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A voxel based morphometry (VBM) analysis of gray matter volume (GMV) loss in patients with refractory mesial temporal lobe epilepsy (MTLE) with and without depression
Abstracts
[P08] A voxel based morphometry (VBM) analysis of gray matter volume (GMV) loss in patients with refractory mesial temporal lobe epilepsy (MTLE) with and without depression P.C. Salgado⁎, C.L. Yasuda, F. Cendes, University of Campinas, Brazil Objective: Study GMV differences in patients with depression, and mesial temporal lobe epilepsy (MTLE) with and without depression, compared to normal controls, by applying VBM technique. Method: We included 24 adults with MTLE without depression (17 women, 38.7 mean age), 24 adults with MTLE with depression (13 women, 39.6 mean age), and 96 healthy controls (75 women, 35.1 mean age). All MTLE patients were diagnosed by clinical, eletro and image features. Depression was diagnosed by a structured clinical interview (SCID I) and its sympomatology was checked by the Beck Depression Inventory. All patients underwent highresolution MRI scan. We performed VBM analysis on SPM5 and MATLAB7, comparing groups of patients with control group. The statistical analysis for all comparisons was performed with grand mean scaling, proportional threshold masking and implicit masking. The results were corrected for multiple comparisons using a false discovery rate of 5%. We also investigated the regional correlation between GMV in MTLE with depression, checking their performance on the BDI. This form of VBM was performed on the whole brain, using the general linear model protocols built into SPM5. Results: Half of the patients with MTLE also had depression. There was no significative difference in terms of sex (p= 0.371), epilepsy onset (p= 0.495), epilepsy duration (p= 0.129) and frequency of seizures (p= 0.285) in the groups of MTLE with or without depression. We found no significant difference between groups when the group of MTLE with depression was divided in right and left MTLE with depression (p= 0.147). Besides the fact that the laterality was not a significant factor for depression in MTLE, the group of left MTLE with depression had a more severe depression than the group of right MTLE with depression (p= 0.014). There was no regional correlation between GMV in MTLE with depression and their performance on the BDI. Patients with MTLE with depression had more areas of reduced volume. Conclusions: The neuropathologic changes of MTLE seem to be magnified in the presence of a chronic untreated depression disorder. The evidence of GMV loss in patients with MTLE with depression calls our attention to the importance of timely recognition and treatment of depression in patients with MTLE and also to the bidirectional relation between the two disorders and their frequent comorbid occurrence. Keywords: Depression, Mesial temporal lobe epilepsy, Magnetic resonance imaging, Voxel based morphometry doi:10.1016/j.yebeh.2011.04.020
[P09] Role of high definition brain SPECT in the evaluation of non-convulsive epilepsy co-morbid to mental disorder S.R. Besta, D.G. Pavela,b,⁎, Y.C. Changb, aThe Neuroscience Center, United States; bUniversity of Illinois, United States The presence of emotional comorbidity including depression seems to interfere with or otherwise delay appropriate treatment in the presumptively psychiatric patient with occult variants of epilepsy. This can happen even in the presence of interictal spike discharges and / or other general nonspecific EEG findings which, in the absence of overt convulsions, seem to be underappreciated or as being of no clinical significance We have evaluated the impact of brain SPECT on patient management in such cases.
185
Method: triple head gamma camera, fan beam collimators, 99mTcHMPAO and a multifaceted display with discreet color coding. Patients 32 (age 22 – 59) with symptom duration of one to several years. None of them had previously been treated with AED-s. Among significant comorbidities, in addition to depression, were one or more of: anxiety, learning, memory, cognitive impairments, TBI or neurotoxic induced symptoms and sleep disorders. Results: On the SPECT display the presence of hyper or hypoperfusion was evaluated in the hemispheres (global or focal), as well as in several subcortical structures . There were multiple combinations of such findings but the common denominator was the presence of one or, more often, of multiple localized areas of marked and / or extreme hyperperfusion. This in turn contributed to the choice of treatment which started with or added AED-s to previous medication and, subsequently, continued with dose adjustments and additions or changes in medications and/or other techniques such as rTMS, Neurofeedback, CBT, etc. In 92% of cases the features detected on Brain SPECT provided a rationale for the clinical manifestations, contributed to the therapeutic strategy and provided an explanation for past medication failures. Conclusion: The presence and type of brain SPECT abnormalities has proven to be of clinical relevance in the evaluation and treatment of patients with occult epilepsy variants, that are comorbid to emotional or cognitive illness. Keywords: SPECT, Brain, Co-morbidity doi:10.1016/j.yebeh.2011.04.021
[P10] Emotional, behavioral and executive dysfunction is associated with a greater degree of epileptiform discharges in children with benign rolandic epilepsy (BRE) S. Lundya,b, D. Sarcoa,b, M. Gregasa,b, M. Takeokaa,b, K. Boyera,b⁎, Children's Hospital Boston, United States; bHarvard Medical School, United States a
Introduction: Increasing evidence links BRE with mild cognitive problems. Not clear is how epileptic discharges affect the severity of neuropsychological dysfunction. Frequent epileptiform discharges are thought to impair cognition. However, the relationship between spike discharges and neuropsychological function is not understood. Our exploratory investigations aimed to survey attention, executive functions as well as emotional and behavioral adjustment of children with BRE and correlate these data with spike frequency. Methods: Twenty-four children, aged 6–12 years with EEG and neurological evaluation consistent with BRE were selected from consecutive routine EEG studies over 1 years time. Parents completed the Behavior Assessment System for Children- Second Edition and the Behavior Rating Inventory of Executive Function within 6 months of clinical EEG. EEG spike indices (SI: absolute number of spike discharges divided by total minutes of recording) were measured for the awake, sleep, and total recording times of routine outpatient partially sleep-deprived EEGs. The strength of association between the SI and neuropsychological variables was measured using Pearson correlation coefficients. Results: Symptoms of depression, aggression, and conduct problems were strongly correlated with SI during awake and sleep states. Executive dysfunction was significantly correlated with SI during sleep. Greater disturbance was associated with higher SI. Symptoms of anxiety, hyperactivity and attention problems were not significantly correlated with the SI. Discussion: Our results suggest that the greater the epileptiform activity in children with BRE, the higher the likelihood of depression, psychological disturbance and executive dysfunction. More research is
[P08] A voxel based morphometry (VBM) analysis of gray matter volume (GMV) loss in patients with refractory mesial temporal lobe epilepsy (MTLE) with and without depression P.C. Salgado⁎, C.L. Yasuda, F. Cendes, University of Campinas, Brazil Objective: Study GMV differences in patients with depression, and mesial temporal lobe epilepsy (MTLE) with and without depression, compared to normal controls, by applying VBM technique. Method: We included 24 adults with MTLE without depression (17 women, 38.7 mean age), 24 adults with MTLE with depression (13 women, 39.6 mean age), and 96 healthy controls (75 women, 35.1 mean age). All MTLE patients were diagnosed by clinical, eletro and image features. Depression was diagnosed by a structured clinical interview (SCID I) and its sympomatology was checked by the Beck Depression Inventory. All patients underwent highresolution MRI scan. We performed VBM analysis on SPM5 and MATLAB7, comparing groups of patients with control group. The statistical analysis for all comparisons was performed with grand mean scaling, proportional threshold masking and implicit masking. The results were corrected for multiple comparisons using a false discovery rate of 5%. We also investigated the regional correlation between GMV in MTLE with depression, checking their performance on the BDI. This form of VBM was performed on the whole brain, using the general linear model protocols built into SPM5. Results: Half of the patients with MTLE also had depression. There was no significative difference in terms of sex (p= 0.371), epilepsy onset (p= 0.495), epilepsy duration (p= 0.129) and frequency of seizures (p= 0.285) in the groups of MTLE with or without depression. We found no significant difference between groups when the group of MTLE with depression was divided in right and left MTLE with depression (p= 0.147). Besides the fact that the laterality was not a significant factor for depression in MTLE, the group of left MTLE with depression had a more severe depression than the group of right MTLE with depression (p= 0.014). There was no regional correlation between GMV in MTLE with depression and their performance on the BDI. Patients with MTLE with depression had more areas of reduced volume. Conclusions: The neuropathologic changes of MTLE seem to be magnified in the presence of a chronic untreated depression disorder. The evidence of GMV loss in patients with MTLE with depression calls our attention to the importance of timely recognition and treatment of depression in patients with MTLE and also to the bidirectional relation between the two disorders and their frequent comorbid occurrence. Keywords: Depression, Mesial temporal lobe epilepsy, Magnetic resonance imaging, Voxel based morphometry doi:10.1016/j.yebeh.2011.04.020
[P09] Role of high definition brain SPECT in the evaluation of non-convulsive epilepsy co-morbid to mental disorder S.R. Besta, D.G. Pavela,b,⁎, Y.C. Changb, aThe Neuroscience Center, United States; bUniversity of Illinois, United States The presence of emotional comorbidity including depression seems to interfere with or otherwise delay appropriate treatment in the presumptively psychiatric patient with occult variants of epilepsy. This can happen even in the presence of interictal spike discharges and / or other general nonspecific EEG findings which, in the absence of overt convulsions, seem to be underappreciated or as being of no clinical significance We have evaluated the impact of brain SPECT on patient management in such cases.
185
Method: triple head gamma camera, fan beam collimators, 99mTcHMPAO and a multifaceted display with discreet color coding. Patients 32 (age 22 – 59) with symptom duration of one to several years. None of them had previously been treated with AED-s. Among significant comorbidities, in addition to depression, were one or more of: anxiety, learning, memory, cognitive impairments, TBI or neurotoxic induced symptoms and sleep disorders. Results: On the SPECT display the presence of hyper or hypoperfusion was evaluated in the hemispheres (global or focal), as well as in several subcortical structures . There were multiple combinations of such findings but the common denominator was the presence of one or, more often, of multiple localized areas of marked and / or extreme hyperperfusion. This in turn contributed to the choice of treatment which started with or added AED-s to previous medication and, subsequently, continued with dose adjustments and additions or changes in medications and/or other techniques such as rTMS, Neurofeedback, CBT, etc. In 92% of cases the features detected on Brain SPECT provided a rationale for the clinical manifestations, contributed to the therapeutic strategy and provided an explanation for past medication failures. Conclusion: The presence and type of brain SPECT abnormalities has proven to be of clinical relevance in the evaluation and treatment of patients with occult epilepsy variants, that are comorbid to emotional or cognitive illness. Keywords: SPECT, Brain, Co-morbidity doi:10.1016/j.yebeh.2011.04.021
[P10] Emotional, behavioral and executive dysfunction is associated with a greater degree of epileptiform discharges in children with benign rolandic epilepsy (BRE) S. Lundya,b, D. Sarcoa,b, M. Gregasa,b, M. Takeokaa,b, K. Boyera,b⁎, Children's Hospital Boston, United States; bHarvard Medical School, United States a
Introduction: Increasing evidence links BRE with mild cognitive problems. Not clear is how epileptic discharges affect the severity of neuropsychological dysfunction. Frequent epileptiform discharges are thought to impair cognition. However, the relationship between spike discharges and neuropsychological function is not understood. Our exploratory investigations aimed to survey attention, executive functions as well as emotional and behavioral adjustment of children with BRE and correlate these data with spike frequency. Methods: Twenty-four children, aged 6–12 years with EEG and neurological evaluation consistent with BRE were selected from consecutive routine EEG studies over 1 years time. Parents completed the Behavior Assessment System for Children- Second Edition and the Behavior Rating Inventory of Executive Function within 6 months of clinical EEG. EEG spike indices (SI: absolute number of spike discharges divided by total minutes of recording) were measured for the awake, sleep, and total recording times of routine outpatient partially sleep-deprived EEGs. The strength of association between the SI and neuropsychological variables was measured using Pearson correlation coefficients. Results: Symptoms of depression, aggression, and conduct problems were strongly correlated with SI during awake and sleep states. Executive dysfunction was significantly correlated with SI during sleep. Greater disturbance was associated with higher SI. Symptoms of anxiety, hyperactivity and attention problems were not significantly correlated with the SI. Discussion: Our results suggest that the greater the epileptiform activity in children with BRE, the higher the likelihood of depression, psychological disturbance and executive dysfunction. More research is