Cortical thickness analysis in temporal lobe epilepsy

Bernhardt, Boris C.; Bernasconi, Neda; Concha, Luis; Bernasconi, Andrea

doi:10.1212/wnl.0b013e3181e0f80a

Cited by 208 publications

(240 citation statements)

References 43 publications

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“…Previous studies in adults have documented widespread neocortical atrophy in patients with TLE 17, 18. Although, pediatric HS patients here showed a cluster of neocortical atrophy in the ipsi‐lesional temporal pole, it is much less extensive than the gray–white matter boundary blurring or FLAIR hyperintensities.…”

Section: Discussioncontrasting

confidence: 57%

“…This was as expected given that the inclusion criteria for patients involved a radiological diagnosis of HS. The surface‐based approach, to calculate per‐vertex cortical thickness, normalized FLAIR signal intensity and gray–white matter intensity contrast, demonstrated that while pediatric TLE patients did not show the widespread cortical thinning present in adult cohorts,16, 17, 18, 19 they nevertheless had morphological and intensity changes in ipsi‐lesional temporopolar neocortex. Furthermore, temporopolar FLAIR hyperintensities were more marked in patients with a history of febrile convulsions and blurring of the gray–white matter boundary was correlated with earlier onset of epilepsy.…”

Section: Discussionmentioning

confidence: 99%

“…This dichotomy between adult and pediatric findings may reflect the fact that pediatric HS patients have shorter durations of epilepsy than adult cohorts. Cortical thinning has previously been associated with duration of epilepsy18 and may be related to generalized, seizure‐related factors and reflect consequences of the overall disease process. Importantly however, in this pediatric TLE cohort, there was no correlation with duration of epilepsy.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond the hippocampus, there is a body of neuroimaging literature in adults, utilizing both volumetric and surface‐based methodologies, describing whole‐brain changes in gray matter volume,16 cortical thickness17, 18, 19 and T2/FLAIR intensity 20, 21. These changes are seen after several decades of illness duration, as seizures often start in childhood and adolescence.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal computational neocortical anatomy in pediatric hippocampal sclerosis

Adler

Blackwood

Northam

et al. 2018

Ann Clin Transl Neurol

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ObjectiveIn contrast to adult cohorts, neocortical changes in epileptic children with hippocampal damage are not well characterized. Here, we mapped multimodal neocortical markers of epilepsy‐related structural compromise in a pediatric cohort of temporal lobe epilepsy and explored how they relate to clinical factors.MethodsWe measured cortical thickness, gray–white matter intensity contrast and intracortical FLAIR intensity in 22 patients with hippocampal sclerosis (HS) and 30 controls. Surface‐based linear models assessed between‐group differences in morphological and MR signal intensity markers. Structural integrity of the hippocampus was measured by quantifying atrophy and FLAIR patterns. Linear models were used to evaluate the relationships between hippocampal and neocortical MRI markers and clinical factors.ResultsIn the hippocampus, patients demonstrated ipsilateral atrophy and bilateral FLAIR hyperintensity. In the neocortex, patients showed FLAIR signal hyperintensities and gray–white matter boundary blurring in the ipsilesional mesial and lateral temporal neocortex. In contrast, cortical thinning was minimal and restricted to a small area of the ipsilesional temporal pole. Furthermore, patients with a history of febrile convulsions demonstrated more pronounced FLAIR hyperintensity in the ipsilesional temporal neocortex.InterpretationPediatric HS patients do not yet demonstrate the widespread cortical thinning present in adult cohorts, which may reflect consequences of a protracted disease process. However, pronounced temporal neocortical FLAIR hyperintensity and blurring of the gray–white matter boundary are already detectable, suggesting that alterations in MR signal intensities may reflect a different underlying pathophysiology that is detectable earlier in the disease and more pervasive in patients with a history of febrile convulsions.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multimodal computational neocortical anatomy in pediatric hippocampal sclerosis

Adler

Blackwood

Northam

et al. 2018

Ann Clin Transl Neurol

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“…findings of more widespread alterations in cortical morphology that extend beyond the hippocampus are consistent with TLE's comorbid deficits in executive, intellectual and language functioning (Oyegbile et al, 2004). More recently, using methods that reconstruct the cortical surface to more precisely measure gray matter structure, researchers found up to 30% reductions in cortical thickness bilaterally in multiple frontal, temporal and occipital regions in TLE patients with MTS compared to controls (Lin et al, 2007;Bernhardt et al, 2010;Kemmotsu et al, 2011). These findings are present in TLE patients with and without MTS but have been shown to be stronger in patients with MTS (Labate et al, 2011).…”

Section: Introductionmentioning

confidence: 93%

Machine learning classification of mesial temporal sclerosis in epilepsy patients

Rudie¹,

Colby²,

Salamon

2015

Epilepsy Research

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a b s t r a c tBackground and purpose: Novel approaches applying machine-learning methods to neuroimaging data seek to develop individualized measures that will aid in the diagnosis and treatment of brain-based disorders such as temporal lobe epilepsy (TLE). Using a large cohort of epilepsy patients with and without mesial temporal sclerosis (MTS), we sought to automatically classify MTS using measures of cortical morphology, and to further relate classification probabilities to measures of disease burden. Materials and methods: Our sample consisted of high-resolution T1 structural scans of 169 adults with epilepsy collected across five different 1.5 T and four different 3 T scanners at UCLA. We applied a multiple support vector machine recursive feature elimination algorithm to morphological measures generated from FreeSurfer's automated segmentation and parcellation in order to classify Epilepsy patients with MTS (n = 85) from those without MTS (N = 84). Results: In addition to hippocampal volume, we found that alterations in cortical thickness, surface area, volume and curvature in inferior frontal and anterior and inferior temporal regions contributed to a classification accuracy of up to 81% (p = 1.3 × 10 −17 ) in identifying MTS. We also found that MTS classification probabilities were associated with a longer duration of disease for epilepsy patients both with and without MTS. Conclusions: In addition to implicating extra-hippocampal involvement of MTS, these findings shed further light on the pathogenesis of TLE and may ultimately assist in the development of automated tools that incorporate multiple neuroimaging measures to assist clinicians in detecting more subtle cases of TLE and MTS.

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Progressive Cortical Thinning in Patients With Focal Epilepsy

et al. 2019

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IMPORTANCEIt is controversial whether epilepsy is a static or progressive disease. Evidence of progressive gray matter loss in epilepsy would support early diagnosis, rapid treatment, and early referral for surgical interventions.OBJECTIVE To demonstrate progressive cortical thinning in patients with focal epilepsy distinct from cortical thinning associated with normal aging. DESIGN, SETTING, AND PARTICIPANTSA case-control neuroimaging study was conducted from August 3, 2004, to January 26, 2016 patients with focal epilepsy at a tertiary epilepsy referral center (epilepsy data) and 3 independent comparison cohorts matched for age and sex (healthy volunteer data; n = 141).EXPOSURES Two or more high-resolution T1-weighted magnetic resonance imaging scans at least 6 months apart (mean [SD] interval, 2.5 [1.6] years). MAIN OUTCOMES AND MEASURES Global and vertexwise rate of progressive cortical thinning.RESULTS A total of 190 people with focal epilepsy (99 women and 91 men; mean [SD] age, 36 [11] years; 396 magnetic resonance imaging scans) were compared with 141 healthy volunteers (76 women and 65 men; mean [SD] age, 35 [17] years; 282 magnetic resonance imaging scans). Widespread highly significant progressive cortical thinning exceeding normal aging effects, mainly involving the bilateral temporal lobes, medial parietal and occipital cortices, pericentral gyri, and opercula, was seen in 146 individuals with epilepsy (76.8%; 95% CI, 58%-95%). The mean (SD) annualized rate of global cortical thinning in patients with epilepsy was twice the rate of age-associated thinning observed in healthy volunteers (0.024 [0.061] vs 0.011 [0.029] mm/y; P = .01). Progression was most pronounced in adults older than 55 years and during the first 5 years after the onset of seizures. Areas of accelerated cortical thinning were detected in patients with early onset of epilepsy and in patients with hippocampal sclerosis. Accelerated thinning was not associated with seizure frequency, history of generalized seizures, or antiepileptic drug load and did not differ between patients with or without ongoing seizures. Progressive atrophy in temporal (n = 101) and frontal (n = 28) lobe epilepsy was most pronounced ipsilaterally to the epileptic focus but also affected a widespread area extending beyond the focus and commonly affected the contralateral hemisphere. For patients with temporal lobe epilepsy, accelerated cortical thinning was observed within areas structurally connected with the ipsilateral hippocampus.CONCLUSIONS AND RELEVANCE Widespread progressive cortical thinning exceeding that seen with normal aging may occur in patients with focal epilepsy. These findings appear to highlight the need to develop epilepsy disease-modifying treatments to disrupt or slow ongoing atrophy. Longitudinal cortical thickness measurements may have the potential to serve as biomarkers for such studies.

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Cortical thickness analysis in temporal lobe epilepsy

Cited by 208 publications

References 43 publications

Multimodal computational neocortical anatomy in pediatric hippocampal sclerosis

Multimodal computational neocortical anatomy in pediatric hippocampal sclerosis

Machine learning classification of mesial temporal sclerosis in epilepsy patients

Progressive Cortical Thinning in Patients With Focal Epilepsy

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