Shakeri Mahsa, Datta Alexandre N, Malfait Domitille, Oser Nadine, Létourneau-Guillon Laurent, Major Philippe, Srour Myriam, Tucholka Alan, Kadoury Samuel, Lippé Sarah
Polytechnique Montréal, Department of Computer and Software Engineering, Montreal, Quebec, Canada; CHU Sainte-Justine, Montreal, Quebec, Canada.
University of Basel Children's Hospital, Basel, Switzerland.
Epilepsy Res. 2017 Dec;138:39-45. doi: 10.1016/j.eplepsyres.2017.09.007. Epub 2017 Oct 7.
Rolandic epilepsy (RE), also called benign epilepsy with centrotemporal spikes (BECTS) is the most common childhood epilepsy syndrome. RE is associated with cognitive difficulties, which can affect children's quality of life. The underlying causes of these cognitive impairments are unclear. The objective of this prospective study is to investigate sub-cortical morphological alterations in RE children with left, right, or bilateral hemispheric focus and its association with cognition.
Participants include 41 children with rolandic epilepsy and 38 healthy controls (age 8-14 years), recruited from CHU Sainte-Justine Montreal Children Hospital (N=40) and Basel's Children Hospital (N=39). Quantitative volumetric assessment of putamen and caudate structures was performed on T1-weighted MR scans along with the morphological analysis to test for differences between patients and controls. These analyses were performed considering the side of epilepsy focus in all participants. Correlations were investigated between the sub-cortical morphometry and cognitive indices such as intelligence quotient (IQ), verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), and processing speed index (PSI).
Children with bilateral BECTS showed statistically significant volume reduction in right caudate (p<.05), while no statistically significant putamen volumetric changes were detected in BECTS participants compared to normal controls. According to a spectral-based groupwise shape analysis, regional alterations were found in both putamen and caudate structures of children with BECTS. In particular, children with left BECTS showed significant outward local deformity in left putamen and individuals with bilateral BECTS showed inward local group differences in both right putamen and right caudate. The correlation assessment showed positive association between the volume of the left caudate and cognitive indices in the group containing all BECTS participants. Negative correlation was found between putamen sub-regional shape alterations and cognition in individuals with right BECTS and in all BECTS participants. Negative associations between caudate sub-regional morphologies and cognitive indices were detected in left cohort.
We have confirmed putamen and caudate shape alterations in children with BECTS. However, our results further suggest that variations in sub-cortical shape affect cognitive functions. Importantly, we have demonstrated that shape alterations and their relation with cognition depend on the side of epilepsy focus. Our results point to different syndromic entities in the BECTS population.
罗兰多癫痫（RE），也称为伴中央颞区棘波的良性癫痫（BECTS），是最常见的儿童癫痫综合征。RE与认知困难有关，这会影响儿童的生活质量。这些认知障碍的潜在原因尚不清楚。这项前瞻性研究的目的是调查左侧、右侧或双侧半球病灶的RE儿童的皮质下形态学改变及其与认知的关系。
参与者包括41名罗兰多癫痫儿童和38名健康对照儿童（年龄8 - 14岁），从蒙特利尔圣朱斯汀儿童医院（N = 40）和巴塞尔儿童医院（N = 39）招募。在T1加权磁共振成像扫描上对壳核和尾状核结构进行定量体积评估，并进行形态学分析，以测试患者与对照之间的差异。这些分析是在考虑所有参与者癫痫病灶侧别的情况下进行的。研究了皮质下形态测量与认知指标之间的相关性，如智商（IQ）、言语理解指数（VCI）、知觉推理指数（PRI）、工作记忆指数（WMI）和处理速度指数（PSI）。
双侧BECTS儿童右侧尾状核体积有统计学意义的减小（p <.05），而与正常对照相比，BECTS参与者的壳核体积未发现有统计学意义的变化。根据基于频谱的组内形状分析，在BECTS儿童的壳核和尾状核结构中均发现了区域改变。特别是，左侧BECTS儿童左侧壳核出现明显的向外局部变形，双侧BECTS个体右侧壳核和右侧尾状核均出现向内局部组间差异。相关性评估显示，在所有BECTS参与者组成的组中，左侧尾状核体积与认知指标呈正相关。在右侧BECTS个体和所有BECTS参与者中，壳核亚区域形状改变与认知呈负相关。在左侧队列中，检测到尾状核亚区域形态与认知指标之间存在负相关。
我们已经证实了BECTS儿童的壳核和尾状核形状改变。然而，我们的结果进一步表明，皮质下形状的变化会影响认知功能。重要的是，我们已经证明形状改变及其与认知的关系取决于癫痫病灶的侧别。我们的结果指出了BECTS人群中不同的综合征实体。
