Abstract
The objective was to study the modulation effects of levetiracetam on the fMRI activation/deactivation patterns associated with centrotemporal spikes (CTS) in Rolandic epilepsy. Forty patients with Rolandic epilepsy, including levetiracetam-medicated patients (n = 20) and drug-naive patients (n = 20), were studied. Single and sequential hemodynamic response functions-based EEG-fMRI analysis was performed to detect dynamic activation/deactivation associated with CTS. Comparisons of spatiotemporal features of activation/deactivation were performed between the two groups. Both the groups (CTS were detected in 12 cases of levetiracetam-medicated group, and 11 cases of drug-naive group) showed CTS-associated activation in the Rolandic cortex, whereas activation strength, time-to-peak delay, and overall activation were diminished in the levetiracetam-medicated group. Moreover, the drug-naive group showed deactivation in the regions engaged in higher cognition networks compared with the levetiracetam-medicated group. Levetiracetam inhibits CTS-associated activation intensity and alters the temporal pattern of this activation in the epileptogenic regions, and it also affects the brain deactivation related to higher cognition networks. The findings sheds a light on the pharmocological mechanism of levetiracetam therapy on Rolandic epilepsy.
Highlights
Rolandic epilepsy, known as benign childhood epilepsy with centrotemporal spikes (CTS), is the most common form of idiopathic epilepsy syndrome in children (Beaussart, 1972)
There were no significant differences in age, gender, seizure frequency before antiepileptic drugs (AEDs), the number of CTS during EEG-fMRI recordings, as well as head motion between both the two groups (p > 0.05)
There was no significant correlation of activation in bilateral Rolandic cortices (ROI from the drug-naive group) with LEV medication duration (LEV-medicated group: r = 0.13, p = 0.68), with epilepsy duration, with seizure frequency, or with CTS numbers during EEG-fMRIin both the groups, respectively
Summary
Known as benign childhood epilepsy with centrotemporal spikes (CTS), is the most common form of idiopathic epilepsy syndrome in children (Beaussart, 1972) It is characterized by mild seizure symptoms and a high-voltage CTS on electroencephalography (EEG). Levetiracetam (LEV) is a relatively new and first-line AED drug in Rolandic epilepsy (Glauser et al, 2006, 2013; Mellish et al, 2015) due to its favorable characteristics on seizure control, tolerance, and pharmacokinetics (Schiemann-Delgado et al, 2012; Beaulieu, 2013). In the previous study, resting-state fMRI investigated longterm effect of LEV on brain activity in epileptogenic regions in Rolandic epilepsy (Zhang et al, 2017)
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