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Canjels LPW, Alers RJ, van de Ven V, Hurks PPM, Gerretsen SC, Brandt Y, Kooi ME, Jansen JFA, Backes WH, Ghossein-Doha C, Spaanderman MEA. Cerebral volume is unaffected after pre-eclampsia. Ultrasound Obstet Gynecol 2023; 62:115-121. [PMID: 36730173 DOI: 10.1002/uog.26172] [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] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Pre-eclampsia has been associated with cardiovascular, cerebrovascular and/or psychological complaints. Signs of altered brain morphology and more white-matter hyperintensities (WMHs) during and shortly after pre-eclampsia have been observed in some, but not all, studies. We compared volumes of cerebral structures and the number of WMHs between formerly pre-eclamptic women and those with normotensive gestational history and assessed the effect of age on brain volumes. METHODS Structural 7-Tesla magnetic resonance imaging of the brain was performed in 59 formerly pre-eclamptic women (aged 37 ± 6 years, 0.5-16 years postpartum) and 20 women with a history of normotensive pregnancy (aged 39 ± 5 years, 1-18 years postpartum). Fazekas scores were obtained to assess WMH load. Volumes of the whole brain, gray and white matter, brain lobes, and ventricular and pericortical cerebrospinal fluid (CSF) spaces were calculated after semiautomatic segmentation. Group differences were analyzed using ANCOVA and Bayes factors. Results were adjusted for age, educational attainment, presence of current hypertension and total intracranial volume. The effect of age on cerebral volumes was analyzed using linear regression analysis. RESULTS No changes in global and local brain volumes were observed between formerly pre-eclamptic and control women. Also, no difference in WMH load was observed. Independent of pre-eclamptic history, gray-matter volume significantly decreased with age, while ventricular and pericortical CSF space volumes significantly increased with age. CONCLUSIONS Volumetric changes of the cerebrum are age-related but are independent of pre-eclamptic history in the first two decades after childbirth. No evidence of greater WMH load after pre-eclampsia was found. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L P W Canjels
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R J Alers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - V van de Ven
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - P P M Hurks
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - S C Gerretsen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Y Brandt
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - M E Kooi
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - J F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - C Ghossein-Doha
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Canjels LPW, Ghossein-Doha C, Alers RJ, Rutten S, van den Kerkhof M, Schiffer VMMM, Mulder E, Gerretsen SC, Aldenkamp AP, Hurks PPM, van de Ven V, Spaanderman MEA, Jansen JFA, Backes WH. Functional connectivity of limbic system and prefrontal cortex years after pre-eclampsia: 7-Tesla functional magnetic resonance imaging study. Ultrasound Obstet Gynecol 2022; 60:532-540. [PMID: 35502135 DOI: 10.1002/uog.24928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pre-eclampsia is a vascular complication of pregnancy, associated with a long-term risk of cerebrovascular and mental disorders. We explored whether formerly pre-eclamptic women exhibit differences in functional brain organization, especially in regions that may explain the commonly reported emotional symptoms and cognitive complaints even years after the pregnancy. METHODS Formerly pre-eclamptic women and control women with a history of normotensive pregnancy underwent structural and functional 7-Tesla magnetic resonance imaging scans. Using graph theoretical analysis, the efficiency and clustering coefficient of the functional brain network were investigated. The study included local analysis focusing on particular brain structures, such as the limbic system and the prefrontal cortex, and global analysis of the whole cerebrum. Univariable and multivariable linear regression was used to investigate the relationship between brain network-related graph measures and the group (formerly pre-eclamptic or control). RESULTS A total of 17 control parous women and 55 women with a history of pre-eclampsia were recruited. The time intervals between the index pregnancy and recruitment were 8.0 and 5.6 years for the two groups, respectively. Compared with control women, formerly pre-eclamptic women had higher local efficiency in the prefrontal cortex (P = 0.048) and anterior cingulate cortex (P = 0.03) but lower local efficiency and local clustering coefficient in the amygdala (P = 0.004 and P = 0.02, respectively) and parahippocampal cortex (P = 0.007 and P = 0.008, respectively). No differences were found in the global functional brain organization. CONCLUSIONS Compared to controls with a history of normotensive pregnancy, formerly pre-eclamptic women displayed a different local functional brain organization. These differences in functional connectivity, especially in the limbic regions and the prefrontal cortex, are in line with the psychological and cognitive complaints reported commonly by women with a history of pre-eclampsia. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L P W Canjels
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - C Ghossein-Doha
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM, School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - R J Alers
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Rutten
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Scannexus Ultra-High Field MRI Center, Maastricht, The Netherlands
| | - M van den Kerkhof
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - V M M M Schiffer
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Mulder
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S C Gerretsen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A P Aldenkamp
- MHeNs, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Academic Center for Epileptology Kempenhaeghe/Maastricht UMC+, Heeze and Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P P M Hurks
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - V van de Ven
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - M E A Spaanderman
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- CARIM, School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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3
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Canjels LPW, Jansen JFA, Alers RJ, Ghossein‐Doha C, van den Kerkhof M, Schiffer VMMM, Mulder E, Gerretsen SC, Aldenkamp AP, Hurks PPM, van de Ven V, Spaanderman MEA, Backes WH. Blood-brain barrier leakage years after pre-eclampsia: dynamic contrast-enhanced 7-Tesla MRI study. Ultrasound Obstet Gynecol 2022; 60:541-548. [PMID: 35502137 PMCID: PMC9826493 DOI: 10.1002/uog.24930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pre-eclampsia is a hypertensive complication of pregnancy that is associated with an increased risk of long-term cardiovascular and cerebrovascular disorders. Although the underlying mechanism of persistent susceptibility to cerebral complications after pre-eclampsia remains largely unclear, impaired blood-brain barrier (BBB) integrity has been suggested to precede several cerebrovascular diseases. In this study, we aimed to investigate the integrity of the BBB years after pre-eclampsia. METHODS This was an observational study of premenopausal formerly pre-eclamptic women and controls with a history of normotensive pregnancy who underwent cerebral magnetic resonance imaging (MRI) at ultra-high field (7 Tesla) to assess the integrity of the BBB. Permeability of the BBB was determined by assessing leakage rate and fractional leakage volume of the contrast agent gadobutrol using dynamic contrast-enhanced MRI. BBB leakage measures were determined for the whole brain and lobar white and gray matter. Multivariable analyses were performed, and odds ratios were calculated to compare women with and those without a history of pre-eclampsia, adjusting for potential confounding effects of age, hypertension status at MRI and Fazekas score. RESULTS Twenty-two formerly pre-eclamptic women (mean age, 37.8 ± 5.4 years) and 13 control women with a history of normotensive pregnancy (mean age, 40.8 ± 5.5 years) were included in the study. The time since the index pregnancy was 6.6 ± 3.2 years in the pre-eclamptic group and 9.0 ± 3.7 years in controls. The leakage rate and fractional leakage volume were significantly higher in formerly pre-eclamptic women than in controls in the global white (P = 0.001) and gray (P = 0.02) matter. Regionally, the frontal (P = 0.04) and parietal (P = 0.009) cortical gray matter, and the frontal (P = 0.001), temporal (P < 0.05) and occipital (P = 0.007) white matter showed higher leakage rates in formerly pre-eclamptic women. The odds of a high leakage rate after pre-eclampsia were generally higher in white-matter regions than in gray-matter regions. CONCLUSION This observational study demonstrates global impairment of the BBB years after a pre-eclamptic pregnancy, which could be an early marker of long-term cerebrovascular disorders. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. P. W. Canjels
- Department of Radiology & Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- MHeNs, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - J. F. A. Jansen
- Department of Radiology & Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- MHeNs, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - R. J. Alers
- Department of Gynaecology and ObstetricsMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- GROW, School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - C. Ghossein‐Doha
- GROW, School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
- CARIM, School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
- Department of CardiologyMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
| | - M. van den Kerkhof
- Department of Radiology & Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- MHeNs, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - V. M. M. M. Schiffer
- Department of Gynaecology and ObstetricsMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- GROW, School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - E. Mulder
- Department of Gynaecology and ObstetricsMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- GROW, School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - S. C. Gerretsen
- Department of Radiology & Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - A. P. Aldenkamp
- MHeNs, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Academic Center for Epileptology Kempenhaeghe/ Maastricht University Medical Center (MUMC+)Heeze and MaastrichtThe Netherlands
- Department of NeurologyMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
| | - P. P. M. Hurks
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - V. van de Ven
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - M. E. A. Spaanderman
- Department of Gynaecology and ObstetricsMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- GROW, School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - W. H. Backes
- Department of Radiology & Nuclear MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- MHeNs, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- CARIM, School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
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4
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van Lanen RHGJ, Wiggins CJ, Colon AJ, Backes WH, Jansen JFA, Uher D, Drenthen GS, Roebroeck A, Ivanov D, Poser BA, Hoeberigs MC, van Kuijk SMJ, Hoogland G, Rijkers K, Wagner GL, Beckervordersandforth J, Delev D, Clusmann H, Wolking S, Klinkenberg S, Rouhl RPW, Hofman PAM, Schijns OEMG. Value of ultra-high field MRI in patients with suspected focal epilepsy and negative 3 T MRI (EpiUltraStudy): protocol for a prospective, longitudinal therapeutic study. Neuroradiology 2022; 64:753-764. [PMID: 34984522 PMCID: PMC8907090 DOI: 10.1007/s00234-021-02884-8] [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: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE Resective epilepsy surgery is a well-established, evidence-based treatment option in patients with drug-resistant focal epilepsy. A major predictive factor of good surgical outcome is visualization and delineation of a potential epileptogenic lesion by MRI. However, frequently, these lesions are subtle and may escape detection by conventional MRI (≤ 3 T). METHODS We present the EpiUltraStudy protocol to address the hypothesis that application of ultra-high field (UHF) MRI increases the rate of detection of structural lesions and functional brain aberrances in patients with drug-resistant focal epilepsy who are candidates for resective epilepsy surgery. Additionally, therapeutic gain will be addressed, testing whether increased lesion detection and tailored resections result in higher rates of seizure freedom 1 year after epilepsy surgery. Sixty patients enroll the study according to the following inclusion criteria: aged ≥ 12 years, diagnosed with drug-resistant focal epilepsy with a suspected epileptogenic focus, negative conventional 3 T MRI during pre-surgical work-up. RESULTS All patients will be evaluated by 7 T MRI; ten patients will undergo an additional 9.4 T MRI exam. Images will be evaluated independently by two neuroradiologists and a neurologist or neurosurgeon. Clinical and UHF MRI will be discussed in the multidisciplinary epilepsy surgery conference. Demographic and epilepsy characteristics, along with postoperative seizure outcome and histopathological evaluation, will be recorded. CONCLUSION This protocol was reviewed and approved by the local Institutional Review Board and complies with the Declaration of Helsinki and principles of Good Clinical Practice. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER www.trialregister.nl : NTR7536.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands. .,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - C J Wiggins
- Scannexus, Ultra-High Field MRI Research Center, Maastricht, the Netherlands
| | - A J Colon
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - W H Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - D Uher
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G S Drenthen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - M C Hoeberigs
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | - G L Wagner
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
| | | | - D Delev
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - H Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - S Wolking
- Department of Epileptology and Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - S Klinkenberg
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P A M Hofman
- Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.,Academic Centre for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, the Netherlands
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5
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van Lanen RHGJ, Colon AJ, Wiggins CJ, Hoeberigs MC, Hoogland G, Roebroeck A, Ivanov D, Poser BA, Rouhl RPW, Hofman PAM, Jansen JFA, Backes W, Rijkers K, Schijns OEMG. Ultra-high field magnetic resonance imaging in human epilepsy: A systematic review. Neuroimage Clin 2021; 30:102602. [PMID: 33652376 PMCID: PMC7921009 DOI: 10.1016/j.nicl.2021.102602] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE Resective epilepsy surgery is an evidence-based curative treatment option for patients with drug-resistant focal epilepsy. The major preoperative predictor of a good surgical outcome is detection of an epileptogenic lesion by magnetic resonance imaging (MRI). Application of ultra-high field (UHF) MRI, i.e. field strengths ≥ 7 Tesla (T), may increase the sensitivity to detect such a lesion. METHODS A keyword search strategy was submitted to Pubmed, EMBASE, Cochrane Database and clinicaltrials.gov to select studies on UHF MRI in patients with epilepsy. Follow-up study selection and data extraction were performed following PRISMA guidelines. We focused on I) diagnostic gain of UHF- over conventional MRI, II) concordance of MRI-detected lesion, seizure onset zone and surgical decision-making, and III) postoperative histopathological diagnosis and seizure outcome. RESULTS Sixteen observational cohort studies, all using 7T MRI were included. Diagnostic gain of 7T over conventional MRI ranged from 8% to 67%, with a pooled gain of 31%. Novel techniques to visualize pathological processes in epilepsy and lesion detection are discussed. Seizure freedom was achieved in 73% of operated patients; no seizure outcome comparison was made between 7T MRI positive, 7T negative and 3T positive patients. 7T could influence surgical decision-making, with high concordance of lesion and seizure onset zone. Focal cortical dysplasia (54%), hippocampal sclerosis (12%) and gliosis (8.1%) were the most frequently diagnosed histopathological entities. SIGNIFICANCE UHF MRI increases, yet variably, the sensitivity to detect an epileptogenic lesion, showing potential for use in clinical practice. It remains to be established whether this results in improved seizure outcome after surgical treatment. Prospective studies with larger cohorts of epilepsy patients, uniform scan and sequence protocols, and innovative post-processing technology are equally important as further increasing field strengths. Besides technical ameliorations, improved correlation of imaging features with clinical semiology, histopathology and clinical outcome has to be established.
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Affiliation(s)
- R H G J van Lanen
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
| | - A J Colon
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - C J Wiggins
- Scannexus, Ultra High Field MRI Research Center, Maastricht, The Netherlands
| | - M C Hoeberigs
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Hoogland
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - A Roebroeck
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - B A Poser
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - R P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P A M Hofman
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K Rijkers
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
| | - O E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands; Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, Heeze/Maastricht, The Netherlands
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Vergoossen LWM, Jansen JFA, de Jong JJA, Stehouwer CDA, Schaper NC, Savelberg HHCM, Koster A, Backes WH, Schram MT. Association of physical activity and sedentary time with structural brain networks-The Maastricht Study. GeroScience 2021; 43:239-252. [PMID: 33034792 PMCID: PMC8050169 DOI: 10.1007/s11357-020-00276-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/05/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022] Open
Abstract
We assessed whether objectively measured low- and high-intensity physical activity (LPA and HPA) and sedentary time (ST) were associated with white matter connectivity, both throughout the whole brain and in brain regions involved in motor function. In the large population-based Maastricht Study (n = 1715, age 59.6 ± 8.1 (mean ± standard deviation) years, and 48% women), the amounts of LPA, HPA, and ST were objectively measured during 7 days by an activPAL accelerometer. In addition, using 3T structural and diffusion MRI, we calculated whole brain node degree and node degree of the basal ganglia and primary motor cortex. Multivariable linear regression analysis was performed, and we report standardized regression coefficients (stβ) adjusted for age, sex, education level, wake time, diabetes status, BMI, office systolic blood pressure, antihypertensive medication, total-cholesterol-to-HDL-cholesterol ratio, lipid-modifying medication, alcohol use, smoking status, and history of cardiovascular disease. Lower HPA was associated with lower whole brain node degree after full adjustment (stβ [95%CI] = - 0.062 [- 0.101, - 0.013]; p = 0.014), whereas lower LPA (stβ [95%CI] = - 0.013 [- 0.061, 0.034]; p = 0.580) and higher ST (stβ [95%CI] = - 0.030 [- 0.081, 0.021]; p = 0.250) was not. In addition, lower HPA was associated with lower node degree of the basal ganglia after full adjustment (stβ [95%CI] = - 0.070 [- 0.121, - 0.018]; p = 0.009). Objectively measured lower HPA, but not lower LPA and higher ST, was associated with lower whole brain node degree and node degree in specific brain regions highly specialized in motor function. Further research is needed to establish whether more HPA may preserve structural brain connectivity.
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Affiliation(s)
- Laura W M Vergoossen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- School for Cardiovascular Disease (CARIM), Maastricht University, Maastricht, The Netherlands
| | - J F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J J A de Jong
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - C D A Stehouwer
- School for Cardiovascular Disease (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, PO Box 5800, AZ, 6202, Maastricht, The Netherlands
| | - N C Schaper
- School for Cardiovascular Disease (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, PO Box 5800, AZ, 6202, Maastricht, The Netherlands
| | - H H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - W H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- School for Cardiovascular Disease (CARIM), Maastricht University, Maastricht, The Netherlands
| | - M T Schram
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
- School for Cardiovascular Disease (CARIM), Maastricht University, Maastricht, The Netherlands.
- Heart and Vascular Centre, Maastricht University Medical Center+, Maastricht, the Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center+, PO Box 5800, AZ, 6202, Maastricht, The Netherlands.
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Mason NL, Kuypers KPC, Müller F, Reckweg J, Tse DHY, Toennes SW, Hutten NRPW, Jansen JFA, Stiers P, Feilding A, Ramaekers JG. Me, myself, bye: regional alterations in glutamate and the experience of ego dissolution with psilocybin. Neuropsychopharmacology 2020; 45:2003-2011. [PMID: 32446245 PMCID: PMC7547711 DOI: 10.1038/s41386-020-0718-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/14/2020] [Indexed: 01/21/2023]
Abstract
There is growing interest in the therapeutic utility of psychedelic substances, like psilocybin, for disorders characterized by distortions of the self-experience, like depression. Accumulating preclinical evidence emphasizes the role of the glutamate system in the acute action of the drug on brain and behavior; however this has never been tested in humans. Following a double-blind, placebo-controlled, parallel group design, we utilized an ultra-high field multimodal brain imaging approach and demonstrated that psilocybin (0.17 mg/kg) induced region-dependent alterations in glutamate, which predicted distortions in the subjective experience of one's self (ego dissolution). Whereas higher levels of medial prefrontal cortical glutamate were associated with negatively experienced ego dissolution, lower levels in hippocampal glutamate were associated with positively experienced ego dissolution. Such findings provide further insights into the underlying neurobiological mechanisms of the psychedelic, as well as the baseline, state. Importantly, they may also provide a neurochemical basis for therapeutic effects as witnessed in ongoing clinical trials.
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Affiliation(s)
- N L Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - K P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - F Müller
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - J Reckweg
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - D H Y Tse
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - S W Toennes
- Institute of Legal Medicine, University of Frankfurt, Kennedyallee 104, D-60596, Frankfurt/Main, Germany
| | - N R P W Hutten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - J F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, the Netherlands
| | - P Stiers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - A Feilding
- The Beckley Foundation, Beckley Park, Oxford, OX3 9SY, UK
| | - J G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
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Wolters AF, Heijmans M, Michielse S, Leentjens AFG, Postma AA, Jansen JFA, Ivanov D, Duits AA, Temel Y, Kuijf ML. The TRACK-PD study: protocol of a longitudinal ultra-high field imaging study in Parkinson's disease. BMC Neurol 2020; 20:292. [PMID: 32758176 PMCID: PMC7409458 DOI: 10.1186/s12883-020-01874-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The diagnosis of Parkinson's Disease (PD) remains a challenge and is currently based on the assessment of clinical symptoms. PD is also a heterogeneous disease with great variability in symptoms, disease course, and response to therapy. There is a general need for a better understanding of this heterogeneity and the interlinked long-term changes in brain function and structure in PD. Over the past years there is increasing interest in the value of new paradigms in Magnetic Resonance Imaging (MRI) and the potential of ultra-high field strength imaging in the diagnostic work-up of PD. With this multimodal 7 T MRI study, our objectives are: 1) To identify distinctive MRI characteristics in PD patients and to create a diagnostic tool based on these differences. 2) To correlate MRI characteristics to clinical phenotype, genetics and progression of symptoms. 3) To detect future imaging biomarkers for disease progression that could be valuable for the evaluation of new therapies. METHODS The TRACK-PD study is a longitudinal observational study in a cohort of 130 recently diagnosed (≤ 3 years after diagnosis) PD patients and 60 age-matched healthy controls (HC). A 7 T MRI of the brain will be performed at baseline and repeated after 2 and 4 years. Complete assessment of motor, cognitive, neuropsychiatric and autonomic symptoms will be performed at baseline and follow-up visits with wearable sensors, validated questionnaires and rating scales. At baseline a blood DNA sample will also be collected. DISCUSSION This is the first longitudinal, observational, 7 T MRI study in PD patients. With this study, an important contribution can be made to the improvement of the current diagnostic process in PD. Moreover, this study will be able to provide valuable information related to the different clinical phenotypes of PD and their correlating MRI characteristics. The long-term aim of this study is to better understand PD and develop new biomarkers for disease progression which may help new therapy development. Eventually, this may lead to predictive models for individual PD patients and towards personalized medicine in the future. TRIAL REGISTRATION Dutch Trial Register, NL7558 . Registered March 11, 2019.
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Affiliation(s)
- A F Wolters
- Department of Neurology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - M Heijmans
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - S Michielse
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A F G Leentjens
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Psychiatry, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - A A Postma
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J F A Jansen
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - D Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A A Duits
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Y Temel
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - M L Kuijf
- Department of Neurology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, EURON, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Freeze WM, Ter Weele DN, Palm WM, van Hooren RW, Hoff EI, Jansen JFA, Jacobs HIL, Verhey FR, Backes WH. Optimal Detection of Subtle Gadolinium Leakage in CSF with Heavily T2-Weighted Fluid-Attenuated Inversion Recovery Imaging. AJNR Am J Neuroradiol 2019; 40:1481-1483. [PMID: 31395665 DOI: 10.3174/ajnr.a6145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/19/2019] [Indexed: 11/07/2022]
Abstract
Pericortical enhancement on postcontrast FLAIR images is a marker for subtle leptomeningeal blood-brain barrier leakage. We explored the optimal FLAIR sequence parameters for the detection of low gadolinium concentrations within the CSF. On the basis of phantom experiments and human in vivo data, we showed that detection of subtle pericortical enhancement can be facilitated by using a relatively long TE. Future studies should choose their FLAIR sequence parameters carefully when assessing pericortical enhancement due to subtle blood-brain barrier leakage.
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Affiliation(s)
- W M Freeze
- From the Department of Psychiatry and Neuropsychology (W.M.F., R.W.v.H., H.I.L.J., F.R.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht, the Netherlands.,Department of Radiology and Nuclear Medicine (W.M.F., W.M.P., J.F.A,J., W.H.B.), Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | | | - W M Palm
- Department of Radiology and Nuclear Medicine (W.M.F., W.M.P., J.F.A,J., W.H.B.), Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - R W van Hooren
- From the Department of Psychiatry and Neuropsychology (W.M.F., R.W.v.H., H.I.L.J., F.R.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht, the Netherlands
| | - E I Hoff
- Neurology (E.I.H.), Zuyderland Medical Center Heerlen, Heerlen, the Netherlands
| | - J F A Jansen
- Department of Radiology and Nuclear Medicine (W.M.F., W.M.P., J.F.A,J., W.H.B.), Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - H I L Jacobs
- From the Department of Psychiatry and Neuropsychology (W.M.F., R.W.v.H., H.I.L.J., F.R.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht, the Netherlands
| | - F R Verhey
- From the Department of Psychiatry and Neuropsychology (W.M.F., R.W.v.H., H.I.L.J., F.R.V.), Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht, the Netherlands
| | - W H Backes
- Department of Radiology and Nuclear Medicine (W.M.F., W.M.P., J.F.A,J., W.H.B.), Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, the Netherlands.
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Gupta L, Hofman PAM, Besseling RMH, Jansen JFA, Backes WH. Abnormal Blood Oxygen Level-Dependent Fluctuations in Focal Cortical Dysplasia and the Perilesional Zone: Initial Findings. AJNR Am J Neuroradiol 2018; 39:1310-1315. [PMID: 29794237 DOI: 10.3174/ajnr.a5684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/01/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Focal cortical dysplasia is a common cause of intractable epilepsy for which neurosurgery is an option. Delineations of a focal cortical dysplasia lesion on structural brain images may not necessarily reflect the functional borders of normal tissue. Our objective was to determine whether abnormalities in spontaneous blood oxygen level-dependent fluctuations arise in focal cortical dysplasia lesions and proximal regions. MATERIALS AND METHODS Fourteen patients with focal cortical dysplasia-related epilepsy and 16 healthy controls underwent structural and resting-state functional MR imaging. Three known blood oxygen level-dependent measures were determined, including the fractional amplitude of low-frequency fluctuations, regional homogeneity, and wavelet entropy. These measures were evaluated in the lesion and perilesional zone and normalized to the contralateral cortex of patients with focal cortical dysplasia and healthy controls. RESULTS Patients showed significantly decreased fractional amplitude of low-frequency fluctuations and increased wavelet entropy in the focal cortical dysplasia lesion and the perilesional zone (≤2 cm) relative to the contralateral homotopic cortex and the same regions in healthy controls. Regional homogeneity was significantly increased in the focal cortical dysplasia lesion compared with the contralateral homotopic cortex and healthy controls. CONCLUSIONS Abnormalities in spontaneous blood oxygen level-dependent fluctuations were seen up to 2 cm distant from the radiologically visible boundary. It was demonstrated that functional boundaries go beyond structural boundaries of focal cortical dysplasia lesions. Validation is required to reveal whether this information is valuable for surgical planning and outcome evaluation of focal cortical dysplasia lesions and comparing current results with electrophysiologic analysis.
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Affiliation(s)
- L Gupta
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
| | - P A M Hofman
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R M H Besseling
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- Department of Electrical Engineering (R.M.H.B.), Eindhoven University of Technology, Eindhoven, the Netherlands
| | - J F A Jansen
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - W H Backes
- From the Department of Radiology and Nuclear Medicine (L.G., P.A.M.H., R.M.H.B., J.F.A.J., W.H.B.)
- School for Mental Health and Neuroscience (P.A.M.H., J.F.A.J., W.H.B.), Maastricht University Medical Center, Maastricht, the Netherlands
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11
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Wong SM, Backes WH, Zhang CE, Staals J, van Oostenbrugge RJ, Jeukens CRLPN, Jansen JFA. On the Reproducibility of Inversion Recovery Intravoxel Incoherent Motion Imaging in Cerebrovascular Disease. AJNR Am J Neuroradiol 2018; 39:226-231. [PMID: 29217741 DOI: 10.3174/ajnr.a5474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/03/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intravoxel incoherent motion imaging can measure both microvascular and parenchymal abnormalities simultaneously. The contamination of CSF signal can be suppressed using inversion recovery preparation. The clinical feasibility of inversion recovery-intravoxel incoherent motion imaging was investigated in patients with cerebrovascular disease by studying its reproducibility. MATERIALS AND METHODS Sixteen patients with cerebrovascular disease (66 ± 8 years of age) underwent inversion recovery-intravoxel incoherent motion imaging twice. The reproducibility of the perfusion volume fraction and parenchymal diffusivity was calculated with the coefficient of variation, intraclass correlation coefficient, and the repeatability coefficient. ROIs included the normal-appearing white matter, cortex, deep gray matter, white matter hyperintensities, and vascular lesions. RESULTS Values for the perfusion volume fraction ranged from 2.42 to 3.97 ×10-2 and for parenchymal diffusivity from 7.20 to 9.11 × 10-4 mm2/s, with higher values found in the white matter hyperintensities and vascular lesions. Coefficients of variation were <3.70% in normal-appearing tissue and <9.15% for lesions. Intraclass correlation coefficients were good to excellent, showing values ranging from 0.82 to 0.99 in all ROIs, except the deep gray matter and cortex, with intraclass correlation coefficients of 0.66 and 0.54, respectively. The repeatability coefficients ranged from 0.15 to 0.96 × 10-2 and 0.10 to 0.37 × 10-4 mm2/s for perfusion volume fraction and parenchymal diffusivity, respectively. CONCLUSIONS Good reproducibility of inversion recovery-intravoxel incoherent motion imaging was observed with low coefficients of variation and high intraclass correlation coefficients in normal-appearing tissue and lesion areas in cerebrovascular disease. Good reproducibility of inversion recovery-intravoxel incoherent motion imaging in cerebrovascular disease is feasible in monitoring disease progression or treatment responses in the clinic.
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Affiliation(s)
- S M Wong
- From the Departments of Radiology and Nuclear Medicine (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.)
- School for Mental Health and Neuroscience (S.M.W., W.H.B., C.E.Z., R.J.v.O., J.F.A.J.)
| | - W H Backes
- From the Departments of Radiology and Nuclear Medicine (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.)
- School for Mental Health and Neuroscience (S.M.W., W.H.B., C.E.Z., R.J.v.O., J.F.A.J.)
| | - C E Zhang
- Neurology (C.E.Z., J.S., R.J.v.O.)
- School for Mental Health and Neuroscience (S.M.W., W.H.B., C.E.Z., R.J.v.O., J.F.A.J.)
- Cardiovascular Research Institute Maastricht (C.E.Z., J.S., R.J.v.O.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Staals
- Neurology (C.E.Z., J.S., R.J.v.O.)
- Cardiovascular Research Institute Maastricht (C.E.Z., J.S., R.J.v.O.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - R J van Oostenbrugge
- Neurology (C.E.Z., J.S., R.J.v.O.)
- School for Mental Health and Neuroscience (S.M.W., W.H.B., C.E.Z., R.J.v.O., J.F.A.J.)
- Cardiovascular Research Institute Maastricht (C.E.Z., J.S., R.J.v.O.), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - C R L P N Jeukens
- From the Departments of Radiology and Nuclear Medicine (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.)
| | - J F A Jansen
- From the Departments of Radiology and Nuclear Medicine (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.)
- School for Mental Health and Neuroscience (S.M.W., W.H.B., C.E.Z., R.J.v.O., J.F.A.J.)
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van Bussel FCG, Backes WH, Hofman PAM, van Boxtel MPJ, Schram MT, Stehouwer CDA, Wildberger JE, Jansen JFA. Altered Hippocampal White Matter Connectivity in Type 2 Diabetes Mellitus and Memory Decrements. J Neuroendocrinol 2016; 28:12366. [PMID: 26791354 DOI: 10.1111/jne.12366] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/23/2015] [Accepted: 01/14/2016] [Indexed: 01/06/2023]
Abstract
Type 2 diabetes mellitus is associated with cognitive decrements. Specifically affected cognitive domains are learning and memory, for which the hippocampus plays an essential role. The pathophysiological mechanism remains to be revealed. The present study examined whether local hippocampal microstructure and white matter connectivity are related to type 2 diabetes and memory performance. Forty participants with type 2 diabetes and 38 participants without type 2 diabetes underwent detailed cognitive assessment and 3-Tesla diffusion magnetic resonance imaging (MRI). Diffusion MRI was performed to assess microstructure (fractional anisotropy and mean diffusivity) and white matter connectivity (tract volume) of the hippocampus, which were compared between participants with and without type 2 diabetes. No differences in hippocampal microstructure were observed. Participants with type 2 diabetes had fewer white matter connections between the hippocampus and frontal lobe (P = 0.017). Participants who scored lower on memory function, regardless of type 2 diabetes, had fewer white matter connections between the hippocampus and temporal lobe (P = 0.017). Taken together, type 2 diabetes and memory decrements appear to be associated with altered hippocampal white matter connectivity.
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Affiliation(s)
- F C G van Bussel
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - W H Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - P A M Hofman
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - M P J van Boxtel
- School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M T Schram
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C D A Stehouwer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J E Wildberger
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - J F A Jansen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
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IJff DM, van Veenendaal TM, Majoie HJM, de Louw AJA, Jansen JFA, Aldenkamp AP. Cognitive effects of lacosamide as adjunctive therapy in refractory epilepsy. Acta Neurol Scand 2015; 131:347-54. [PMID: 25630655 DOI: 10.1111/ane.12372] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lacosamide (LCM) is a novel antiepileptic drug (AED) with potential benefit as adjunctive treatment in patients with partial-onset seizures. As yet, limited information on cognitive effects of LCM is available, especially in real-life settings. AIMS In this open clinical prospective study, the cognitive effects of LCM were evaluated when used as adjunctive antiepileptic therapy in patients with refractory epilepsy. METHODS We included 33 patients aged between 16 and 74 years (mean: 37 years). All patients had a localization-related epilepsy. Patients were assessed at baseline before starting LCM treatment and during follow-up when the optimal clinical dose was achieved. MATERIALS Subjective complaints were evaluated using the SIDAED; effects on cognition were evaluated using the computerized visual searching task (CVST). RESULTS The CVST showed significant faster information processing reaction times at the second evaluation (P = 0.013), which was not correlated with seizure control, type of epilepsy, age, gender, drug load, number of concomitant drugs, dose or duration of LCM treatment. On the SIDAED, patients complained more about their cognitive function at the second evaluation (P = 0.005). For the SIDAED, a positive correlation at follow-up was found between the total severity score and higher age (r = 0.375, P = 0.031), but not with epilepsy factors or treatment characteristics. DISCUSSION/CONLUSION Screening of the cognitive effects of LCM showed that LCM does not have negative effects on information processing speed. As this is the most sensitive function for cognitive side effects of AEDs, LCM does not seem to induce the common negative cognitive effects. Remarkably, patients complained more, especially about their cognitive function, which is possible the 'doing better, feeling worse phenomenon'.
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Affiliation(s)
- D. M. IJff
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - T. M. van Veenendaal
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - H. J. M. Majoie
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - A. J. A. de Louw
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
| | - J. F. A. Jansen
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - A. P. Aldenkamp
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Neurology; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Neurology; Gent University Hospital; Gent Belgium
- Faculty of Electrical Engineering; University of Technology; Eindhoven The Netherlands
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Braakman HMH, Vaessen MJ, Jansen JFA, Debeij-van Hall MHJA, de Louw A, Hofman PAM, Vles JSH, Aldenkamp AP, Backes WH. Aetiology of cognitive impairment in children with frontal lobe epilepsy. Acta Neurol Scand 2015; 131:17-29. [PMID: 25208759 DOI: 10.1111/ane.12283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cognitive impairment is frequent in children with frontal lobe epilepsy (FLE), but its aetiology is unknown. MRI scans often reveal no structural brain abnormalities that could explain the cognitive impairment. This does not exclude more subtle morphological abnormalities that can only be detected by automated morphometric techniques. AIMS With these techniques, we investigate the relationship between cortical brain morphology and cognitive functioning in a cohort of children with FLE and healthy controls. MATERIALS AND METHODS Thirty-four children aged 8-13 years with FLE of unknown cause and 41 healthy age-matched controls underwent neuropsychological assessment and structural brain MRI. Patients were grouped as cognitively impaired or unimpaired. Intracranial volume, white matter volume, lobular cortical volume, cortical thickness and volumes of cortex structures were compared between patients and controls, and potential correlations with cognitive status were determined. RESULTS The group of cognitively impaired children with FLE had significantly smaller left temporal cortex volumes, specifically middle temporal grey matter volume and entorhinal cortex thickness. In addition, cognitively impaired children with FLE had smaller volumes of structures in the left and right frontal cortex, right temporal cortex and the left subcortical area. CONCLUSION Cognitively impaired children with FLE have smaller volumes of various cortex structures within the frontal lobes and in extra-frontal regions, most notably temporal cortex volumes. These findings might well explain the broad scale of cognitive domains affected in children with FLE complicated by cognitive impairment and highlight that FLE impacts on areas beyond the frontal lobe.
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Affiliation(s)
- H. M. H. Braakman
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - M. J. Vaessen
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - J. F. A. Jansen
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | | | - A. de Louw
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - P. A. M. Hofman
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - J. S. H. Vles
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - A. P. Aldenkamp
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - W. H. Backes
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
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15
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Braakman HMH, Vaessen MJ, Jansen JFA, Debeij-van Hall MHJA, de Louw A, Hofman PAM, Vles JSH, Aldenkamp AP, Backes WH. Pediatric frontal lobe epilepsy: white matter abnormalities and cognitive impairment. Acta Neurol Scand 2014; 129:252-62. [PMID: 24112290 DOI: 10.1111/ane.12183] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cognitive impairment is frequent in children with frontal lobe epilepsy (FLE). Its etiology remains unknown. With diffusion tensor imaging, we have studied cerebral white matter properties and associations with cognitive functioning in children with FLE and healthy controls. METHODS Thirty children aged 8-13 years with FLE of unknown cause and 39 healthy age-matched controls underwent neuropsychological assessment, structural and diffusion-weighted brain MRI. Patients were grouped as cognitively impaired or unimpaired, and their white matter diffusion properties were compared with the controls. RESULTS Children with FLE had reduced apparent diffusion coefficients in various posteriorly located tract bundles, a reduced fractional anisotropy (FA) of the white matter tract between the right frontal and right occipital lobe, and smaller volumes of several collections of interlobar bundle tracts, compared with controls. The cognitively impaired patient group demonstrated significant increases in FA of the white matter of both occipital lobes, a reduced FA of white matter tract bundles between the right frontal and both left occipital lobe and subcortical white matter area, and smaller volumes of two collections of tract bundles connecting the frontal lobe with the temporal and parietal lobes, compared with controls. CONCLUSIONS Children with FLE had white matter abnormalities mainly in posterior brain regions, not confined to the area of the seizure focus. Cognitively impaired children with FLE showed the most pronounced white matter abnormalities. These possibly reflect disturbed maturation and might be part of the etiology of the cognitive impairment.
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Affiliation(s)
- H. M. H. Braakman
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - M. J. Vaessen
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - J. F. A. Jansen
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | | | - A. de Louw
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - P. A. M. Hofman
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - J. S. H. Vles
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - A. P. Aldenkamp
- Department of Neurology; Maastricht University Medical Centre; Maastricht the Netherlands
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Research and Development; Epilepsy Centre Kempenhaeghe; Heeze the Netherlands
| | - W. H. Backes
- Research School for Mental Health & Neuroscience; Maastricht University Medical Centre; Maastricht the Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht the Netherlands
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Vaessen MJ, Braakman HMH, Heerink JS, Jansen JFA, Debeij-van Hall MHJA, Hofman PAM, Aldenkamp AP, Backes WH. Abnormal modular organization of functional networks in cognitively impaired children with frontal lobe epilepsy. ACTA ACUST UNITED AC 2012; 23:1997-2006. [PMID: 22772649 DOI: 10.1093/cercor/bhs186] [Citation(s) in RCA: 69] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Many children with frontal lobe epilepsy (FLE) have significant cognitive comorbidity, for which the underlying mechanism has not yet been unraveled, but is likely related to disturbed cerebral network integrity. Using resting-state fMRI, we investigated whether cerebral network characteristics are associated with epilepsy and cognitive comorbidity. We included 37 children with FLE and 41 healthy age-matched controls. Cognitive performance was determined by means of a computerized visual searching task. A connectivity matrix for 82 cortical and subcortical brain regions was generated for each subject by calculating the inter-regional correlation of the fMRI time signals. From the connectivity matrix, graph metrics were calculated and the anatomical configuration of aberrant connections and modular organization was investigated. Both patients and controls displayed efficiently organized networks. However, FLE patients displayed a higher modularity, implying that subnetworks are less interconnected. Impaired cognition was associated with higher modularity scores and abnormal modular organization of the brain, which was mainly expressed as a decrease in long-range and an increase in interhemispheric connectivity in patients. We showed that network modularity analysis provides a sensitive marker for cognitive impairment in FLE and suggest that abnormally interconnected functional subnetworks of the brain might underlie the cognitive problems in children with FLE.
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Affiliation(s)
- M J Vaessen
- Department of Radiology, Maastricht University Medical Centre, Maastricht 6202 AZ, The Netherlands
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Vlooswijk MCG, Vaessen MJ, Jansen JFA, de Krom MCFTM, Majoie HJM, Hofman PAM, Aldenkamp AP, Backes WH. Loss of network efficiency associated with cognitive decline in chronic epilepsy. Neurology 2011; 77:938-44. [PMID: 21832213 DOI: 10.1212/wnl.0b013e31822cfc2f] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To study the relation between possibly altered whole brain topology and intellectual decline in chronic epilepsy, a combined study of neurocognitive assessment and graph theoretical network analysis of fMRI was performed. METHODS Forty-one adult patients with cryptogenic localization-related epilepsy and 23 healthy controls underwent an intelligence test and fMRI with a silent-word generation paradigm. A set of undirected graphs was constructed by cross-correlating the signal time series of 893 cortical and subcortical regions. Possible changes in cerebral network efficiency were assessed by performing graph theoretical network analysis. RESULTS Healthy subjects displayed efficient small world properties, characterized by high clustering and short path lengths. On the contrary, in patients with epilepsy a disruption of both local segregation and global integration was found. An association of more pronounced intellectual decline with more disturbed local segregation was observed in the patient group. The effect of antiepileptic drug use on cognitive decline was mediated by decreased clustering. CONCLUSIONS These findings support the hypothesis that chronic localization-related epilepsy causes cognitive deficits by inducing global cerebral network changes instead of a localized disruption only. Whether this is the result of epilepsy per se or the use of antiepileptic drugs remains to be elucidated. For application in clinical practice, future studies should address the relevance of altered cerebral network topology in prediction of cognitive deficits and monitoring of therapeutic interventions.
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Affiliation(s)
- M C G Vlooswijk
- Department of Radiology, Maastricht University Medical Center, 6202 AZ Maastricht, the Netherlands
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Vlooswijk MCG, Jansen JFA, Majoie HJM, Hofman PAM, de Krom MCTFM, Aldenkamp AP, Backes WH. Functional connectivity and language impairment in cryptogenic localization-related epilepsy. Neurology 2010; 75:395-402. [PMID: 20679633 DOI: 10.1212/wnl.0b013e3181ebdd3e] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND An often underestimated cognitive morbidity in patients with epilepsy is language dysfunction. To investigate the neuronal mechanisms underlying neuropsychological language impairment, activation maps and functional connectivity networks were studied by fMRI of language. METHOD Fifty-two patients with cryptogenic localization-related epilepsy and 27 healthy controls underwent neuropsychological assessment of IQ, word fluency, and text reading. fMRI was performed with a standard covert word-generation and text-reading paradigm. Functional connectivity analysis comprised cross-correlation of signal time series of the characteristic and most strongly activated regions involved in the language tasks. RESULTS After careful selection, 34 patients and 20 healthy controls were found eligible for analysis. Patients displayed lower IQ, lower fluency word count, and lower number of words correctly read compared to controls. fMRI activation maps did not differ significantly between patients and controls. For the word-generation paradigm, patients with epilepsy had significantly lower functional connectivity than controls in the prefrontal network. Patients performing worse on the word-fluency test demonstrated a significantly lower mean functional connectivity than controls. Text reading demonstrated lower functional connectivity in patients with epilepsy in the frontotemporal network. Similarly, lower mean functional connectivity was observed in patients with lowest reading performance compared to controls. A relation between reduced functional connectivity and performance on word-fluency and text-reading tests was demonstrated in epilepsy patients. CONCLUSION Impaired performance on language assessment in epilepsy patients is associated with loss of functional connectivity in the cognitive language networks.
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Affiliation(s)
- M C G Vlooswijk
- Department of Neurology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Jansen JFA, Stambuk HE, Koutcher JA, Shukla-Dave A. Non-gaussian analysis of diffusion-weighted MR imaging in head and neck squamous cell carcinoma: A feasibility study. AJNR Am J Neuroradiol 2010; 31:741-8. [PMID: 20037133 DOI: 10.3174/ajnr.a1919] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Water in biological structures often displays non-Gaussian diffusion behavior. The objective of this study was to test the feasibility of non-Gaussian fitting by using the kurtosis model of the signal intensity decay curves obtained from DWI by using an extended range of b-values in studies of phantoms and HNSCC. MATERIALS AND METHODS Seventeen patients with HNSCC underwent DWI by using 6 b-factors (0, 50-1500 s/mm(2)) at 1.5T. Monoexponential (yielding ADC(mono)) and non-Gaussian kurtosis (yielding apparent diffusion coefficient D(app) and apparent kurtosis coefficient K(app)) fits were performed on a voxel-by-voxel basis in selected regions of interest (primary tumors, metastatic lymph nodes, and spinal cord). DWI studies were also performed on phantoms containing either water or homogenized asparagus. To determine whether the kurtosis model provided a significantly better fit than did the monoexponential model, an F test was performed. Spearman correlation coefficients were calculated to assess correlations between K(app) and D(app). RESULTS The kurtosis model fit the experimental data points significantly better than did the monoexponential model (P < .05). D(app) was approximately twice the value of ADC(mono) (eg, in neck nodal metastases D(app) was 1.54 and ADC(mono) was 0.84). K(app) showed a weak Spearman correlation with D(app) in a homogenized asparagus phantom and for 44% of tumor lesions. CONCLUSIONS The use of kurtosis modeling to fit DWI data acquired by using an extended b-value range in HNSCC is feasible and yields a significantly better fit of the data than does monoexponential modeling. It also provides an additional parameter, K(app), potentially with added value.
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Affiliation(s)
- J F A Jansen
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Jansen JFA, Vlooswijk MCG, de Baets MH, de Krom MCTFM, Rieckmann P, Backes WH, Aldenkamp AP. Cognitive fMRI and soluble telencephalin assessment in patients with localization-related epilepsy. Acta Neurol Scand 2008; 118:232-9. [PMID: 18460045 DOI: 10.1111/j.1600-0404.2008.01005.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives - The use of telencephalin as a possible marker for altered cortical function as demonstrated by functional MRI was investigated in a pilot study with 16 patients with localization-related epilepsy and secondarily generalized seizures. Materials and methods - Functional MRI of verbal working memory performance (Sternberg paradigm) and self-regulatory control processes (Stroop paradigm) was used to examine cortical activation in 16 patients with localization-related epilepsy and secondarily generalized seizures. Additionally, blood serum concentrations of soluble telencephalin (marker for neuronal damage) were determined. Results - In three patients (one temporal and two frontal focus), telencephalin was detected. All three patients had lower functional MRI activation in the frontotemporal region (P = 0.04), but not in other regions (P > 0.35) compared with patients without detectable telencephalin. Additionally, an association of levetiracetam and frontotemporal activation was observed. Conclusions - These preliminary data in a heterogeneous group suggest an association between decreased frontotemporal activation on fMRI and both detectable telencephalin serum levels and levetiracetam use. Future longitudinal studies with larger patient groups are required to confirm these observations. It is hypothesized that altered local function of the frontotemporal cortex in localization-related epilepsy might be better predicted by the biochemical marker telencephalin than epilepsy characteristics such as seizure focus.
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Affiliation(s)
- J F A Jansen
- Department of Radiology, Maastricht University Hospital, the Netherlands.
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