Multimethodological brain imaging studies of human epilepsy
Author: Ciumas, Carolina
Date: 2007-08-31
Location: Föreläsningssalen, MR Centrum, N8-01, Karolinska Universitetssjukhuset, Solna, Stockholm
Time: 09.00
Department: Institutionen för klinisk neurovetenskap / Department of Clinical Neuroscience
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Abstract
Although the pathophysiological mechanisms of human epilepsy are
extensively investigated, many questions remain unanswered. One is
whether idiopathic generalized epilepsies (IGE) have anatomical
substrates. Another is functional integrity of the limbic networks
outside the epileptogenic region in mesial temporal lobe epilepsy (MTLE).
The present work addresses these important issues by combining several
different magnetic resonance (MR) and positron emission tomography (PET)
methods.
According to electrophysiological experiments, IGE is associated with
abnormal thalamo-cortical volleys, suggesting that both thalamus and
cortex could be affected. In Study I MR spectroscopy (MRS) was used in
patients with two major IGE syndromes of adulthood - juvenile myoclonic
epilepsy (JME) and generalized tonic clonic seizures on isolation (GTCS)
to investigate whether the thalamic concentration of Glx (glutamine and
glutamate) is altered, and if there are any signs of neuronal damage in
this region. The concentration of Glx was significantly elevated in both
syndromes, whereas the concentration of the neuronal marker N-acetyl
aspartate (NAA) was reduced (Study I).
To exploratively investigate possible anatomical changes also elsewhere
in the brain we subsequently employed MR volumetry and voxel based
morphometry (Study II) in 19 patients with GTCS and 52 controls. Reduced
gray matter fractions were detected in patients in the frontal, parietal,
temporal cortex, the thalamus, and cerebellum, along with elevated
frontal lobe fractions of cerebrospinal fluid. Furthermore, the
structural volumes were reduced in the thalamus, cerebellum, and also the
caudate and putamen.
These findings, suggesting a particular affection of motor circuits in
human IGE were further evaluated in Study III, which strictly focused on
the dopamine (DA) system. Only patients with JME were investigated in
these first experiments because our previous studies showed that JME in
contrast to GTCS is associated with working memory problems, which like
seizures could be attributed to the DA system. Using PET and [11C] PE2I
we estimated the binding potential to the DA transporter (DAT) in the
substantia nigra/midbrain, as well as the striatum. The nigral/midbrain
DAT binding was significantly reduced in relation to controls, whereas
the striatal values were normal. Patients also showed impairments in
executive and motor functions, with results directly related to the
midbrain DAT, and suggesting that the DA system indeed may be involved in
the pathophysiology of JME.
Together, the findings in study I-III suggest that IGE is associated with
specific cortical and subcortical changes. Their distribution is
compatible with the semiology in the two investigated syndromes. The
results provide a further argument for a re-evaluation of the current
classification and diagnostic criteria for IGE, which currently assumes
absence of anatomical substrates.
In study IV cerebral blood flow was measured with PET during passive
perception of familiar and unfamiliar odors as a unique tool to
investigate how the extrahippocampal limbic structures respond to normal
environmental stimuli in mesial temporal lobe epilepsy (MTLE). Although
widespread interictal metabolic and receptor changes may exceed the
seizure generating area, little is known about functional integrity of
the limbic circuits in human MTLE. In controls, both odor types
bilaterally activated the amygdala, piriform, insular and cingulate
cortex. Familiar odors also activated the right parahippocampus, and the
left Brodmann area (BA) 44, 45, and 47. Patients failed to activate the
amygdala, piriform and anterior insular cortex on the epileptogenic side.
Those with left MTLE also could not activate the left BA 44, 45 and 47
with familiar odors, which they perceived as less familiar than the
controls. Analysis of functional connectivity confirmed these findings
including the functional disconnection with the language circuits in
left, but not right MTLE.
Imaging of odor perception seems to be a suitable approach to delineate
functional disintegration of the limbic networks in MTLE. It shows an
altered response in several regions, which may underlay some interictal
behavioral problems associated with this condition.
List of papers:
I. Helms G, Ciumas C, Kyaga S, Savic I (2006). "Increased thalamus levels of glutamate and glutamine (Glx) in patients with idiopathic generalised epilepsy." J Neurol Neurosurg Psychiatry 77(4): 489-94
Pubmed
II. Ciumas C, Savic I (2006). "Structural changes in patients with primary generalized tonic and clonic seizures." Neurology 67(4): 683-6
Pubmed
III. Ciumas C, Robins Walhin TB, Jucaite A, Lindstrom P, Savic I (2007). "Reduced DA transporter binding in patients with juvenile myoclonic epilepsy." Neurology (Submitted)
IV. Ciumas C, Lindstrom P, Aoun B, Savic I (2007). "Imaging of odor perception delineates functional disintegration of the limbic circuits in mesial temporal lobe epilepsy." Neuroimage (Submitted)
I. Helms G, Ciumas C, Kyaga S, Savic I (2006). "Increased thalamus levels of glutamate and glutamine (Glx) in patients with idiopathic generalised epilepsy." J Neurol Neurosurg Psychiatry 77(4): 489-94
Pubmed
II. Ciumas C, Savic I (2006). "Structural changes in patients with primary generalized tonic and clonic seizures." Neurology 67(4): 683-6
Pubmed
III. Ciumas C, Robins Walhin TB, Jucaite A, Lindstrom P, Savic I (2007). "Reduced DA transporter binding in patients with juvenile myoclonic epilepsy." Neurology (Submitted)
IV. Ciumas C, Lindstrom P, Aoun B, Savic I (2007). "Imaging of odor perception delineates functional disintegration of the limbic circuits in mesial temporal lobe epilepsy." Neuroimage (Submitted)
Issue date: 2007-08-10
Rights:
Publication year: 2007
ISBN: 978-91-7357-268-2
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