Thalamus and focal to bilateral seizures: A multiscale cognitive imaging study.
Publication/Presentation Date
10-27-2020
Abstract
OBJECTIVE: To investigate the functional correlates of recurrent secondarily generalized seizures in temporal lobe epilepsy (TLE) using task-based fMRI as a framework to test for epilepsy-specific network rearrangements. Because the thalamus modulates propagation of temporal lobe onset seizures and promotes cortical synchronization during cognition, we hypothesized that occurrence of secondarily generalized seizures, i.e., focal to bilateral tonic-clonic seizures (FBTCS), would relate to thalamic dysfunction, altered connectivity, and whole-brain network centrality.
METHODS: FBTCS occur in a third of patients with TLE and are a major determinant of disease severity. In this cross-sectional study, we analyzed 113 patients with drug-resistant TLE (55 left/58 right), who performed a verbal fluency fMRI task that elicited robust thalamic activation. Thirty-three patients (29%) had experienced at least one FBTCS in the year preceding the investigation. We compared patients with TLE-FBTCS to those without FBTCS via a multiscale approach, entailing analysis of statistical parametric mapping (SPM) 12-derived measures of activation, task-modulated thalamic functional connectivity (psychophysiologic interaction), and graph-theoretical metrics of centrality.
RESULTS: Individuals with TLE-FBTCS had less task-related activation of bilateral thalamus, with left-sided emphasis, and left hippocampus than those without FBTCS. In TLE-FBTCS, we also found greater task-related thalamotemporal and thalamomotor connectivity, and higher thalamic degree and betweenness centrality. Receiver operating characteristic curves, based on a combined thalamic functional marker, accurately discriminated individuals with and without FBTCS.
CONCLUSIONS: In TLE-FBTCS, impaired task-related thalamic recruitment coexists with enhanced thalamotemporal connectivity and whole-brain thalamic network embedding. Altered thalamic functional profiles are proposed as imaging biomarkers of active secondary generalization.
Volume
95
Issue
17
First Page
2427
Last Page
2427
ISSN
1526-632X
Published In/Presented At
Caciagli, L., Allen, L. A., He, X., Trimmel, K., Vos, S. B., Centeno, M., Galovic, M., Sidhu, M. K., Thompson, P. J., Bassett, D. S., Winston, G. P., Duncan, J. S., Koepp, M. J., & Sperling, M. R. (2020). Thalamus and focal to bilateral seizures: A multiscale cognitive imaging study. Neurology, 95(17), e2427–e2441. https://doi.org/10.1212/WNL.0000000000010645
Disciplines
Medicine and Health Sciences
PubMedID
32847951
Department(s)
Department of Medicine
Document Type
Article