Prolonged febrile seizures cause reversible reductions in white matter integrity

Yoong, Michael; Seunarine, Kiran K.; Martinos, Marina; Chin, Richard; Clark, Chris A.; Scott, Rodney C.

doi:10.1016/j.nicl.2013.10.010

Cited by 16 publications

(20 citation statements)

References 39 publications

(48 reference statements)

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“…We note from our short‐term follow‐up study that FA decreased at 1 month and 6 months post‐PFS and then normalized at 1 year with no evidence for FA increases as observed here 13. Similarly, AD was decreased at 1 and 6 months post‐PFS with no evidence for AD increases as observed in the present study.…”

Section: Discussionsupporting

confidence: 71%

“…A longitudinal study design could have provided a better description of the evolution of WM diffusion changes following PFS. We, nonetheless, have referred to the results from our previous study on a comparable cohort, but with a shorter follow‐up, to complement our data and interpret the findings 13. A possible limitation of TBSS is misregistration of individual scans to the common template for group analysis, which may be an issue particularly for structurally abnormal conventional scans.…”

Section: Discussionmentioning

confidence: 68%

“…In a recent study, we performed longitudinal DTI analysis in the first year following PFS, and found widespread changes suggestive of reduced WM integrity at 1 and 6 months, with apparent normalization 12 months post-PFS. 13 The WM changes were seen in the absence of any hippocampal or extra-hippocampal structural abnormalities. Whether these WM changes persist or evolve after 1 year post-PFS is unknown, and therefore medium-to long-term follow-up is necessary to investigate the outcomes.…”

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confidence: 95%

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Long‐term white matter tract reorganization following prolonged febrile seizures

et al. 2017

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SummaryObjectiveDiffusion magnetic resonance imaging (MRI) studies have demonstrated acute white matter changes following prolonged febrile seizures (PFS), but their longer‐term evolution is unknown. We investigated a population‐based cohort to determine white matter diffusion properties 8 years after PFS.MethodsWe used diffusion tensor imaging (DTI) and applied Tract‐Based Spatial Statistics for voxel‐wise comparison of white matter microstructure between 26 children with PFS and 27 age‐matched healthy controls. Age, gender, handedness, and hippocampal volumes were entered as covariates for voxel‐wise analysis.ResultsMean duration between the episode of PFS and follow‐up was 8.2 years (range 6.7–9.6). All children were neurologically normal, and had normal conventional neuroimaging. On voxel‐wise analysis, compared to controls, the PFS group had (1) increased fractional anisotropy in early maturing central white matter tracts, (2) increased mean and axial diffusivity in several peripheral white matter tracts and late‐maturing central white matter tracts, and (3) increased radial diffusivity in peripheral white matter tracts. None of the tracts had reduced fractional anisotropy or diffusivity indices in the PFS group.SignificanceIn this homogeneous, population‐based sample, we found increased fractional anisotropy in early maturing central white matter tracts and increased mean and axial diffusivity with/without increased radial diffusivity in several late‐maturing peripheral white matter tracts 8 years post‐PFS. We propose disruption in white matter maturation secondary to seizure‐induced axonal injury, with subsequent neuroplasticity and microstructural reorganization as a plausible explanation.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 68%

mentioning

confidence: 95%

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Long‐term white matter tract reorganization following prolonged febrile seizures

et al. 2017

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“…Non-epilepsy children with CSE were younger at testing (p<0.001) and the epilepsy CSE group had lower Full-scale IQ (p<0.001) in comparison with the control and the nonepilepsy CSE groups. A multivariate analysis of variance with age at test and Full-scale IQ as covariates and SDQ, ASSQ, and SNAP-IV scores as dependent variables revealed a significant effect of Full-scale IQ (F [3,74] =11.05; p<0.001) and a trend for an effect of group (F [3,75]=2.6; p=0.067) on behavioural scores. Pairwise comparisons revealed a trend for a difference between the nonepilepsy CSE and the control group on the SDQ scale (F [2,76]=3.07; p=0.063).…”

Section: Questionnaire Results Compared With Population Norms and Conmentioning

confidence: 99%

Long‐term behavioural outcomes after paediatric convulsive status epilepticus: a population‐based cohort study

Martinos

Pujar

Gillberg

et al. 2017

Develop Med Child Neuro

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AimTo describe behavioural and psychiatric outcomes of children within 10 years of convulsive status epilepticus (CSE).MethodChildren originally identified by the population‐based North London Convulsive Status Epilepticus in Childhood Surveillance Study were followed‐up between July 2009 and February 2013. They were grouped into epilepsy‐ and non‐epilepsy‐related CSE, and compared with population norms and healthy controls using the Strengths and Difficulties Questionnaire; the Autism Spectrum Screening Questionnaire; and the Swanson, Nolan, and Pelham questionnaire. Children who scored above recommended clinical cut‐offs on any scale were invited for a neuropsychiatric assessment. Regression models were fitted to identify clinically relevant covariates associated with behavioural outcomes.ResultsAt a mean follow‐up of 8.1 years post‐CSE, 28% of enrolled children were found to have a psychiatric disorder. Children with epilepsy‐related CSE scored higher than norms on all scales and children with non‐epilepsy‐related CSE scored higher than norms on the Strengths and Difficulties Questionnaire and the Autism Spectrum Screening Questionnaire. Presence of seizures at baseline and recurrence of CSE was associated with worse outcomes in the group with epilepsy. Intellectual abilities were associated with behavioural outcomes in all participants.InterpretationA large proportion of children manifest behavioural issues 8 years after CSE. The present data highlight the need for behavioural screening in children with neurodevelopmental impairments post‐CSE.What this paper adds Eight years post convulsive status epilepticus (CSE), 37% of parents report behavioural issues.Of enrolled children, 28% were found to have a Diagnostic and Statistical Manual mental disorder.Intellectual abilities are strongly associated with behavioural outcomes in children post‐CSE.

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“…Although animal studies support the hypothesis that a decrease of AD reflects axonal injury, studies on humans report inconclusive results. Some studies found an AD decrease, for example, following ischemic stroke or prolonged febrile seizures, whereas others report an AD increase, for example, in multiple sclerosis or idiopathic epilepsy syndromes in children . Hence, the nature of AD changes seems to be complex in humans and an increased AD (along with increased MD and RD) may reflect decreased tissue density, reflecting cell loss of both neurons and glia.…”

Section: Discussionmentioning

confidence: 99%

Distinct white matter integrity in glutamic acid decarboxylase and voltage‐gated potassium channel‐complex antibody‐associated limbic encephalitis

et al. 2016

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SUMMARYObjective: Autoantibodies against glutamic acid decarboxylase (GAD) and the voltage-gated potassium channel (VGKC) complex are associated with distinct subtypes of limbic encephalitis regarding clinical presentation, response to therapy, and outcome. The aim of this study was to investigate white matter changes in these two limbic encephalitis subtypes by means of diffusion tensor imaging (DTI). Methods: Diffusion data were obtained in 14 patients with GAD antibodies and 16 patients with VGKC-complex antibodies and compared with age-and gender-matched control groups. Voxelwise statistical analysis was carried out using tract-based spatial statistics. The results were furthermore compared with those of 15 patients with unilateral histologically confirmed hippocampal sclerosis and correlated with verbal and figural memory performance. Results: We found widespread changes of fractional anisotropy and all diffusivity parameters in GAD-associated limbic encephalitis, whereas no changes were found in VGKC-complex-associated limbic encephalitis. The changes observed in the GAD group were even more extensive when compared against those of the hippocampal sclerosis group, although the disease duration was markedly shorter in patients with GAD antibodies. Correlation analysis revealed areas with a trend toward a negative correlation of diffusivity parameters with figural memory performance located mainly in the right temporal lobe in the GAD group as well. Significance: The present study provides further evidence that, depending on the associated antibody, limbic encephalitis features clearly distinct imaging characteristics by showing widespread white matter changes in GAD-associated limbic encephalitis and preserved white matter integrity in VGKC-complex-associated limbic encephalitis. Furthermore, our results contribute to a better understanding of the specific pathophysiologic properties in these two subforms of limbic encephalitis by revealing that patients with GAD antibodies show widespread affections of white matter across various regions of the brain. In contrast to this, the inflammatory process seems to be more localized in VGKC-complex-associated limbic encephalitis, primarily affecting mesiotemporal gray matter.

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Prolonged febrile seizures cause reversible reductions in white matter integrity

Cited by 16 publications

References 39 publications

Long‐term white matter tract reorganization following prolonged febrile seizures

Long‐term white matter tract reorganization following prolonged febrile seizures

Long‐term behavioural outcomes after paediatric convulsive status epilepticus: a population‐based cohort study

Distinct white matter integrity in glutamic acid decarboxylase and voltage‐gated potassium channel‐complex antibody‐associated limbic encephalitis

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