Neurodevelopmental disruption in early-onset temporal lobe epilepsy: Evidence from a voxel-based morphometry study

Kaaden, Sabine; Quesada, Carlos M.; Urbach, Horst; Koenig, Roy; Weber, Bernd; Schramm, Johannes; Rudinger, Georg; Helmstaedter, Christoph

doi:10.1016/j.yebeh.2011.02.020

Cited by 22 publications

(11 citation statements)

References 46 publications

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“…This suggests that fMRI measures of lexical‐semantic processing contribute to an understanding of language impairment in combination with clinical features, particularly age at seizure onset. Our results point toward an underlying neurobiological feature of language impairment in TLE being dysfunction within left superior temporal areas, for both LTLE and RTLE, that may be driven by poor development of (or damage to) left perisylvian WM tracts in patients with an early age at seizure onset …”

Section: Discussionmentioning

confidence: 66%

“…In the nine patients without Engle scores (seven who have not yet undergone surgery and two who are awaiting Engle outcomes), seizure onset laterality was determined by intracranial EEG (n = 4) or continuous video scalp EEG monitoring with strong evidence of right temporal lobe seizure onset (n = 5). Our contention is that language impairment in our RTLEs represents bilateral pathology, not bilateral seizure onsets. As the field of epilepsy is moving toward establishing more meaningful taxonomies and identifying stable cognitive phenotypes, understanding the underlying neurobiology of these phenotypes could improve our ability to match patients to treatments and improve a range of epilepsy‐related outcomes.…”

Section: Discussionmentioning

confidence: 70%

“…Our results point toward an underlying neurobiological feature of language impairment in TLE being dysfunction within left superior temporal areas, for both LTLE and RTLE, that may be driven by poor development of (or damage to) left perisylvian WM tracts in patients with an early age at seizure onset. [48][49][50]…”

Section: Discussionmentioning

confidence: 99%

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Identifying the neural basis of a language‐impaired phenotype of temporal lobe epilepsy

et al. 2019

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Objective To identify neuroimaging and clinical biomarkers associated with a language‐impaired phenotype in refractory temporal lobe epilepsy (TLE). Methods Eighty‐five patients with TLE were characterized as language‐impaired (TLE‐LI) or non–language‐impaired (TLE‐NLI) based on comprehensive neuropsychological testing. Structural magnetic resonance imaging (MRI), diffusion tensor imaging, and functional MRI (fMRI) were obtained in patients and 47 healthy controls (HC). fMRI activations and cortical thickness were calculated within language regions of interest, and fractional anisotropy (FA) was calculated within deep white matter tracts associated with language. Analyses of variance were performed to test for differences among the groups in imaging measures. Receiver operator characteristic curves were used to determine how well different clinical versus imaging measures discriminated TLE‐LI from TLE‐NLI. Results TLE‐LI patients showed significantly less activation within left superior temporal cortex compared to HC and TLE‐NLI, regardless of side of seizure onset. TLE‐LI also showed decreased FA in the inferior longitudinal fasciculus and arcuate fasciculus compared to HC. Cortical thickness did not differ between groups in any region. A model that included language‐related fMRI activations within the superior temporal gyrus, age at onset, and demographic variables was the most predictive of language impairment (area under the curve = 0.80). Significance These findings demonstrate a unique imaging signature associated with a language‐impaired phenotype in TLE, characterized by functional and microstructural alterations within the language network. Reduced left superior temporal activation combined with compromise to language association tracts underlies this phenotype, extending our previous work on cognitive phenotypes that could have implications for treatment‐planning or cognitive progression in TLE.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 70%

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Identifying the neural basis of a language‐impaired phenotype of temporal lobe epilepsy

et al. 2019

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“…Although this is not yet well understood, several studies assume an effect of early onset mTLE on the maturation of extratemporal and especially frontal brain areas due to irradiating and interfering epileptic dysfunction (11, 15). Up to now, the impact of the onset of epilepsy on brain anatomy has been evaluated with regard to various brain structures but rarely the CC (16–19).…”

Section: Introductionmentioning

confidence: 99%

Relation of Callosal Structure to Cognitive Abilities in Temporal Lobe Epilepsy

et al. 2014

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The main objective of this paper is to analyze the influence of mesial temporal lobe epilepsy (mTLE) on the morphology of the corpus callosum (CC) and its relation to cognitive abilities. More specifically, we investigated correlations between intellectual abilities and callosal morphology, while additionally exploring the modulating impact of (a) side of seizure onset (b) age of disease onset. For this reason a large representative sample of patients with hippocampal sclerosis (n = 79; 35 males; 44 females; age: 18–63 years) with disease onset ranging from 0 to 50 years of age, and consisting of 46 left and 33 right mTLE-patients was recruited. Intelligence was measured using the Wechsler-Adult Intelligence Scale Revised. To get localizations of correlations with high anatomic precision, callosal morphology was examined using computational mesh-based modeling methods, applied to anatomical brain MRI scans. Intellectual performance was positively associated with callosal thickness in anterior and midcallosal callosal regions, with anterior parts being slightly more affected by age of disease onset and side of seizure onset than posterior parts. Earlier age at onset of epilepsy was associated with lower thickness in anterior and midcallosal regions. In addition, laterality of seizure onset had a significant influence on anterior CC morphology, with left hemispheric origin having stronger effects. We found that in mTLE, anterior and midcallosal CC morphology are related to cognitive performance. The findings support recent findings of detrimental effects of early onset mTLE on anterior brain regions and of a distinct effect particularly of left mTLE on frontal lobe functioning and structure. The causal nature of the relationship remains an open question, i.e., whether CC morphology impacts IQ development or whether IQ development impacts CC morphology, or both.

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“…first hit or onset of epilepsy must be considered as an important moderator variable, since early epilepsy and underlying pathologies can negatively affect brain maturation and development [3,4]. Additionally, individual reserve capacities and age-and sexdependent neural plasticity need to be considered [5].…”

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confidence: 99%

Cognition in the early stages of adult epilepsy

Witt

Helmstaedter

2015

Seizure

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The high prevalence of objective cognitive impairments present at epilepsy onset calls for early neuropsychological assessments soon after the diagnosis of epilepsy, and at best before medical treatment is initiated. Without such baseline assessments subsequent neuropsychological testing during follow-up is difficult to interpret in regard to the effects of treatment success or the course of underlying disease processes. Beyond that, the baseline assessment may also guide treatment choices and serve as an early indicator of the need for support or rehabilitation. In this way neuropsychological monitoring can improve individual medical care, and increase tolerability, adherence, and treatment retention from the point of diagnosis.

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Neurodevelopmental disruption in early-onset temporal lobe epilepsy: Evidence from a voxel-based morphometry study

Cited by 22 publications

References 46 publications

Identifying the neural basis of a language‐impaired phenotype of temporal lobe epilepsy

Identifying the neural basis of a language‐impaired phenotype of temporal lobe epilepsy

Relation of Callosal Structure to Cognitive Abilities in Temporal Lobe Epilepsy

Cognition in the early stages of adult epilepsy

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