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December 27, 2010

Focal structural changes and cognitive dysfunction in juvenile myoclonic epilepsy

J. O'Muircheartaigh, MSc, C. Vollmar, MD, G.J. Barker, PhD, V. Kumari, PhD, M.R. Symms, PhD, P. Thompson, PhD, J.S. Duncan, FRCP, FMedSci, M.J. Koepp, MD, PhD, and M.P. Richardson, PhD, FRCPAuthors Info & Affiliations
January 4, 2011 issue
76 (1) 34-40
https://doi.org/10.1212/WNL.0b013e318203e93d
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Abstract

Objective:

The aim of this study was to determine if there were focal cortical abnormalities in juvenile myoclonic epilepsy (JME) using neuropsychological investigations and MRI.

Methods:

Twenty-eight patients with JME and a large sample of healthy controls were assessed using a series of neuropsychological tests as well as structural and diffusion tensor MRI (DTI). DTI measures assessed fractional anisotropy (FA) within a white matter skeleton.

Results:

Neuropsychological testing indicated subtle dysfunctions in verbal fluency, comprehension, and expression, as well as nonverbal memory and mental flexibility. Utilizing whole-brain voxel-based morphometry for gray matter MRI data and tract-based spatial statistics for white matter diffusion MRI data, we found reductions in gray matter volume (GMV) in the supplementary motor area and posterior cingulate cortex and reductions in FA in underlying white matter of the corpus callosum. Supplementary motor area FA predicted scores in word naming tasks and expression scores. Posterior cingulate cortex GMV and FA predicted cognitive inhibition scores on the mental flexibility task.

Conclusions:

The neuropsychological, structural, and tractography results implicate mesial frontal cortex, especially the supplementary motor area, and posterior cingulate cortex in JME.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 76 • Number 1 • January 4, 2011
Pages: 34-40
PubMed: 21205693

Copyright

Copyright © 2010 by AAN Enterprises, Inc.

Publication History

Received: March 29, 2010
Accepted: September 30, 2010
Published online: December 27, 2010
Published in issue: January 4, 2011

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Disclosure

J. O'Muircheartaigh and Dr. Vollmar report no disclosures. Prof. Barker serves on a scientific advisory board for and has received funding for travel and speaker honoraria from GE Healthcare and receives research support from the Medical Research Council UK, the Wellcome Trust, Guy's and St Thomas, Epilepsy Research UK, and the Baily Thomas Charitable Fund. Prof. Kumari and Dr. Symms report no disclosures. Dr. Thompson serves on the editorial board of Seizure and receives research support from the Wellcome Trust. Prof. Duncan has served on scientific advisory boards for GE Healthcare, Eisai Inc., and Sanofi-Aventis; has received funding for travel from Janssen-Cilag; serves on the editorial boards of Seizure, Epilepsy Research, and Epilepsia; may accrue revenue on a patent re: A miniaturized wearable apnoea detector ; receives royalties from the publication of Eyelid Myoclonia and Typical Absences (Libbey, 1995); has received speaker honoraria from UCB and Eisai Inc.; has an active practice in epilepsy surgery; and receives research support from the Medical Research Council UK and the Wellcome Trust. Prof. Koepp has served on scientific advisory boards for GE Healthcare; has received funding for travel from Desitin Pharmaceuticals, GmbH, UCB, and Pfizer Inc.; serves on the editorial boards of Epilepsy Research and Epileptic Disorders; receives research support from MRC, Wellcome Trust, and EU-Framework 7 programme; and he and his spouse own stock in GlaxoSmithKline. Prof. Richardson has served on scientific advisory boards for Schwarz Pharma and UCB; has received funding for travel from Funding Janssen Cilag, UCB, and Eisai Inc.; serves on the editorial board of the Journal of Neurology, Neurosurgery and Psychiatry; and receives research support from the Medical Research Council UK, the Wellcome Trust, Epilepsy Research UK, the Charles Sykes Memorial Fund, King's Medical Research Trust, and the Getty Family Foundation.

Authors

Affiliations & Disclosures

J. O'Muircheartaigh, MSc
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
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C. Vollmar, MD
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author
G.J. Barker, PhD
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author
V. Kumari, PhD
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author
M.R. Symms, PhD
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author
P. Thompson, PhD
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author
J.S. Duncan, FRCP, FMedSci
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author
M.J. Koepp, MD, PhD
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author
M.P. Richardson, PhD, FRCP
From the Departments of Clinical Neuroscience (J.O., M.P.R.), Neuroimaging (G.J.B.), and Psychology (V.K.), Institute of Psychiatry, King's College London, London; and National Society for Epilepsy MRI Unit (C.V., M.R.S., P.T., J.S.D., M.J.K.), Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK.
View all articles by this author

Notes

Study funding: Supported by the Wellcome Trust (project grant no. 079474) and the Big Lottery Fund, Wolfson Trust, and the National Society for Epilepsy (NSE) for supporting the NSE MRI scanner. Infrastructure support was provided by the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King's College London. Part of this work was undertaken at University College London Hospitals, who received a proportion of funding from the National Institute for Health Research, Biomedical Research Centres funding scheme.
Address correspondence and reprint requests to Dr. Mark P. Richardson, Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK [email protected]

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