TY - JOUR
T1 - Later onset focal epilepsy with roots in childhood
T2 - Evidence from early learning difficulty and brain volumes in the Human Epilepsy Project
AU - Pellinen, Jacob
AU - Pardoe, Heath
AU - Sillau, Stefan
AU - Barnard, Sarah
AU - French, Jacqueline
AU - Knowlton, Robert
AU - Lowenstein, Daniel
AU - Cascino, Gregory D.
AU - Glynn, Simon
AU - Jackson, Graeme
AU - Szaflarski, Jerzy
AU - Morrison, Chris
AU - Meador, Kimford J.
AU - Kuzniecky, Ruben
N1 - Publisher Copyright:
© 2023 International League Against Epilepsy.
PY - 2023/10
Y1 - 2023/10
N2 - Objective: Visual assessment of magnetic resonance imaging (MRI) from the Human Epilepsy Project 1 (HEP1) found 18% of participants had atrophic brain changes relative to age without known etiology. Here, we identify the underlying factors related to brain volume differences in people with focal epilepsy enrolled in HEP1. Methods: Enrollment data for participants with complete records and brain MRIs were analyzed, including 391 participants aged 12–60 years. HEP1 excluded developmental or cognitive delay with intelligence quotient <70, and participants reported any formal learning disability diagnoses, repeated grades, and remediation. Prediagnostic seizures were quantified by semiology, frequency, and duration. T1-weighted brain MRIs were analyzed using Sequence Adaptive Multimodal Segmentation (FreeSurfer v7.2), from which a brain tissue volume to intracranial volume ratio was derived and compared to clinically relevant participant characteristics. Results: Brain tissue volume changes observable on visual analyses were quantified, and a brain tissue volume to intracranial volume ratio was derived to compare with clinically relevant variables. Learning difficulties were associated with decreased brain tissue volume to intracranial volume, with a ratio reduction of.005 for each learning difficulty reported (95% confidence interval [CI] = −.007 to −.002, p =.0003). Each 10-year increase in age at MRI was associated with a ratio reduction of.006 (95% CI = −.007 to −.005, p <.0001). For male participants, the ratio was.011 less than for female participants (95% CI = −.014 to −.007, p <.0001). There were no effects from seizures, employment, education, seizure semiology, or temporal lobe electroencephalographic abnormalities. Significance: This study shows lower brain tissue volume to intracranial volume in people with newly treated focal epilepsy and learning difficulties, suggesting developmental factors are an important marker of brain pathology related to neuroanatomical changes in focal epilepsy. Like the general population, there were also independent associations between brain volume, age, and sex in the study population.
AB - Objective: Visual assessment of magnetic resonance imaging (MRI) from the Human Epilepsy Project 1 (HEP1) found 18% of participants had atrophic brain changes relative to age without known etiology. Here, we identify the underlying factors related to brain volume differences in people with focal epilepsy enrolled in HEP1. Methods: Enrollment data for participants with complete records and brain MRIs were analyzed, including 391 participants aged 12–60 years. HEP1 excluded developmental or cognitive delay with intelligence quotient <70, and participants reported any formal learning disability diagnoses, repeated grades, and remediation. Prediagnostic seizures were quantified by semiology, frequency, and duration. T1-weighted brain MRIs were analyzed using Sequence Adaptive Multimodal Segmentation (FreeSurfer v7.2), from which a brain tissue volume to intracranial volume ratio was derived and compared to clinically relevant participant characteristics. Results: Brain tissue volume changes observable on visual analyses were quantified, and a brain tissue volume to intracranial volume ratio was derived to compare with clinically relevant variables. Learning difficulties were associated with decreased brain tissue volume to intracranial volume, with a ratio reduction of.005 for each learning difficulty reported (95% confidence interval [CI] = −.007 to −.002, p =.0003). Each 10-year increase in age at MRI was associated with a ratio reduction of.006 (95% CI = −.007 to −.005, p <.0001). For male participants, the ratio was.011 less than for female participants (95% CI = −.014 to −.007, p <.0001). There were no effects from seizures, employment, education, seizure semiology, or temporal lobe electroencephalographic abnormalities. Significance: This study shows lower brain tissue volume to intracranial volume in people with newly treated focal epilepsy and learning difficulties, suggesting developmental factors are an important marker of brain pathology related to neuroanatomical changes in focal epilepsy. Like the general population, there were also independent associations between brain volume, age, and sex in the study population.
KW - clinical neurology
KW - cognition
KW - development
KW - magnetic resonance imaging
KW - seizures
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U2 - 10.1111/epi.17727
DO - 10.1111/epi.17727
M3 - Article
C2 - 37517050
AN - SCOPUS:85167334707
SN - 0013-9580
VL - 64
SP - 2761
EP - 2770
JO - Epilepsia
JF - Epilepsia
IS - 10
ER -