Patterns of Gray Matter Abnormalities in Idiopathic Generalized Epilepsy: A Meta-Analysis of Voxel-Based Morphology Studies.

Guo Bin,Xiaoming He,Feng Li,Jian Zhang,Bingsheng Huang,Tianfu Wang,Hongwu Zeng,Huiguang He

doi:10.1371/journal.pone.0169076

Abstract

ObjectiveWe aimed to identify the consistent regions of gray matter volume (GMV) abnormalities in idiopathic generalized epilepsy (IGE), and to study the difference of GMV abnormalities among IGE subsyndromes by applying activation likelihood estimation (ALE) meta-analysis.MethodsA systematic review of VBM studies on GMV of patients with absence epilepsy (AE), juvenile myoclonic epilepsy (JME), IGE and controls indexed in PubMed and ScienceDirect from January 1999 to June 2016 was conducted. A total of 12 IGE studies, including 7 JME and 3 AE studies, were selected. Meta-analysis was performed on these studies by using the pooled and within-subtypes analysis (www.brainmap.org). Based on the above results, between-subtypes contrast analysis was carried out to detect the abnormal GMV regions common in and unique to each subtype as well.ResultsIGE demonstrated significant GMV increase in right ventral lateral nucleus (VL) and right medial frontal gyrus, and significant GMV decrease in bilateral pulvinar. For JME, significant GMV increase was seen in right medial frontal gyrus, right anterior cingulate cortex (ACC), while significant GMV decrease was found in right pulvinar. In AE, the most significant GMV increase was found in right VL, and slight GMV reduction was seen in right medial dorsal nucleus, right subcallosal gyrus, left caudate and left precuneus. No overlapped and unique regions with significant GMV abnormalities were found between JME and AE.SignificanceThis meta-analysis demonstrated that thalamo-frontal network was a structure with significant GMV abnormality in IGE, and the IGE subsyndromes showed different GMV abnormal regions. These observations may provide instructions on the clinical diagnosis of IGE.

Highlights

Idiopathic generalized epilepsy (IGE) is a group of epileptic disorders with high prevalence across all ages[1]
For juvenile myoclonic seizures (JME), significant gray matter volume (GMV) increase was seen in right medial frontal gyrus, right anterior cingulate cortex (ACC), while significant GMV decrease was found in right pulvinar
In absence epilepsy (AE), the most significant GMV increase was found in right ventral lateral nucleus (VL), and slight GMV reduction was seen in right medial dorsal nucleus, right subcallosal gyrus, left caudate and left precuneus

Summary

Introduction

Idiopathic generalized epilepsy (IGE) is a group of epileptic disorders with high prevalence across all ages[1]. According to predominant clinical symptoms and age onset, IGE can be either childhood or juvenile absence epilepsy (AE), juvenile myoclonic seizures (JME), and generalized tonic–clonic seizures (GTCS) on awakening [1]. Some studies in patients with clinically homogeneous IGE pointed to distinct genetic abnormalities among IGE subsyndromes, supporting the existence of different subtypes[2,3]. Blurred distinctions for IGE subsydromes occurred in the measurement by magnetic resonance imaging (MRI). Conventional MRI was usually normal in patients with IGE, and it is often difficult to detect the subtle brain abnormalities, if exist, for IGE. The differentiation between IGE subsydromes have been very challenging

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Discussion

Conclusion