the relationship between cognition and level of physical exercise in leisure (PEL) in people with IGE who have been seizurefree for at least 6 months (IGE-) as compared to those who have not been seizurefree (IGE+) and healthy controls (HCs). We hypothesized that higher level of physical exercise is associated with better cognitive functioning in patients with IGE and HCs, and that seizure control affects both PEL levels and cognitive functioning in patients with IGE. We recruited 75 participants aged 18-65: 31 people with IGE (17 IGE-, 14 IGE+) and 44 HCs. Participants completed assessments of quality of life (SF-36), physical activity levels (Baecke questionnaire and International Physical Activity Questionnaire (IPAQ)) and cognition (Montreal Cognitive Assessment (MoCA), Hopkins Verbal Learning Test - Revised (HVLT), and flanker task). Group differences (HCs vs. IGE; HCs vs. IGE+ vs. IGE-) were assessed. Pearson correlations examined linear relationships between PEL and cognitive performance. Groups were similar in age and sex. Compared to HCs, patients with IGE had higher body mass index, fewer years of education, and consistently scored worse on all measures except flanker task accuracy on incongruent trials. When examining IGE- and IGE+ subgroups, compared to HCs, both had higher body mass index, and fewer years of education. Healthy controls scored significantly better than one or both of the IGE groups on SF-36 scores, PEL levels, IPAQ activity level, MoCA scores, HVLT learning and long-delay free-recall scores, and flanker task accuracy on congruent trials. Among patients with IGE, there were no significant differences between age of epilepsy onset, duration of epilepsy, number of anti-seizure drugs (ASDs) currently being used, or the group distribution of type of IGE. In the combined sample (IGE+, IGE- and HCs), PEL positively correlated with MoCA scores (Pearson's r = 0.238; p = 0.0397) and with flanker task accuracy on congruent trials (Pearson's r = 0.295; p = 0.0132). Overall, patients with IGE performed worse than HCs on cognitive and physical activity measures, but the cognitive impairments were more pronounced for IGE+, while physical exercise levels were less for patients with IGE regardless of seizure control. While positive relationships between leisure-time PEL and cognitive performance are promising, further investigations into how exercise levels interact with cognitive functioning in epilepsy are needed.
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Affiliation(s)
- Johanna L Popp
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA; University of Alabama at Birmingham (UAB), Department of Neurobiology, Birmingham, AL, USA; University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Manmeet Kaur
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - Roy C Martin
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA; University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Gabrielle A Brokamp
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - D Mackensie Terry
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - M David Diggs
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA
| | - Jane B Allendorfer
- University of Alabama at Birmingham (UAB), Department of Neurology, Birmingham, AL, USA; University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA.
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27
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Houston JT, Nenert R, Allendorfer JB, Bebin EM, Gaston TE, Goodman AM, Szaflarski JP. White matter integrity after cannabidiol administration for treatment resistant epilepsy. Epilepsy Res 2021; 172:106603. [PMID: 33725662 DOI: 10.1016/j.eplepsyres.2021.106603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/15/2021] [Accepted: 03/05/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The effects of individual cannabinoids on white matter integrity are unclear. Human studies have shown white matter maturation alterations in regular recreational cannabis users with the magnitude of these effects dependent on the age of exposure. However, studies have yet to determine which phytocannabinoids are most responsible for these changes. In the current study, we analyzed the effects of pharmaceutical grade cannabidiol oral solution (CBD; Epidiolex® in the U.S.; Epidyolex® in the EU; 100 mg/mL oral solution) on white matter integrity using diffusion MRI in patients with treatment resistant epilepsy (TRE). METHODS 15 patients with TRE underwent 3 T diffusion MRI prior to receiving CBD and then again approximately 12 weeks later while on a stable dose of CBD for at least two weeks. DTI analyzes were conducted using DSI Studio and tract-based spatial statistics (TBSS). RESULTS DTI analysis using DSI Studio showed significant increases in fractional anisotropy (FA) in the right medial lemniscus (p = 0.03), right superior cerebellar peduncle (p = 0.03) and the pontine crossing tract (p = 0.04); decreased mean diffusivity (MD) in the left uncinate fasciculus (p = 0.02) and the middle cerebellar peduncle (p = 0.04); decreased axial diffusivity (AD) in the left superior cerebellar peduncle (p = 0.05), right anterior limb of the internal capsule (p = 0.03), and right posterior limb of the internal capsule (p = 0.02); and decreased radial diffusivity (RD) in the middle cerebellar peduncle (p = 0.03) and left uncinate fasiculus (p = 0.01). The follow-up ANCOVA also yielded significant results when controlling for covariates of CBD dosage, age, sex, change in seizure frequency, and scanner type: FA increased in the pontine crossing tract (p = 0.03); RD decreased in the middle cerebellar peduncle (p = 0.04) and left uncinate fasciculus (p = 0.04). Subsequent TBSS analysis controlling for the same variables yielded no significant white matter differences between groups. CONCLUSION These findings indicate relatively minor short-term effects of highly-purified plant-derived CBD on white matter structural integrity in patients with TRE.
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Affiliation(s)
- J T Houston
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - R Nenert
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J B Allendorfer
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E M Bebin
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - T E Gaston
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A M Goodman
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J P Szaflarski
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Departments of Neurosurgery and Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
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28
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Goodman AM, Diggs MD, Balachandran N, Kakulamarri PS, Oster RA, Allendorfer JB, Szaflarski JP. Repeatability of Neural and Autonomic Responses to Acute Psychosocial Stress. Front Neurosci 2020; 14:585509. [PMID: 33328855 PMCID: PMC7732671 DOI: 10.3389/fnins.2020.585509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
FMRI Montreal Imaging Stress Tasks (MIST) have been shown to activate endocrine and autonomic stress responses that are mediated by a prefrontal cortex (PFC)-hippocampus-amygdala circuit. However, the stability of the neurobehavioral responses over time and the ability to monitor response to clinical interventions has yet to be validated. The objective of this study was to compare the fMRI and physiologic responses to acute psychosocial stress in healthy volunteers during initial and follow-up visits approximately 13 weeks later, simulating a typical duration of clinical intervention. We hypothesized that responses to stress would remain highly conserved across the 2 visits in the absence of an intervention. 15 healthy volunteers completed a variant of control math task (CMT) and stress math task (SMT) conditions based on MIST. Neural responses were modeled using an event-related design with estimates for math performance and auditory feedback for each task condition. For each visit, measures of stress reactivity included differential fMRI and heart rate (SMT-CMT), as well as salivary alpha-amylase before and after scanning sessions. The results revealed that differential fMRI, as well as increased heart rate and salivary alpha-amylase from before and after scanning remained similar between visits. Intraclass correlation coefficient (ICC) values revealed areas of reliable task-dependent BOLD fMRI signal response across visits for peaks of clusters for the main effect of condition (SMT vs CMT) within dorsal anterior cingulate cortex (ACC), insula, and hippocampus regions during math performance and within subgenual ACC, posterior cingulate cortex, dorsolateral PFC regions during auditory feedback. Given that the neurobehavioral response to acute stress remained highly conserved across visits in the absence of an intervention, this study confirms the utility for MIST for assessing longitudinal changes in controlled trials that can identify underlying neurobiological mechanisms involved in mediating the efficacy of stress-reduction interventions.
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Affiliation(s)
- Adam M Goodman
- Department of Neurology, University of Alabama at Birmingham (UAB) Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael David Diggs
- Department of Neurology, University of Alabama at Birmingham (UAB) Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Neha Balachandran
- Department of Neurology, University of Alabama at Birmingham (UAB) Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pranav S Kakulamarri
- Department of Neurology, University of Alabama at Birmingham (UAB) Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert A Oster
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham (UAB) Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham (UAB) Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, United States
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29
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Balachandran N, Goodman AM, Allendorfer JB, Martin AN, Tocco K, Vogel V, LaFrance WC, Szaflarski JP. Relationship between neural responses to stress and mental health symptoms in psychogenic nonepileptic seizures after traumatic brain injury. Epilepsia 2020; 62:107-119. [PMID: 33238045 DOI: 10.1111/epi.16758] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To utilize traumatic brain injury (TBI) as a model for investigating functioning during acute stress experiences in psychogenic nonepileptic seizures (PNES) and to identify neural mechanisms underlying the link between changes in processing of stressful experiences and mental health symptoms in PNES. METHODS We recruited 94 participants: 50 with TBI only (TBI-only) and 44 with TBI and PNES (TBI + PNES). Participants completed mood (Beck Depression Inventory-II), anxiety (Beck Anxiety Inventory), and posttraumatic stress disorder (PTSD) symptom (PTSD Checklist-Specific Event) assessments before undergoing functional magnetic resonance imaging during an acute psychosocial stress task. Linear mixed-effects analyses identified clusters of significant interactions between group and neural responses to stressful math performance and stressful auditory feedback conditions within limbic brain regions (volume-corrected α = .05). Spearman rank correlation tests compared mean cluster signals to symptom assessments (false discovery rate-corrected α = .05). RESULTS Demographic and TBI-related measures were similar between groups; TBI + PNES demonstrated worse clinical symptom severity compared to TBI-only. Stressful math performance induced relatively greater reactivity within dorsomedial prefrontal cortex (PFC) and right hippocampal regions and relatively reduced reactivity within left hippocampal and dorsolateral PFC regions for TBI + PNES compared to TBI-only. Stressful auditory feedback induced relatively reduced reactivity within ventral PFC, cingulate, hippocampal, and amygdala regions for TBI + PNES compared to TBI-only. Changes in responses to stressful math within hippocampal and dorsal PFC regions were correlated with increased mood, anxiety, and PTSD symptom severity. SIGNIFICANCE Corticolimbic functions underlying processing of stressful experiences differ between patients with TBI + PNES and those with TBI-only. Relationships between these neural responses and symptom assessments suggest potential pathophysiologic mechanisms in PNES.
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Affiliation(s)
- Neha Balachandran
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Departments of Neurobiology and Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber N Martin
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Krista Tocco
- Providence Veterans Administration Medical Center, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Valerie Vogel
- Providence Veterans Administration Medical Center, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - W Curt LaFrance
- Providence Veterans Administration Medical Center, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Jerzy P Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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30
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Nenert R, Allendorfer JB, Bebin EM, Gaston TE, Grayson LE, Houston JT, Szaflarski JP. Cannabidiol normalizes resting-state functional connectivity in treatment-resistant epilepsy. Epilepsy Behav 2020; 112:107297. [PMID: 32745959 DOI: 10.1016/j.yebeh.2020.107297] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Resting-state (rs) network dysfunction is a contributing factor to treatment resistance in epilepsy. In treatment-resistant epilepsy (TRE), pharmacological and nonpharmacological therapies have been shown to improve such dysfunction. In this study, our goal was to prospectively evaluate the effect of highly purified plant-derived cannabidiol (CBD; Epidiolex®) on rs functional magnetic resonance imaging (fMRI) functional connectivity (rs-FC). We hypothesized that CBD would change and potentially normalize the rs-FC in TRE. METHODS Twenty-two of 27 participants with TRE completed all study procedures including longitudinal pre-/on-CBD rs-fMRI (8M/14F, mean age = 36.2 ± 15.9 years, TRE duration = 18.3 ± 12.6 years); there were no differences in age (p = 0.99) or sex (p = 0.15) between groups. Assessments collected included seizure frequency (SF), Chalfont Seizure Severity Scale (CSSS), Columbia Suicide Severity Rating Scale (C-SSRS), Adverse Events Profile (AEP), and Profile of Mood States (POMS). Twenty-three healthy controls (HCs) received rs-fMRI and POMS once. RESULTS Participants with TRE showed average decrease of 71.7% in SF (p < 0.0001) and improved CSSS, AEP, and POMS confusion, depression, and fatigue subscores (all p < 0.05) on-CBD with POMS scores becoming similar to those of HCs. Paired t-tests showed significant pre-/on-CBD changes in rs-FC in cerebellum, frontal areas, temporal areas, hippocampus, and amygdala with some of them correlating with improvement in behavioral measures. Significant differences in rs-FC between pre-CBD and HCs were found in cerebellum, frontal, and occipital regions. After controlling for changes in SF with CBD, these differences were no longer present when comparing on-CBD to HCs. SIGNIFICANCE This study indicates that highly purified CBD modulates and potentially normalizes rs-FC in the epileptic brain. This effect may underlie its efficacy. This study provides Class III evidence for CBD's normalizing effect on rs-FC in TRE.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Martina Bebin
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tyler E Gaston
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Leslie E Grayson
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - James T Houston
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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31
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Goodman AM, Allendorfer JB, Blum AS, Bolding MS, Correia S, Ver Hoef LW, Gaston TE, Grayson LE, Kraguljac NV, Lahti AC, Martin AN, Monroe WS, Philip NS, Tocco K, Vogel V, LaFrance WC, Szaflarski JP. White matter and neurite morphology differ in psychogenic nonepileptic seizures. Ann Clin Transl Neurol 2020; 7:1973-1984. [PMID: 32991786 PMCID: PMC7545605 DOI: 10.1002/acn3.51198] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To further evaluate the relationship between the clinical profiles and limbic and motor brain regions and their connecting pathways in psychogenic nonepileptic seizures (PNES). Neurite Orientation Dispersion and Density Indices (NODDI) multicompartment modeling was used to test the relationships between tissue alterations in patients with traumatic brain injury (TBI) and multiple psychiatric symptoms. METHODS The sample included participants with prior TBI (TBI; N = 37) but no PNES, and with TBI and PNES (TBI + PNES; N = 34). Participants completed 3T Siemens Prisma MRI high angular resolution imaging diffusion protocol. Statistical maps, including fractional anisotropy (FA), mean diffusivity (MD), neurite dispersion [orientation dispersion index (ODI)] and density [intracellular volume fraction (ICVF), and free water (i.e., isotropic) volume fraction (V-ISO)] signal intensity, were generated for each participant. Linear mixed-effects models identified clusters of between-group differences in indices of white matter changes. Pearson's r correlation tests assessed any relationship between signal intensity and psychiatric symptoms. RESULTS Compared to TBI, TBI + PNES revealed decreases in FA, ICVF, and V-ISO and increases in MD for clusters within cingulum bundle, uncinate fasciculus, fornix/stria terminalis, and corticospinal tract pathways (cluster threshold α = 0.05). Indices of white matter changes for these clusters correlated with depressive, anxiety, PTSD, psychoticism, and somatization symptom severity (FDR threshold α = 0.05). A follow-up within-group analysis revealed that these correlations failed to reach the criteria for significance in the TBI + PNES group alone. INTERPRETATION The results expand support for the hypothesis that alterations in pathways comprising the specific PNES network correspond to patient profiles. These findings implicate myelin-specific changes as possible contributors to PNES, thus introducing novel potential treatment targets.
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Affiliation(s)
- Adam M. Goodman
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jane B. Allendorfer
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Andrew S. Blum
- Department of NeurologyRhode Island HospitalProvidenceRhode IslandUSA
- Brown UniversityProvidenceRhode IslandUSA
| | - Mark S. Bolding
- Department of RadiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Stephen Correia
- Brown UniversityProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorAlpert Medical SchoolBrown UniversityRhode Island HospitalProvidenceRhode IslandUSA
- Center for Neurorestoration and NeurotechnologyProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - Lawrence W. Ver Hoef
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Birmingham VA Medical CenterBirminghamAlabamaUSA
| | - Tyler E. Gaston
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Birmingham VA Medical CenterBirminghamAlabamaUSA
| | - Leslie E. Grayson
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Birmingham VA Medical CenterBirminghamAlabamaUSA
- Children’s of AlabamaUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nina V. Kraguljac
- Department of Psychiatry and Behavioral NeurobiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Adrienne C. Lahti
- Department of Psychiatry and Behavioral NeurobiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Departments of Neurobiology and NeurosurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Amber N. Martin
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - William S. Monroe
- Department of Research ComputingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Noah S. Philip
- Brown UniversityProvidenceRhode IslandUSA
- Center for Neurorestoration and NeurotechnologyProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - Krista Tocco
- Department of NeurologyRhode Island HospitalProvidenceRhode IslandUSA
- Brown UniversityProvidenceRhode IslandUSA
- Center for Neurorestoration and NeurotechnologyProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - Valerie Vogel
- Department of NeurologyRhode Island HospitalProvidenceRhode IslandUSA
- Brown UniversityProvidenceRhode IslandUSA
- Center for Neurorestoration and NeurotechnologyProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - W. Curt LaFrance
- Center for Neurorestoration and NeurotechnologyProvidence VA Medical CenterProvidenceRhode IslandUSA
- Departments of Psychiatry and NeurologyRhode Island Hospital and Brown UniversityProvidenceRhode IslandUSA
| | - Jerzy P. Szaflarski
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Children’s of AlabamaUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Departments of Neurobiology and NeurosurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Comprehensive Neuroscience CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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32
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Binder JR, Tong JQ, Pillay SB, Conant LL, Humphries CJ, Raghavan M, Mueller WM, Busch RM, Allen L, Gross WL, Anderson CT, Carlson CE, Lowe MJ, Langfitt JT, Tivarus ME, Drane DL, Loring DW, Jacobs M, Morgan VL, Allendorfer JB, Szaflarski JP, Bonilha L, Bookheimer S, Grabowski T, Vannest J, Swanson SJ. Temporal lobe regions essential for preserved picture naming after left temporal epilepsy surgery. Epilepsia 2020; 61:1939-1948. [PMID: 32780878 DOI: 10.1111/epi.16643] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To define left temporal lobe regions where surgical resection produces a persistent postoperative decline in naming visual objects. METHODS Pre- and postoperative brain magnetic resonance imaging data and picture naming (Boston Naming Test) scores were obtained prospectively from 59 people with drug-resistant left temporal lobe epilepsy. All patients had left hemisphere language dominance at baseline and underwent surgical resection or ablation in the left temporal lobe. Postoperative naming assessment occurred approximately 7 months after surgery. Surgical lesions were mapped to a standard template, and the relationship between presence or absence of a lesion and the degree of naming decline was tested at each template voxel while controlling for effects of overall lesion size. RESULTS Patients declined by an average of 15% in their naming score, with wide variation across individuals. Decline was significantly related to damage in a cluster of voxels in the ventral temporal lobe, located mainly in the fusiform gyrus approximately 4-6 cm posterior to the temporal tip. Extent of damage to this region explained roughly 50% of the variance in outcome. Picture naming decline was not related to hippocampal or temporal pole damage. SIGNIFICANCE The results provide the first statistical map relating lesion location in left temporal lobe epilepsy surgery to picture naming decline, and they support previous observations of transient naming deficits from electrical stimulation in the basal temporal cortex. The critical lesion is relatively posterior and could be avoided in many patients undergoing left temporal lobe surgery for intractable epilepsy.
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Affiliation(s)
- Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jia-Qing Tong
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara B Pillay
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Colin J Humphries
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade M Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robyn M Busch
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Linda Allen
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William L Gross
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Chad E Carlson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mark J Lowe
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - John T Langfitt
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Daniel L Drane
- Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - David W Loring
- Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Monica Jacobs
- Department of Psychology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Victoria L Morgan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Susan Bookheimer
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Thomas Grabowski
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Jennifer Vannest
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sara J Swanson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Gaston TE, Nair S, Allendorfer JB, Martin RC, Beattie JF, Szaflarski JP. Memory response and neuroimaging correlates of a novel cognitive rehabilitation program for memory problems in epilepsy: A pilot study. Restor Neurol Neurosci 2020; 37:457-468. [PMID: 31282442 DOI: 10.3233/rnn-190919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Memory deficits are very common in epilepsy, but no standard of care exists to effectively manage them. OBJECTIVE We assessed effectiveness of cognitive rehabilitation (CR) on memory and neural plasticity in people with epilepsy (PWE) reporting memory impairments. METHODS Nine PWE completed 6 weekly sessions adapted from 2 generic CR programs enriched with information regarding epilepsy. Participants completed neuropsychological, mood, and quality of life (QOLIE-31) measures prior and after completion of CR; 5/9 participants also completed pre- and post-CR fMRI while performing a verbal paired associates learning task. FMRI data were analyzed using group spatial independent components analysis methods; paired t-tests compared spatial activations for pre-/post-CR. RESULTS Improvements were seen in immediate recall in Rey Auditory Verbal Learning Task, QOLIE-31, and read word recognition in paired associates task (all p's≤0.05). FMRI changes comparing pre-to-post CR were noted through increased activation in the left inferior frontal gyrus (IFG) and anterior cingulate and decreased activation in the left superior temporal gyrus; also noted were decreased activations in the default mode network (DMN), right cingulate, right middle temporal gyrus, right supramarginal gyrus, and increased DMN activation in the left cuneus. CONCLUSIONS This study demonstrates feasibility of conducting CR program in PWE with fMRI as a mechanistic biomarker. Improvements in cognition and cortical plasticity await confirmation in larger samples.
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Affiliation(s)
- Tyler E Gaston
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham Veterans Administration Medical Center, Birmingham, AL, USA
| | - Sangeeta Nair
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia Fleming Beattie
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Sharma AA, Nenert R, Allendorfer JB, Gaston TE, Grayson LP, Hernando K, Szaflarski JP. A preliminary study of the effects of cannabidiol (CBD) on brain structure in patients with epilepsy. Epilepsy Behav Rep 2019; 12:100341. [PMID: 32322816 PMCID: PMC7170322 DOI: 10.1016/j.ebr.2019.100341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 11/25/2022] Open
Abstract
Cannabis use is associated with changes in brain structure and function; its neurotoxic effects are largely attributed to Δ9-tetrahydrocannabidiol. Whether such effects are present in patients with epilepsy exposed to a highly-purified cannabidiol isolate (CBD; Epidiolex®; Greenwich Biosciences, Inc.) has not been investigated to date. This preliminary study examines whether daily CBD dose of 15-25 mg/kg produces cerebral macrostructure changes and, if present, how they relate to changes in seizure frequency. Twenty-seven patients with treatment-resistant epilepsy were recruited from the University of Alabama at Birmingham CBD Program. Participants provided seizure frequency diaries (SF), completed the Chalfont Seizure Severity Scale (CSSS) and Adverse Events Profile (AEP), and underwent MRI before CBD (baseline) and after achieving a stable CBD dosage (on-CBD). We examined T1-weighted structural images for gray matter volume (GMV) and cortical thickness changes from baseline to on-CBD in 18 participants. Repeated measures t-tests confirmed decreases in SF [t(17) = 3.08, p = 0.0069], CSSS [t(17) = 5.77, p < 0.001], and AEP [t(17) = 3.04, p = 0.0074] between the two time-points. Voxel-level paired samples t-tests did not identify significant changes in GMV or cortical thickness between these two time-points. In conclusion, short-term exposure to highly purified CBD may not affect cortical macrostructure.
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Affiliation(s)
- Ayushe A Sharma
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA
| | - Tyler E Gaston
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA.,Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Leslie P Grayson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA.,Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Kathleen Hernando
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham Epilepsy Center, Birmingham, AL, USA
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35
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Espay AJ, Ries S, Maloney T, Vannest J, Neefus E, Dwivedi AK, Allendorfer JB, Wulsin LR, LaFrance WC, Lang AE, Szaflarski JP. Clinical and neural responses to cognitive behavioral therapy for functional tremor. Neurology 2019; 93:e1787-e1798. [PMID: 31586023 DOI: 10.1212/wnl.0000000000008442] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/19/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To evaluate changes in tremor severity and motor/emotion-processing circuits in response to cognitive behavioral therapy (CBT) delivered as treatment for functional tremor (FT), the most common functional movement disorder in adults. METHODS Fifteen patients with FT underwent fMRI with motor, basic-emotion, and intense-emotion tasks before and after 12 weeks of CBT. Baseline fMRI was compared to those of 25 healthy controls (HCs). The main clinical endpoint was the tremor score (sum of severity, duration, and incapacitation subscores) adapted from the Rating Scale for Psychogenic Movement Disorders (PMDRS) assessed by a blinded clinician. CBT responders were defined as those with PMDRS score reduction >75%. Anatomic and functional brain images were obtained with a 4T MRI system. Generalized linear model and region-of-interest analyses were used to evaluate before-versus-after treatment-related changes in brain activation. RESULTS CBT markedly reduced tremor severity (p < 0.01) with remission/near remission achieved in 73.3% of the cohort. Compared to HCs, in those with FT, a functionally defined fMRI region of interest in the anterior cingulate/paracingulate cortex showed increased activation at baseline and decreased activation after CBT during basic-emotion processing (p = 0.012 for CBT responders). Among CBT responders, the change in anterior cingulate/paracingulate was more significant in those with more severe baseline depression (r = 0.75, p < 0.01). CONCLUSIONS Tremor severity improved significantly after CBT. The improvement was associated with changes in the anterior cingulate/paracingulate activity, which may represent a marker of emotional dysregulation in FT and a predictor of treatment response. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that CBT significantly improves tremor severity in patients with functional tremor.
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Affiliation(s)
- Alberto J Espay
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada.
| | - Scott Ries
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Thomas Maloney
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Jennifer Vannest
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Erin Neefus
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Alok K Dwivedi
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Jane B Allendorfer
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Lawson R Wulsin
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - W Curt LaFrance
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Anthony E Lang
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Jerzy P Szaflarski
- From the Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E., E.N.); Mood Disorders Center (S.R., L.R.W.), University of Cincinnati Gardner Neuroscience Institute; Pediatric Neuroimaging Research Consortium (T.M., J.V.), Cincinnati Children's Hospital; Department of Pediatrics (J.V.), University of Cincinnati College of Medicine, OH; Department of Biomedical Sciences (A.K.D.), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Neurology (J.B.A., J.P.S.), University of Alabama at Birmingham; Division of Neuropsychiatry and Behavioral Neurology (W.C.L.), Rhode Island Hospital, Providence; and Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital, University of Toronto, Ontario, Canada
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Nair S, Nenert RE, Allendorfer JB, Goodman AM, Vannest J, Mirman D, Szaflarski JP. Sex, Age, and Handedness Modulate the Neural Correlates of Active Learning. Front Neurosci 2019; 13:961. [PMID: 31572114 PMCID: PMC6749092 DOI: 10.3389/fnins.2019.00961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Self-generation of material compared to passive learning results in mproved memory performance; this may be related to recruitment of a fronto-temporal encoding network. Using a verbal paired-associate learning fMRI task, we examined the effects of sex, age, and handedness on the neural correlates of self-generation. METHODS Data from 174 healthy English-speaking participants (78M, 56 atypically handed; ages 19-76) were preprocessed using AFNI and FSL. Independent component analysis was conducted using GIFT (Group ICA fMRI Toolbox). Forty-one independent components were temporally sorted by task time series. Retaining correlations (r > 0.25) resulted in three task-positive ("generate") and three task-negative ("read") components. Using participants' back-projected components, we evaluated the effects of sex, handedness, and aging on activation lateralization and localization in task-relevant networks with two-sample t-tests. Further, we examined the linear relationship between sex and neuroimaging data with multiple regression, covarying for scanner, age, and handedness. RESULTS Task-positive components identified using ICA revealed a fronto-parietal network involved with self-generation, while task-negative components reflecting passive reading showed temporo-occipital involvement. Compared to older adults, younger adults exhibited greater task-positive involvement of the left inferior frontal gyrus and insula, whereas older adults exhibited reduced prefrontal lateralization. Greater involvement of the left angular gyrus in task-positive encoding networks among right-handed individuals suggests the reliance on left dominant semantic processing areas may be modulated by handedness. Sex effects on task-related encoding networks while controlling for age and handedness suggest increased right hemisphere recruitment among males compared to females, specifically in the paracentral lobe during self-generation and the suparmarginal gyrus during passive reading. IMPLICATIONS Identified neuroimaging differences suggest that sex, age, and handedness are factors in the differential recruitment of encoding network regions for both passive and active learning.
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Affiliation(s)
- Sangeeta Nair
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rodolphe E. Nenert
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jane B. Allendorfer
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Adam M. Goodman
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer Vannest
- Department of Pediatrics, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Pediatric Neuroimaging Research Consortium, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Daniel Mirman
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Jerzy P. Szaflarski
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, United States
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Allendorfer JB, Nenert R, Bebin EM, Gaston TE, Grayson LE, Hernando KA, Houston JT, Hansen B, Szaflarski JP. fMRI study of cannabidiol-induced changes in attention control in treatment-resistant epilepsy. Epilepsy Behav 2019; 96:114-121. [PMID: 31129526 DOI: 10.1016/j.yebeh.2019.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
Abstract
Patients with treatment-resistant epilepsy (TRE) frequently exhibit memory and attention deficits that contribute to their poor personal and societal outcomes. We studied the effects of adjunct treatment with pharmaceutical grade cannabidiol (CBD) oral solution (Epidiolex®; Greenwich Biosciences, Inc.) on attention control processes related to stimulus conflict resolution in patients with TRE. Twenty-two patients with TRE underwent 3 T magnetic resonance imaging (MRI) before receiving (PRE) and after achieving a stable dose of CBD (ON). Functional MRI (fMRI) data were collected while patients performed 2 runs of a flanker task (FT). Patients were instructed to indicate via button press the congruent (CON) and incongruent (INC) conditions. We performed t-tests to examine with FT attention control processes at PRE and ON visits and to compare the 2 visits using derived general linear model (GLM) data (INC - CON). We performed generalized psychophysiological interaction (gPPI) analyses to assess changes in condition-based functional connectivity on FT. Median time between fMRI visits was 10 weeks, and median CBD dose at follow-up was 25 mg/kg/d. From PRE to ON, participants experienced improvements in seizure frequency (SF) (p = 0.0009), seizure severity (Chalfont Seizure Severity Scale (CSSS); p < 0.0001), and mood (Total Mood Disturbance (TMD) score from Profile of Mood States (POMS); p = 0.0026). Repeated measures analysis of variance showed nonsignificant improvements in executive function from 34.6 (23.5)% to 41.9 (22.4)% CON accuracy and from 34.2 (25.7)% to 37.6 (24.4)% INC accuracy (p = 0.199). Change in CON accuracy was associated with change in INC accuracy (rS = 0.81, p = 0.0005). Participants exhibited CBD-induced increases in fMRI activation in the right superior frontal gyrus (SFG) and right insula/middle frontal gyrus (MFG) and decrease in activation for both regions at ON relative to PRE (corrected p = 0.05). The subset of patients who improved in FT accuracy with CBD showed a negative association between change in right insula/MFG activation and change in accuracy for the INC condition (rS = -0.893, p = 0.0068). The gPPI analysis revealed a CBD-induced decrease in condition-based functional connectivity differences for the right SFG seed region (corrected p = 0.05). Whole-brain regression analysis documented a negative association of change in right insula/MFG condition-based connectivity with change in INC accuracy (corrected p = 0.005). Our results suggest that CBD modulates attention control processing in patients with TRE by reducing right SFG and right insula/MFG activation related to stimulus conflict resolution and by dampening differences in condition-based functional connectivity of the right SFG. Our study is the first to provide insight into how CBD affects the neural substrates involved in attention processing and how modulation of the activity and functional connectivity related to attentional control processes in the right insula/MFG may be working to improve cognitive performance in TRE.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rodolphe Nenert
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Martina Bebin
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tyler E Gaston
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Leslie E Grayson
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA
| | - Kathleen A Hernando
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James T Houston
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Hansen
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Goodman AM, Allendorfer JB, Heyse H, Szaflarski BA, Eliassen JC, Nelson EB, Storrs JM, Szaflarski JP. Neural response to stress and perceived stress differ in patients with left temporal lobe epilepsy. Hum Brain Mapp 2019; 40:3415-3430. [PMID: 31033120 DOI: 10.1002/hbm.24606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/21/2019] [Accepted: 04/14/2019] [Indexed: 01/28/2023] Open
Abstract
Patients with epilepsy are often able to predict seizure occurrence subsequent to an acute stress experience. However, neuroimaging investigations into the neural basis of this relationship or the potential influence of perceived life stress are limited. The current study assessed the relationship between perceived stress and the neurobehavioral response to stress in patients with left temporal lobe epilepsy (LTLE) and healthy controls (HCs) using heart rate, salivary cortisol level, and functional magnetic resonance imaging and compared these effects between HCs and LTLE. Matched on perceived stress levels, groups of 36 patients with LTLE and 36 HCs completed the Montreal Imaging Stress Task, with control and stress math task conditions. Among LTLEs, 27 reported that prior (acute) stress affected their seizures (LTLES+), while nine did not (LTLES-). The results revealed that increased perceived stress was associated with seizure frequency in LTLE. Further, cortisol secretion was greater in LTLE, but did not vary with perceived stress as observed in HCs. A linear mixed-effects analysis revealed that as perceived stress increased, activation in the hippocampal complex (parahippocampal gyrus and hippocampus) decreased during stressful math in the LTLES+, increased in HCs, but did not vary in the LTLES-. Task-based functional connectivity analyses revealed LTLE differences in hippocampal functional connectivity with sensory cortex specific to stressor modalities. We argue that the current study demonstrates an inhibitory hippocampal mechanism underlying differences in resilience to stress between HCs and LTLE, as well as LTLE patients who report stress as a precipitant of seizures.
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Affiliation(s)
- Adam M Goodman
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Heidi Heyse
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Basia A Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - James C Eliassen
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Erik B Nelson
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Judd M Storrs
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
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Barghi A, Allendorfer JB, Taub E, Womble B, Hicks JM, Uswatte G, Szaflarski JP, Mark VW. Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 2: Effect on White Matter Integrity. Neurorehabil Neural Repair 2019; 32:233-241. [PMID: 29668401 DOI: 10.1177/1545968317753073] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) is a method of physical rehabilitation that has demonstrated clinical efficacy in patients with chronic stroke, cerebral palsy, and multiple sclerosis (MS). OBJECTIVE This pilot randomized controlled trial tested whether CIMT can also induce increases in white matter integrity in patients with MS. METHODS Twenty adults with chronic hemiparetic MS were randomized to receive either CIMT or complementary and alternative medicine (CAM) treatment (reported in the first article of this pair). Structural white matter change was assessed by tract-based spatial statistics (TBSS); measures included fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS CIMT and CAM groups did not differ in pretreatment disability or expectancy to benefit. As noted in the companion paper, the motor activity log (MAL) improved more after CIMT than CAM ( P < .001); the within-group effect size for CIMT was 3.7 (large d' = 0.57), while for CAM it was just 0.7. Improvements in white matter integrity followed CIMT and were observed in the contralateral corpus callosum (FA, P < .05), ipsilateral superior occipital gyrus (AD, P < .05), ipsilateral superior temporal gyrus (FA, P < .05), and contralateral corticospinal tract (MD and RD, P < .05). CONCLUSION CIMT produced a very large improvement in real-world limb use and induced white matter changes in patients with hemiparetic MS when compared with CAM. The findings suggest in preliminary fashion that the adverse changes in white matter integrity induced by MS might be reversed by CIMT. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01081275).
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Affiliation(s)
| | | | - Edward Taub
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent Womble
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jarrod M Hicks
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Victor W Mark
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
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Bolden LB, Griffis JC, Nenert R, Allendorfer JB, Szaflarski JP. Cortical excitability and seizure control influence attention performance in patients with idiopathic generalized epilepsies (IGEs). Epilepsy Behav 2018; 89:135-142. [PMID: 30415135 DOI: 10.1016/j.yebeh.2018.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/08/2018] [Accepted: 10/21/2018] [Indexed: 02/05/2023]
Abstract
We recently found that higher cortical excitability is associated with poorer attention performance in healthy adults. While patients with idiopathic generalized epilepsies (IGEs), previously termed genetic generalized epilepsies, are known to demonstrate increased cortical excitability and cognitive deficits, a relationship between these variables in IGEs has not been investigated. Therefore, we aimed to characterize the effects of cortical excitability and seizure control on cognitive performance in IGEs. We studied 30 patients with IGEs (16 patients with controlled IGEs (cIGEs) and 14 patients with treatment-resistant IGEs (trIGEs)) and 24 healthy controls (HCs). Transcranial magnetic stimulation (TMS) was used to measure cortical excitability, including long-interval intracortical inhibition (LICI). Attention was assessed with the Digit Span Forwards, Digit Span Backwards, Trails A, and Flanker tasks. Executive functioning was assessed using Trails B, Stroop Color and Word, and the Wisconsin Card Sorting Task. Two-way multivariate analyses of variance (MANOVAs) were conducted to assess the influences of seizure control (HCs vs. cIGEs vs. trIGEs) and cortical excitability (inhibitory vs. excitatory) on composite measures of attention and executive functions. Attention performance was significantly affected by cortical excitability and seizure control. Participants with primarily excitatory LICI responses, indicating higher cortical excitability, performed worse than inhibitory responders on composite attention (Wilks' lambda = 0.748, F(4, 44) = 3.72, p = 0.011). While participants with cIGEs and trIGEs did not significantly differ in attention performance, participants with trIGEs performed worse on the Digit Forwards (False Discovery Rate (FDR)p < 0.001), Digit Backwards (FDRp = 0.015), and Flanker (FDRp = 0.0075) tasks compared with HCs. These results provide support for the relationship between cortical excitability and attention dysfunction in IGEs. Further investigation is needed to determine whether there is a causal relationship between these variables and whether intracortical gamma-aminobutyric acid (GABA)B networks may be targeted to improve attention deficits in clinical populations with decreased LICI. Findings also suggest that additional research directly comparing cognition in patients with cIGEs and trIGEs is warranted.
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Affiliation(s)
- Lauren B Bolden
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Joseph C Griffis
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Nenert R, Allendorfer JB, Martin AM, Banks C, Vannest J, Holland SK, Hart KW, Lindsell CJ, Szaflarski JP. Longitudinal fMRI study of language recovery after a left hemispheric ischemic stroke. Restor Neurol Neurosci 2018; 36:359-385. [PMID: 29782329 DOI: 10.3233/rnn-170767] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recovery from stroke-induced aphasia is typically protracted and involves complex functional reorganization. The relative contributions of the lesioned and non-lesioned hemispheres to this process have been examined in several cross-sectional studies but longitudinal studies involving several time-points and large numbers of subjects are scarce. OBJECTIVE The aim of this study was to address the gaps in the literature by longitudinally studying the evolution of post-stroke lateralization and localization of language-related fMRI activation in the first year after single left hemispheric ischemic stroke. METHOD Seventeen patients with stroke-induced aphasia were enrolled to undergo detailed behavioral testing and fMRI at 2, 6, 12, 26, and 52 weeks post-stroke. Matched for age, handedness and sex participants were also enrolled to visualize canonical language regions. RESULTS Behavioral results showed improvements over time for all but one of the behavioral scores (Semantic Fluency Test). FMRI results showed that the left temporal area participates in compensation for language deficits in the first year after stroke, that there is a correlation between behavioral improvement and the left cerebellar activation over time, and that there is a shift towards stronger frontal left-lateralization of the fMRI activation over the first year post-stroke. Temporary compensation observed in the initial phases of post-stroke recovery that involves the non-lesioned hemisphere may not be as important as previously postulated, since in this study the recovery was driven by activations in the left fronto-temporal regions. CONCLUSION Language recovery after left hemispheric ischemic stroke is likely driven by the previously involved in language and attention left hemispheric networks.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber M Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christi Banks
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott K Holland
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly W Hart
- Department of Emergency Medicine, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Christopher J Lindsell
- Department of Emergency Medicine, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.,currently at Department of Biostatistics, Vanderbilt University, Department of Biostatistics, Nashville, TN, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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Szaflarski JP, Griffis J, Vannest J, Allendorfer JB, Nenert R, Amara AW, Sung V, Walker HC, Martin AN, Mark VW, Zhou X. A feasibility study of combined intermittent theta burst stimulation and modified constraint-induced aphasia therapy in chronic post-stroke aphasia. Restor Neurol Neurosci 2018; 36:503-518. [DOI: 10.3233/rnn-180812] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jerzy P. Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Griffis
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Currently at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer Vannest
- Cincinnati Children’s Hospital Medical Center, Division of Neurology and Pediatric Neuroimaging Research Consortium, Cincinnati, OH, USA
| | - Jane B. Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy W. Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor Sung
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harrison C. Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber N. Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor W. Mark
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiaohua Zhou
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
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Szaflarski JP, Allendorfer JB, Nenert R, LaFrance WC, Barkan HI, DeWolfe J, Pati S, Thomas AE, Ver Hoef L. Facial emotion processing in patients with seizure disorders. Epilepsy Behav 2018; 79:193-204. [PMID: 29309953 DOI: 10.1016/j.yebeh.2017.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
Abstract
Studies of emotion processing are needed to better understand the pathophysiology of psychogenic nonepileptic seizures (PNES). We examined the differences in facial emotion processing between 12 patients with PNES, 12 patients with temporal lobe epilepsy (TLE), and 24 matched healthy controls (HCs) using fMRI with emotional faces task (EFT) (happy/sad/fearful/neutral) and resting state connectivity. Compared with TLE, patients with PNES exhibited increased fMRI response to happy, neutral, and fearful faces in visual, temporal, and/or parietal regions and decreased fMRI response to sad faces in the putamen bilaterally. Regions showing significant differences between PNES and TLE were used as functional seed regions of interest (ROIs), in addition to amygdala structural seed ROIs for resting state functional connectivity analyses. Whole brain analyses showed that compared with TLE and HCs, patients with PNES exhibited increased functional connectivity of the functional seed ROIs to several brain regions, particularly to cerebellar, visual, motor, and frontotemporal regions. Connectograms showed increased functional connections between left parahippocampal gyrus/uncus ROIs and right temporal ROIs in PNES compared with both the TLE and HC groups. Resting state functional connectivity of the left and right amygdala to various brain regions including emotion regulation and motor control circuits was increased in PNES when compared with those with TLE. This study provides preliminary evidence that patients with PNES exhibit altered facial emotion processing compared with patients with TLE and HCs and increased amygdala functional connectivity compared with TLE. These findings identify potential key differences in facial emotion processing reflective of neurophysiologic markers of neural circuitry alterations that can be used to generate further hypotheses for developing studies that examine the contributions of emotion processing to the development and maintenance of PNES.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Helen I Barkan
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer DeWolfe
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashley E Thomas
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence Ver Hoef
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Allendorfer JB, Arida RM. Role of Physical Activity and Exercise in Alleviating Cognitive Impairment in People With Epilepsy. Clin Ther 2018; 40:26-34. [DOI: 10.1016/j.clinthera.2017.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 01/02/2023]
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Kelly NA, Wood KH, Allendorfer JB, Ford MP, Bickel CS, Marstrander J, Amara AW, Anthony T, Bamman MM, Skidmore FM. High-Intensity Exercise Acutely Increases Substantia Nigra and Prefrontal Brain Activity in Parkinson's Disease. Med Sci Monit 2017; 23:6064-6071. [PMID: 29273705 PMCID: PMC5747933 DOI: 10.12659/msm.906179] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Pathologic alterations in resting-state brain activity patterns exist among individuals with Parkinson’s disease (PD). Since physical exercise alters resting-state brain activity in non-PD populations and improves PD symptoms, we assessed the acute effect of exercise on resting-state brain activity in exercise-trained individuals with PD. Material/Methods Resting-state functional magnetic resonance imaging (fMRI) was collected twice for 17 PD participants at the conclusion of an exercise intervention. The acute effect of exercise was examined for PD participants using the amplitude of low frequency fluctuation (ALFF) before and after a single bout of exercise. Correlations of clinical variables (i.e., PDQ-39 quality of life and MDS-UPDRS) with ALFF values were examined for the exercise-trained PD participants. Results An effect of acute exercise was observed as an increased ALFF signal within the right ventromedial prefrontal cortex (PFC), left ventrolateral PFC, and bilaterally within the substantia nigra (SN). Quality of life was positively correlated with ALFF values within the vmPFC and vlPFC. Conclusions Given the role of the SN and PFC in motor and non-motor symptoms in PD, the acute increases in brain activity within these regions, if repeated frequently over time (i.e., exercise training), may serve as a potential mechanism underlying exercise-induced PD-specific clinical benefits.
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Affiliation(s)
- Neil A Kelly
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA.,UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimberly H Wood
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew P Ford
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | - C Scott Bickel
- Department of Physical Therapy, Samford University, Birmingham, AL, USA
| | - Jon Marstrander
- Department of Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy W Amara
- Department of Physical Therapy, University of Alabama, Birmingham, AL, USA
| | - Thomas Anthony
- Department of Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcas M Bamman
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA.,UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Frank M Skidmore
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Chen R, Szaflarski JP. Dysfunction in emotion processing underlies functional (psychogenic) dystonia. Mov Disord 2017; 33:136-145. [PMID: 29124784 DOI: 10.1002/mds.27217] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/16/2017] [Accepted: 09/24/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to determine whether abnormalities in emotion processing underlie functional (psychogenic) dystonia, one of the most common functional movement disorders. METHODS Motor and emotion circuits were examined in 12 participants with functional dystonia, 12 with primary organic dystonia, and 25 healthy controls using functional magnetic resonance imaging at 4T and a finger-tapping task (motor task), a basic emotion-recognition task (emotional faces task), and an intense-emotion stimuli task. RESULTS There were no differences in motor task activation between groups. In the faces task, when compared with the other groups, functional dystonia patients showed areas of decreased activation in the right middle temporal gyrus and bilateral precuneus and increased activation in the right inferior frontal gyrus, bilateral occipital cortex and fusiform gyrus, and bilateral cerebellum. In the intense-emotion task, when compared with the other groups, functional dystonia patients showed decreased activation in the left insular and left motor cortices (compared to organic dystonia, they showed an additional decrease in activation in the right opercular cortex and right motor cortex) and increased activation in the left fusiform gyrus. CONCLUSIONS Functional dystonia patients exhibited stimulus-dependent altered activation in networks involved in motor preparation and execution, spatial cognition, and attentional control. These results support the presence of network dysfunction in functional dystonia. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alberto J Espay
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.,Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, Ohio, USA
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Matthew M Norris
- University of Cincinnati Center for Imaging Research, Cincinnati, Ohio, USA
| | - James C Eliassen
- University of Cincinnati Center for Imaging Research, Cincinnati, Ohio, USA
| | - Erin Neefus
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert Chen
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network and the University of Toronto, Toronto, Canada
| | - Jerzy P Szaflarski
- UC Neuroscience Institute, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Griffis JC, Nenert R, Allendorfer JB, Szaflarski JP. Linking left hemispheric tissue preservation to fMRI language task activation in chronic stroke patients. Cortex 2017; 96:1-18. [PMID: 28961522 PMCID: PMC5675757 DOI: 10.1016/j.cortex.2017.08.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/09/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
Abstract
The preservation of near-typical function in distributed brain networks is associated with less severe deficits in chronic stroke patients. However, it remains unclear how task-evoked responses in networks that support complex cognitive functions such as semantic processing relate to the post-stroke brain anatomy. Here, we used recently developed methods for the analysis of multimodal MRI data to investigate the relationship between regional tissue concentration and functional MRI activation evoked during auditory semantic decisions in a sample of 43 chronic left hemispheric stroke patients and 43 age, handedness, and sex-matched controls. Our analyses revealed that closer-to-normal levels of tissue concentration in left temporo-parietal cortex and the underlying white matter correlated with the level of task-evoked activation in distributed regions associated with the semantic network. This association was not attributable to the effects of left hemispheric lesion or brain volumes, and similar results were obtained when using explicit lesion data. Left temporo-parietal tissue concentration and the associated task-evoked activations predicted patient performance on the in-scanner task, and also predicted patient performance on out-of-scanner naming and verbal fluency tasks. Exploratory analyses using the average HCP-842 tractography dataset revealed the presence of fronto-temporal, fronto-parietal, and temporo-parietal semantic network connections in the locations where tissue concentration was found to correlate with task-evoked activation in the semantic network. In summary, our results link the preservation of left posterior temporo-parietal structures with the preservation of task-evoked semantic network function in chronic left hemispheric stroke patients. Speculatively, this relationship may reflect the status of posterior temporo-parietal areas as cortical and white matter convergence zones that support coordinated processing in the distributed semantic network. Damage to these regions may contribute to atypical task-evoked responses during semantic processing in chronic stroke patients.
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Affiliation(s)
- Joseph C Griffis
- University of Alabama at Birmingham, Department of Psychology, USA.
| | - Rodolphe Nenert
- University of Alabama at Birmingham, Department of Neurology, USA
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Lang AE, Szaflarski JP. Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study. Neuroimage Clin 2017; 17:179-187. [PMID: 29085776 PMCID: PMC5655406 DOI: 10.1016/j.nicl.2017.10.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/13/2017] [Accepted: 10/18/2017] [Indexed: 02/06/2023]
Abstract
Background Despite its high prevalence and associated disability, the neural correlates of emotion processing in patients with functional (psychogenic) tremor (FT), the most common functional movement disorder, remain poorly understood. Methods In this cross sectional functional magnetic resonance imaging (fMRI) study at 4T, 27 subjects with FT, 16 with essential tremor (ET), and 25 healthy controls (HCs) underwent a finger-tapping motor task, a basic-emotion task, and an intense-emotion task to probe motor and emotion circuitries. Anatomical and functional MRI data were processed with FSL (FMRIB Software Library) and AFNI (Analysis of Functional Neuroimages), followed by seed-to-seed connectivity analyses using anatomical regions defined from the Harvard-Oxford subcortical atlas; all analyses were corrected for multiple comparisons. Results After controlling for depression scores and correcting for multiple comparisons, the FT group showed increased activation in the right cerebellum compared to ET during the motor task; and increased activation in the paracingulate gyrus and left Heschl's gyrus compared with HC with decreased activation in the right precentral gyrus compared with ET during the basic-emotion task. No significant differences were found after adjusting for multiple comparisons during the intense-emotion task but increase in connectivity between the left amygdala and left middle frontal gyrus survived corrections in the FT subjects during this task, compared to HC. Conclusions In response to emotional stimuli, functional tremor is associated with alterations in activation and functional connectivity in networks involved in emotion processing and theory of mind. These findings may be relevant to the pathophysiology of functional movement disorders. Patients with functional tremor exhibit altered emotion processing circuitry. There is increased activation in the paracingulate gyrus after emotional stimuli. Increased connectivity between the left amygdala and middle frontal gyrus Functional disorders may be associated with disturbances in the theory of mind.
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Key Words
- AFNI, Analysis of Functional Neuroimages
- CPT-END, continuous performance task with emotional and neutral distracters
- Conversion disorder
- EPI, echo-planar imaging
- Emotion processing
- FSL, FMRIB Software Library
- FT, functional tremor
- Functional movement disorders
- Functional tremor
- HAM-A, Hamilton Anxiety Rating Scale
- HAM-D, Hamilton Depression Rating Scale
- MDEFT, modified equilibrium Fourier transform
- MINI, Mini International Neuropsychiatric Interview
- Psychogenic tremor
- fMRI
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Matthew M Norris
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - James C Eliassen
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - Erin Neefus
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anthony E Lang
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Nenert R, Allendorfer JB, Martin AM, Banks C, Ball A, Vannest J, Dietz AR, Szaflarski JP. Neuroimaging Correlates of Post-Stroke Aphasia Rehabilitation in a Pilot Randomized Trial of Constraint-Induced Aphasia Therapy. Med Sci Monit 2017; 23:3489-3507. [PMID: 28719572 PMCID: PMC5529460 DOI: 10.12659/msm.902301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Recovery from post-stroke aphasia is a long and complex process with an uncertain outcome. Various interventions have been proposed to augment the recovery, including constraint-induced aphasia therapy (CIAT). CIAT has been applied to patients suffering from post-stroke aphasia in several unblinded studies to show mild-to-moderate linguistic gains. The aim of the present study was to evaluate the neuroimaging correlates of CIAT in patients with chronic aphasia related to left middle cerebral artery stroke. Material/Methods Out of 24 patients recruited in a pilot randomized blinded trial of CIAT, 19 patients received fMRI of language. Eleven of them received CIAT (trained) and eight served as a control group (untrained). Each patient participated in three fMRI sessions (before training, after training, and 3 months later) that included semantic decision and verb generation fMRI tasks, and a battery of language tests. Matching healthy control participants were also included (N=38; matching based on age, handedness, and sex). Results Language testing showed significantly improved performance on Boston Naming Test (BNT; p<0.001) in both stroke groups over time and fMRI showed differences in the distribution of the areas involved in language production between groups that were not present at baseline. Further, regression analysis with BNT indicated changes in brain regions correlated with behavioral performance (temporal gyrus, postcentral gyrus, precentral gyrus, thalamus, left middle and superior frontal gyri). Conclusions Overall, our results suggest the possibility of language-related cortical plasticity following stroke-induced aphasia with no specific effect from CIAT training.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber M Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christi Banks
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Vannest
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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Allendorfer JB, Szaflarski JP. Neuroimaging studies towards understanding the central effects of pharmacological cannabis products on patients with epilepsy. Epilepsy Behav 2017; 70:349-354. [PMID: 28109780 DOI: 10.1016/j.yebeh.2016.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 02/04/2023]
Abstract
Recent interest for the use of cannabis-derived products as therapeutic agents in the treatment of epilepsies has necessitated a reevaluation of their effects on brain and behavior. Overall, prolonged cannabis use is thought to result in functional and structural brain alterations. These effects may be dependent on a number of factors: e.g., which phytocannabinoid is used (e.g., cannabidiol (CBD) vs. tetrahyrocannabinol (THC)), the frequency of use (occasional vs. heavy), and at what age (prenatal, childhood, adulthood) the use began. However, due to the fact that there are over seven hundred constituents that make up the Cannabis sativa plant, it is difficult to determine which compound or combination of compounds is responsible for specific effects when studying recreational users. Therefore, this review focuses only on the functional MRI studies investigating the effects of specific pharmacological preparations of cannabis compounds, specifically THC, tetrahydrocannabivarin (THCV), and CBD, on brain function in healthy individuals and persons with epilepsy with references to non-epilepsy studies only to underline the gaps in research that need to be filled before cannabis-derived products are considered for a wide use in the treatment of epilepsy. This article is part of a Special Issue entitled "Cannabinoids and Epilepsy".
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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