TLE Group Research Articles

Implicancia social del compromiso crossmodal en la dislexia

IntroductionRecently, many studies have revealed a multisensory deficit in subjects with dyslexia. One of the most studied crossmodal correspondences is the Bouba-Kiki effect. Several studies have shown that our names have social implications that could impact in our future. Some authors suggest that people expect names with letters o/a to correspond with “round” face and letters i/e with “angular” faces, favoring this coincidence to a more positive judgment of that person toward the other. In this research, we analyzed crossmodal engagement and its social implication in subjects with dyslexia. MethodsSixty seven participants between 6 and 18 years old were included and divided into: group with reading disorder (TLE) (n=35), and control group (n=32). Everyone saw 10 photographs: 5 rounded faces, and 5 angular faces, having to assign them a name (e.g., Rolo, Mili). ResultsThe control group was 2.38 times more likely to select names containing the vowels “o” and/or “a” for round faces (OR=2.38, P=.002); and 1.96 times more likely to choose names containing the vowels “i” and/or “e” for angular faces (OR=1.96, P=.007) compared to the TLE group. The control group presented a Bouba-Kki effect of 90.62%, while the TLE group did so in 60% (P=.004). ConclusionOur research not only objectifies the atypical response in the crossmodal processing of visual–auditory stimuli in subjects with dyslexia, but also reveals that this situation could have an influence on social aspects with implications for the style in which they interact with others.

Clinical outcomes of uninterrupted embryo culture with or without time-lapse-based embryo selection versus interrupted standard culture (SelecTIMO): a three-armed, multicentre, double-blind, randomised controlled trial

Time-lapse monitoring is increasingly used in fertility laboratories to culture and select embryos for transfer. This method is offered to couples with the promise of improving pregnancy chances, even though there is currently insufficient evidence for superior clinical results. We aimed to evaluate whether a potential improvement by time-lapse monitoring is caused by the time-lapse-based embryo selection method itself or the uninterrupted culture environment that is part of the system. In this three-armed, multicentre, double-blind, randomised controlled trial, couples undergoing in-vitro fertilisation or intracytoplasmic sperm injection were recruited from 15 fertility clinics in the Netherlands and randomly assigned using a web-based, computerised randomisation service to one of three groups. Couples and physicians were masked to treatment group, but embryologists and laboratory technicians could not be. The time-lapse early embryo viability assessment (EEVA; TLE) group received embryo selection based on the EEVA time-lapse selection method and uninterrupted culture. The time-lapse routine (TLR) group received routine embryo selection and uninterrupted culture. The control group received routine embryo selection and interrupted culture. The co-primary endpoints were the cumulative ongoing pregnancy rate within 12 months in all women and the ongoing pregnancy rate after fresh single embryo transfer in a good prognosis population. Analysis was by intention to treat. This trial is registered on the ICTRP Search Portal, NTR5423, and is closed to new participants. 1731 couples were randomly assigned between June 15, 2017, and March 31, 2020 (577 to the TLE group, 579 to the TLR group, and 575 to the control group). The 12-month cumulative ongoing pregnancy rate did not differ significantly between the three groups: 50·8% (293 of 577) in the TLE group, 50·9% (295 of 579) in the TLR group, and 49·4% (284 of 575) in the control group (p=0·85). The ongoing pregnancy rates after fresh single embryo transfer in a good prognosis population were 38·2% (125 of 327) in the TLE group, 36·8% (119 of 323) in the TLR group, and 37·8% (123 of 325) in the control group (p=0·90). Ten serious adverse events were reported (five TLE, four TLR, and one in the control group), which were not related to study procedures. Neither time-lapse-based embryo selection using the EEVA test nor uninterrupted culture conditions in a time-lapse incubator improved clinical outcomes compared with routine methods. Widespread application of time-lapse monitoring for fertility treatments with the promise of improved results should be questioned. Health Care Efficiency Research programme from Netherlands Organisation for Health Research and Development and Merck.

Abnormal metabolic connectivity in default mode network of right temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) is a common neurological disorder associated with the dysfunction of the default mode network (DMN). Metabolic connectivity measured by 18F-fluorodeoxyglucose Positron Emission Computed Tomography (18F-FDG PET) has been widely used to assess cumulative energy consumption and provide valuable insights into the pathophysiology of TLE. However, the metabolic connectivity mechanism of DMN in TLE is far from fully elucidated. The present study investigated the metabolic connectivity mechanism of DMN in TLE using 18F-FDG PET. Participants included 40 TLE patients and 41 health controls (HC) who were age- and gender-matched. A weighted undirected metabolic network of each group was constructed based on 14 primary volumes of interest (VOIs) in the DMN, in which Pearson's correlation coefficients between each pair-wise of the VOIs were calculated in an inter-subject manner. Graph theoretic analysis was then performed to analyze both global (global efficiency and the characteristic path length) and regional (nodal efficiency and degree centrality) network properties. Metabolic connectivity in DMN showed that regionally networks changed in the TLE group, including bilateral posterior cingulate gyrus, right inferior parietal gyrus, right angular gyrus, and left precuneus. Besides, significantly decreased (P < 0.05, FDR corrected) metabolic connections of DMN in the TLE group were revealed, containing bilateral hippocampus, bilateral posterior cingulate gyrus, bilateral angular gyrus, right medial of superior frontal gyrus, and left inferior parietal gyrus. Taken together, the present study demonstrated the abnormal metabolic connectivity in DMN of TLE, which might provide further insights into the understanding the dysfunction mechanism and promote the treatment for TLE patients.

Outcomes of leadless pacemaker implantation following transvenous lead extraction in high-volume referral centers: Real-world data from a large international registry

Limited data on the real-world safety and efficacy of leadless pacemakers (LPMs) post-transvenous lead extraction (TLE) are available. The purpose of this study was to assess the long-term safety and effectiveness of LPMs following TLE in comparison with LPMs de novo implantation. Consecutive patients who underwent LPM implantation in 12 European centers joining the International LEAdless PacemakEr Registry were enrolled. The primary end point was the comparison of LPM-related complication rate at implantation and during follow-up (FU) between groups. Differences in electrical performance were deemed secondary outcomes. Of the 1179 patients enrolled, 15.6% underwent a previous TLE. During a median FU of 33 (interquartile range 24-47) months, LPM-related major complications and all-cause mortality did not differ between groups (TLE group: 1.6% and 5.4% vs de novo group: 2.2% and 7.8%; P = .785 and P = .288, respectively). Pacing threshold (PT) was higher in the TLE group at implantation and during FU, with very high PT (>2 V@0.24 ms) patients being more represented than in the de novo implantation group (5.4% vs 1.6 %; P = .004). When the LPM was deployed at a different right ventricular (RV) location than the one wherethe previous transvenous RV lead was extracted, a lower proportion of high PT (>1-2 V@0.24 ms) patients at implantation, 1-month FU, and 12-month FU (5.9% vs 18.2%, P = .012; 3.4% vs 12.9%, P = .026; and 4.3% vs 14.5%, P = .037, respectively) was found. LPMs showed a satisfactory safety and efficacy profile after TLE. Better electrical parameters were obtained when LPMs were implanted at a different RV location than the one where the previous transvenous RV lead was extracted.

Diffusion Tensor Imaging Shows More Extensive White Matter Changes in Frontal than in Temporal Lobe Epilepsy

Introduction: FLE is known to have a poorer prognosis than TLE. We compared the extent of white matter changes in these groups using diffusion tensor imaging-based tractography. Methods: 20 tracts each were made in five TLE and six FLE patients (bilateral FORX, CGC, PH, UF, SLF, ILF, IFOF, ATR, CST; FMajor and FMinor) and their FA values compared. Results: The TLE group had decreased FA of all ipsilateral fibres except IFOF, with a statistically significant decrease in FORX and UF. The FLE group had a significant decrease (p&lt; 0.05) in the FA values of contralateral ATR and CST. A few contralateral tracts (PH, UF, SLF, IFOF) and ipsilateral FORX and ILF also showed (statistically nonsignificant) decreased mean FA. Mann-Whitney U test comparing ipsilateral nine fibre pairs of FLE vs. TLE was non-significant and significant (p&lt;0.05) only for CST in contralateral fibre comparison. However, a generalised decrease in all fibre FA in FLE vs. TLE was noticed, except for the ‘intimate’ temporal fibres, viz., FORX and PH. The mean FA of all tracts was 0.4982 and 0.5201 for FLE and TLE, respectively (p&lt;0.05). The mean FMajor and FMinor FA were 0.6146 vs. 0.6702 and 0.5598 vs. 0.5917 in FLE vs. TLE, respectively. Conclusion: Tractography based FA value comparison reveals more extensive and severe white matter changes in FLE than in TLE.

The Assessment of Brain Functional Changes in the Temporal Lobe Epilepsy Patient with Cognitive Impairment by Resting-state Functional Magnetic Resonance Imaging.

Objectives:The objective of the study was to detect functional changes in the brain of cognitive impairment-temporal lobe epilepsy (CI-TLE) patient and to sort out the possible mechanism involved in CI in CI-TLE patients using resting-state functional magnetic resonance imaging (RS-fMRI).Material and Methods:Fifty-eight TLE cases were included, which was divided into 44 TLE patients without CI (cognitive not impairment [CNI]-TLE) and 14 TLE patients with CI (CI-TLE). The normal control (NC) group consisted of 40 participants. RS-fMRI data preprocessing was carried out in statistical parametric mapping (SPM) software. The data were realigned, coregistered, normalized, and finally smoothened and then were taken for amplitude of low-frequency fluctuation (ALFF) calculation in RS-fMRI data analysis toolkit (REST) software. For data analysis, voxel-wise two-sample t-test was carried out between TLE group and NC group; CI-TLE group and cognitive not impairment-TLE (CNI-TLE) group in SPM software, a cluster >10 voxels and P < 0.01 was considered to be significant.Results:Compared to NC, the TLE patients showed increased ALFF activation mostly in parahippocampal gyrus (PG), frontal lobe, midbrain, pons, insula, inferior temporal gyrus, and anterior cingulate gyrus (ACG) while decreased ALFF value was seen in posterior cingulate gyrus, cuneus, cerebellum posterior lobe, inferior parietal lobule (IPL), and superior temporal gyrus. Compared to CNI-TLE, CI-TLE patients showed increased ALFF in middle temporal gyrus (MTG), cuneus, ACG, IPL, middle frontal gyrus (MFG), superior frontal gyrus (SFG), cerebellum posterior lobe, and decreased ALFF cluster in the corpus callosum and MFG.Conclusion:Between TLE and NC, we found increased ALFF activation in PG, frontal lobe, thalamus, insula, midbrain, and pons in TLE patient. Between CI and CNI TLE, area of executive control network and default model network, especially in MTG, ACG, IPL, MFG, and SFG, had increased ALFF value in CI-TLE patient. Activation of these areas should be because of the decompensation mechanism.

Effect of methylprednisolone shock therapy on immune function of electrical status epilepticus during sleep in children

Objective To study the effect of methylprednisolone shock therapy on electrical status epilepticus during sleep (ESES) in children and the changes of immune function before and after methylprednisolone shock therapy. Methods Thirty-five children hospitalized in pediatric neurology ward of Shengjing Hospital of China Medical University from October 2017 to October 2018 were selected, including 19 children with newly diagnosed temporal lobe epilepsy (TLE group) and 16 children with initial diagnosis of TLE with ESES (ESES group), and 21 healthy children in the same period were selected as normal control group.A total of 32 cases with ESES who were taken oral administration of more than 2 anti-epileptic drugs(AEDs)ineffective were given methylprednisolone shock treatment for 3 days.Changes of lymphocyte subsets and cytokines among groups were compared. Results The longer the course of disease, the worse the prognosis of children with ESES.Compared with normal control group, the NK cell activity were significantly lower in children of ESES group(P<0.05). The levels of IL-6 were higher in children of ESES group compared with that in children of TLE group, and there was significant difference between two groups(P<0.05). In children with ESES who had poor therapeutic effect of oral AEDs, the proportion of peripheral blood B lymphocytes increased after methylprednisolone shock treatment, and the proportion of T lymphocyte subsets and NK cells decreased, and the differences were statistically significant(P<0.05). The levels of IL-2, IL-4 and IL-10 were higher than those before treatment, the levels of IL-6, IL-17, INF-γ and TNF were lower than those before treatment, and the difference between the level of IL-6 before and after treatment was statistically significant(P<0.05). EEG spike waves index decreased significantly after treatment, some children′s growth and development and cognitive function improved, all children had no serious infection, high blood pressure, electrolyte imbalance and other adverse reactions.The correlation between therapeutic effect and changes of immune indexes was statistically significant in levels of NK cells(r=0.50, P<0.01), B lymphocytes (r=0.35, P=0.04) and IL-6(r=0.46, P=0.01), and all of them were positively correlated(P<0.05). Conclusion Children with ESES have immune dysfunction and may have excessive inactivation of NK cells and elevated levels of IL-6.Congenital immunity and adaptive immunity may play a role in the pathogenesis and pathophysiology of ESES syndrome.Methylprednisolone shock therapy could significantly reduce the non-rapid eye movement discharge index in children with ESES.The mechanism may be related to the significant decrease of IL-6 level.It may also be related to redistribution of lymphocyte subsets, affecting cell differentiation and balancing various cytokines. Key words: Electrical status epilepticus during sleep; Lymphocyte; Cytokines; Methylprednisolone

Emotional Processing in Patients With Early- and Late-Onset Temporal Lobe Epilepsy

ObjectiveTemporal Lobe Epilepsy (TLE) could cause various emotional symptoms due to the damages imposed on the temporal lobe. This study aimed at comparing emotional processing between patients with early- and late-onset TLE and a healthy group.MethodsIn a cross-sectional study, after a definitive diagnosis of TLE, 60 patients were compared with 60 healthy controls without any epilepsy to identify emotional-processing styles in them. The research instruments were the Emotional Processing Scale and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)-based psychiatric interview. The obtained data were analyzed using a multivariate analysis of variance by SPSS.ResultsThe present study results suggested significant differences in emotional processing between the investigated epileptic and non-epileptic groups (P<0.01). Besides, emotional processing indicated significant differences in intrusion, the lack of attunement, and dissociation subscales between patients with early-onset TLE, compared to those with late-onset TLE.ConclusionThe obtained data revealed more emotional processing dysfunction in patients affected by TLE, compared to the non-epileptics. Besides, in some subscales of emotional processing, there was more malfunctioning in the early-onset TLE group, compared to the late-onset TLE group.

Efficacy of a third or later antiepileptic drug regimen according to epilepsy syndrome among adult patients

ObjectiveTo evaluate the efficacy of third or later antiepileptic drug (AED) regimens in adult patients with epilepsy according to epilepsy syndrome. MethodsThe time courses of AEDs and their efficacy were evaluated in 449 adults with temporal lobe epilepsy (TLE, n =153), juvenile myoclonic epilepsy (JME, n =33), or extratemporal focal epilepsy (FE, n =263) based mainly on clinical symptoms and EEG findings. Any change in AEDs after their initiation demarcated the end of one regimen, whereas changes in dose did not. Patients were judged to be seizure-free when they had no seizures for at least 1year with no changes in AED regimen. ResultsOnly 55 of 153 patients in the TLE group were free of seizures at the last visit, and the rate was significantly lower in the TLE group than the extratemporal FE group. The rate of seizure freedom with the first regimen was lower in TLE group than in the other groups, whereas the rate at the third regimen or later was significantly higher in the TLE group than the JME group. In the TLE group, a greater proportion of patients who became seizure-free with the first regimen were first treated with carbamazepine (CBZ), whereas a greater proportion of patients who became seizure-free with the fourth regimen were first treated with valproate (VPA).

An early intervention to promote well-being and flourishing and reduce anxiety and depression: A randomized controlled trial

BackgroundThere is growing evidence that fostering mental well-being and flourishing might effectively prevent mental disorders. In this study, we examined whether a 9-week comprehensive positive self-help intervention with email support (TL-E) was effective in enhancing well-being and flourishing and decreasing anxiety and depressive symptoms in a non-clinical sample. MethodsA total of 275 participants with low or moderate well-being (mean age=48years, 86% female) were randomly assigned to a TL-E (n=137) or wait-list control group (WL; n=138). Participants completed online self-reporting questionnaires at baseline and at 3, 6 and 12months. ResultsRepeated measure analyses revealed significant more improvement on mental well-being (F=42.00, p≤0.001, d=0.66, 95% CI=0.42–0.90), anxiety (F=21.65, p≤0.001, d=0.63, 95% CI=0.39–0.87) and depression (F=13.62, p≤0.001, d=0.43, 95% CI=0.19–0.67) in the TL-E group versus the WL group. The proportion of flourishing in the TL-E group increased from 7 to 30% after 3months (NNT=5.46) and to 34% after 6months (NNT=5.25). All within group effects were maintained up to 12months. We found no meaningful dose-response relationship for adherence, nor a clear moderator pattern. LimitationsIt is unknown whether results were influenced by the email support that accompanied the self-help intervention since TL-E was only compared to a wait-list condition. The generalizability of the findings is limited by the self-selected sample of mainly higher-educated women. ConclusionA guided positive self-help intervention might be considered as a new mental health promotion strategy because it has the potential to improve well-being up to the status of flourishing mental health, and to decrease anxiety and depressive symptomatology.

Study of absence of theta oscillation of working memory dysfunction in temporal lobe epilepsy

Objective Temporal lobe epilepsy (TLE), frequently accompanied by working memory dysfunction, is an important form of adult epilepsy syndrome. Study on neural mechanisms of TLE with working memory dysfunction has important scientific value and clinical significance. Theta oscillations are synchronous activity of the brain in the 4-8 Hz frequency range. It is well recognized that there is a close relationship between the theta oscillations and working memory behavior. TLE patients with working memory dysfunction were taken as the research subjects, and the theta oscillations absence in TLE with working memory behavioral disorder was carried out, which provide the reference for further research into the neural mechanisms of TLE with working memory dysfunction. Methods The 34-channel electroencephalographs (EEGs) were recorded from TLE group (18 TLE patients) and control groups (18 healthy subjects) while subjects were performing visual working memory (delayed matching-to-sample) tasks. The EEGs during the 3 s delay period was analyzed as experimental data. Fourier transform was used to assess the EEGs spectrum. The channel with the strongest spectrum was selected as the feature channel. Short-time Fourier transform algosiths was employed to calculate the time-frequency representation of the feature channel for the TLE and control groups. Frequency band with the strongest spectrum was selected for control group as the feature frequency band in working memory. Then, the topographical maps of the feature frequency band spectrum were calculated for the TLE and control groups. Results Compared with the control group, the working memory behavioral performance of the TLE group was lower: accuracy of the TLE group was significantly lower than that of the control group (P<0.05), and reaction time of the TLE group was significantly longer than that of the control group (P<0.001). The feature channel in working memory was frontal midline (Fz) and the feature frequency band was theta band. The Fz spectrum of the feature frequency for TLE was lower than that for control (P<0.05). The frontal spectrum (seven channels) of the feature frequency for TLE was lower than that of control (P<0.01). Conclusions Theta oscillations for TLE with working memory behavioral disorder is absent, which maybe one of the possible neural mechanism of TLE with working memory dysfunction. Key words: Temporal lobe epilepsy; Working memory dysfunction; Multi-channel electroencephalographs; Theta oscillations

OP59 – 2642: Cognitive functions in children with frontal and temporal epilepsy – Long term observations

Objective In order to compare the cognitive functions in children with newly diagnosed temporal (TLE) versus frontal lobe epilepsy (FLE) and control group which consisted of healthy children the following prospective study was performed. Material and methods 39 children with TLE 24 children with FLE and 24 healthy subject were included in study. Each child had neuropsychology assessment using age-normed and validated instruments. The applied test battery consisted of measures assessing both intelligence as well as executive and motor skills. The children were reassessed one and two years. Results In all epilepsy patients there was no evidence of anatomical brain damage. There were no differences in mean age and gender between the groups. There was no significant difference in global IQ scores between the groups. Children with FLE had significantly lower scores than the other two groups in non-verbal memory tasks, presented higher attention deficit and had slower performance speed. The TLE group performed significantly worse as compared with control group in verbal learning and performance speed with no differences in attention. The correlations between the results of test and the localization of epileptic foci were performed. In long term outcome the “frontal” group performed significantly worse than other groups. detailed analysis of cognitive impairment was performed. Conclusion The children with new onset FLE present with more severe cognitive and attention problems in course of disease compared with TLE group, however the TLE group differ significantly in some measures with control group.

(599) - Extracorporeal Membrane Oxygenation for Concomitant Coronary Artery Bypass Grafting and Lung Transplantation

s S223 infection in the remaining 10. There were no reoperations for bleeding, strokes, or operative mortalities post-TLE. During the follow-up period, two patients died and six were transplanted. Mean survival to transplant time was 1.6 ± 1.4 years. Survival outcomes in the 10 patients undergoing TLE for infection were compared to the cohort of 40 VAD patients with lead intact and confirmed infection (non-TLE). Cumulative survival-to-transplant was 89% at 12 and 24 months each for the TLE group, versus 79% at 12 months and 37% at 24 months for the non-TLE group, with a median survival-to-transplant of 24.0 months for TLE patients versus 16.6 months for non-TLE patients (p= 0.09). Conclusion: In this series, TLE in VAD patients was performed predominantly for bacteremia and/or CIED related endocarditis. There were no major complications and no operative mortality. When compared to VAD patients with infection and intact leads, there was better survival-to-transplant in the TLE group. VAD patients can be safely managed with TLE. TLE is associated with improved survival-to-transplant.

Sensitivity of Green’s Word Memory Test Genuine Memory Impairment Profile to Temporal Pathology: A Study in Patients With Temporal Lobe Epilepsy

Performance validity tests (PVTs) such as Green’s Word Memory Test (WMT) are designed to have face validity as memory tests while individuals with neurologically based memory deficits can score adequately provided there is sufficient task engagement. Some patients with severe memory loss have performed poorly on the WMT, raising questions about false positive errors. This study compared performances of 43 patients with left, right, or bilateral temporal lobe epilepsy on the WMT to a test known to be sensitive to temporal lobe pathology, the Rey Auditory Verbal Learning Test (RAVLT). The right TLE group outperformed the left on the WMT free recall (FR) scores and RAVLT short-delay and long-delay trials (Trials 6 and 7) (p < .05); no other between-group differences occurred (p ≥ .10). Ten participants (20.4%) performed below the cut-off score on at least one WMT effort subtest, but eight (80%) exhibited the genuine memory impairment profile (GMIP). Logistic regression found no WMT subtest contributed to predicting side of seizure with RAVLT scores in the model. Data suggest WMT primary effort subtests are generally insensitive to known temporal lobe pathology, and using the GMIP is valuable to identify individuals with severe memory loss who score below criterion on WMT primary effort subtests.

The utility of 18F-fluorodeoxyglucose PET (FDG PET) in epilepsy surgery

To investigate the utility of 18F-fluorodeoxyglucose Positron Emission Tomography (FDG PET) in helping decision making for epilepsy surgery. All patients with medically refractory focal epilepsy and MRI that was normal or discordant with clinical and EEG data underwent FDG PET. FDG PET scans were reported by two investigators blinded to clinical data using visual assessment aided by the semiquantitative assessment. All clinical, MRI and FDG PET data were reviewed in the multidisciplinary patient management conferences for the localization and further decisions, which were recorded in the electronic database. For this study, we reviewed the charts of all these patients to decide the usefulness of PET in further decision making. FDG PET was considered to be useful if led directly to surgery, helped in planning intracranial EEG or helped in excluding patients from further evaluation. 194 consecutive adult patients (median age, 32.5 years) underwent FDG PET; 158 had normal MRI, 12 had subtle MRI abnormalities and 24 had discordant non-invasive data. Final localization was temporal lobe epilepsy (TLE, n=64), frontal lobe epilepsy (FLE, n=66), temporal-plus epilepsy (n=26) and other extratemporal lobe epilepsies (ETE, n=38). PET scans were normal in 72 (37%) patients, showed unifocal hypometabolism in 98 (50.5%) and bilateral hypometabolism in 24 (12%) patients. The TLE group had a higher proportion of abnormal PET scans (67%) than FLE (52%) and ETE (61%). PET data were useful in 103 (53%) patients, more in TLE (63%) than FLE (38%) or ETE (50%). It led directly to surgery in 12 (6%) cases, helped in planning intracranial EEG in 67 (35%) patients and excluded 24 (12%) patients from further evaluation. Focal hypometabolism on FDG PET increased the odds of being selected for surgery or intracranial EEG by five fold [odds ratio, 5.1 (2.8-9.4); p<0.0001]. FDG PET scan can help decision making in 53% of presurgical patients with normal or discordant MRI. PET findings need to be evaluated in conjunction with other data.

MRI segmentation analysis in temporal lobe and idiopathic generalized epilepsy

BackgroundTemporal lobe epilepsy (TLE) and idiopathic generalized epilepsy (IGE) patients have each been associated with extensive brain atrophy findings, yet to date there are no reports of head to head comparison of both patient groups. Our aim was to assess and compare between tissue-specific and structural brain atrophy findings in TLE to IGE patients and to healthy controls (HC).MethodsTLE patients were classified in TLE lesional (L-TLE) or non-lesional (NL-TLE) based on presence or absence of MRI temporal structural abnormalities. High resolution 3 T MRI with automated segmentation by SIENAX and FIRST tools were performed in a group of patients with temporal lobe epilepsy (11 L-TLE and 15 NL-TLE) and in15 IGE as well as in 26 HC. Normal brain volume (NBV), normal grey matter volume (NGMV), normal white matter volume (NWMV), and volumes of subcortical deep grey matter structures were quantified. Using regression analyses, differences between the groups in both volume and left/right asymmetry were evaluated. Additionally, laterality of results was also evaluated to separately quantify ipsilateral and contralateral effects in the TLE group.ResultsAll epilepsy groups had significantly lower NBV and NWMV compared to HC (p < 0.001). L-TLE had lower hippocampal volume than HC and IGE (p = 0.001), and all epilepsy groups had significantly lower amygdala volume than HC (p < = 0.004). In L-TLE, there was evidence of atrophy in both ipsilateral and contralateral structures.ConclusionsOur study revealed that TLE and IGE patients demonstrated similar overall tissue-specific brain atrophy, although specific structures differences were appreciated. L-TLE also appeared to behave differently than NL-TLE, with atrophy not limited to the ipsilateral side.

A reduction of sleep spindles heralds seizures in focal epilepsy

ObjectivesSleep has profound effects on epilepsy. It may alter the occurrence of interictal discharges (IEDs) and seizures. Vice versa, an active epilepsy changes sleep. Sleep spindles are typically associated with an increase of IEDs. We examined whether seizures change the number and power of spindles preceding nightly seizures. MethodsWe retrospectively examined the nightly EEG recordings of presurgical epilepsy patients from our EEG-video-monitoring unit. We evaluated the 200s before the EEG seizure onset for spindle density (spindles per minute) and spindle power and compared that to the interictal baseline sleep. ResultsThe spindle density and the spindle power decreased significantly before the first seizure. The reduction before secondarily generalized seizures (8.7±2.5; p=0.001) was more pronounced than before focal seizures (10.5±2.5; p=0.003) compared to baseline (12.2±2.7). This finding was more pronounced in extratemporal lobe epilepsies than in temporal lobe epilepsies. The reduction of spindle power was also significant and was more pronounced in XTLE. These results were consistent for all other seizures during sleep, the mean spindle density decreased significantly in all focal (10.2±1.9; p=0.001) and generalized preictal period (8.8±2.4; p=0.001) compared to the mean interictal period (12.1±2.1). These were also more significant in XTLE than TLE group. ConclusionsOur data demonstrate that the occurrence of seizures and propensity of seizure generalisation in focal epilepsy is modulated by specific characteristics of light sleep such as sleep spindles. SignificanceThis study supports the notion that changes in the epileptic network precede the seizure onset and have an influence on seizure generation and termination.

Multifactorial etiology of interictal behavior in frontal and temporal lobe epilepsy

Based on discussions on the so called "epileptic personality" in patients with epilepsy, interictal behavioral impairments in frontal and temporal lobe epilepsies were examined in a multivariate approach that took demographic, clinical, and neuropsychological determinants into consideration. A total of 428 patients with epilepsies originating from the temporal (TLE; 84%) or frontal (FLE; 16%) lobes were examined in regard to personality (Fragebogen zur Persönlichkeit bei zerebralen Erkrankungen [FPZ], a clinical personality questionnaire) and mood (Beck Depression Inventory [BDI I]). Prevalence of impaired behavioral domains was determined. Etiologically relevant determinants of behavioral problems were identified via multiple regression analyses. Elevated depression scores (BDI) were evident in 42% of the patients, and not different in TLE and FLE. In regard to personality, introversion together with low mood, sociability, and self-determination, as well as problems with interpersonal communication were frequent. The TLE group tended to show greater neuroticism and introversion, while FLE appeared more associated with behavioral aspects of an organic psychosyndrome. Multivariate analyses revealed demographic characteristics (age, gender, education), clinical aspects (psychiatric history, affected hemisphere, mesial pathology, seizure frequency, cognitive functions), and treatment (antiepileptic drug treatment) as relevant determinants, explaining up to 30% of the behavior. Behavioral abnormalities in patients with frontal or temporal lobe epilepsy are common but on the average mostly mild. Within a multivariate etiological model, localization (mesial yes/no) and lateralization (left > right) dependent behavioral problems in TLE and FLE seem to be overshadowed by other variables, of which patients' and their families' psychiatric history, patient characteristics and pharmacological treatment appear of major importance. Better education and cognitive capabilities may be discussed as protective features.

Widespread epileptic networks in focal epilepsies: EEG‐fMRI study

To assess the extent of brain involvement during focal epileptic activity, we studied patterns of cortical and subcortical metabolic changes coinciding with interictal epileptic discharges (IEDs) using group analysis of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) scans in patients with focal epilepsy. We selected patients with temporal lobe epilepsy (TLE, n = 32), frontal lobe epilepsy (FLE, n = 14), and posterior quadrant epilepsy (PQE, n = 20) from our 3 Tesla EEG-fMRI database. We applied group analysis upon the blood oxygen-level dependent (BOLD) response associated with focal IEDs. Patients with TLE and FLE showed activations and deactivations, whereas in PQE only deactivations occurred. In TLE and FLE, the largest activation was in the mid-cingulate gyri bilaterally. In FLE, activations were also found in the ipsilateral frontal operculum, thalamus, and internal capsule, and in the contralateral cerebellum, whereas in TLE, we found additional activations in the ipsilateral mesial and neocortical temporal regions, insula, and cerebellar cortex. All three groups showed deactivations in default mode network regions, the most widespread being in the TLE group, and less in PQE and FLE. These results indicate that different epileptic syndromes result in unique and widespread networks related to focal IEDs. Default mode regions are deactivated in response to focal discharges in all three groups with syndrome specific pattern. We conclude that focal IEDs are associated with specific networks of widespread metabolic changes that may cause more substantial disturbance to brain function than might be appreciated from the focal nature of the scalp EEG discharges.

Executive functions in patients with frontal and temporal lobe epilepsy

Objective To investigate the executive functions of the frontal and temporal lobe epilepsy patients. Methods Fifty-five epilepsy patients (twenty-five frontal lobe epilepsy patients and thirty temporal lobe epilepsy patients) and fifty age, gender and education matched healthy controls were evaluated by means of Mini Mental State Examination (MMSE ). Executive function was assessed using Stroop color words test and trail making test. Results MMSE total score of frontal and temporal lobe epilepsy patients were (26.02±0.30) and (25.82±0.67), respectively. There was significant abnormality between epilepsy patients and the controls (P<0.05). Compared with normal control group, FLP group and TLP group took longer time and their score was lower in stroop color words test (P<0.05). There were significant difference between FLP and TLP on card B and C′s reading time, correct number and stroop interference effects (P<0.05). The epilepsy patients performed significantly worse than the controls in whole trail making test (P<0.05). The scores indicate that the TLE group outperformed the FLE group on all analysis values (P<0.05). Conclusion The frontal and temporal lobe epilepsy patients have executive function deficit. The FLE group has prominent deficits in executive functioning. Key words: Frontal lobe epilepsy; Temporal lobe epilepsy; Executive functions