Laboratory of Neuroimaging, University of Campinas, Campinas, Brazil.
Department of Neurology, University of Campinas, Campinas, Brazil.
Epilepsia. 2019 Apr;60(4):679-688. doi: 10.1111/epi.14687. Epub 2019 Mar 10.
To analyze the lifetime trajectories in genetic generalized epilepsies (GGEs) and investigate the impact of symptoms of anxiety and depression on resting state functional connectivity (FC).
Seventy-four GGE patients were classified according to the pharmacological response as seizure-free (12 patients), pharmacoresistant (PhR; 14 patients), and fluctuating (FL; 48 patients). Fifty-four subjects completed both the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and 38 also underwent 3-T resting state functional magnetic resonance imaging. These 38 patients were subdivided into a positive group (13 patients with concurrent symptoms of depression and anxiety) and a negative group (21 asymptomatic patients and four with mild anxiety or depression symptoms). For FC analysis of resting state networks, we matched 38 healthy asymptomatic volunteers and used the UF2C toolbox running on MATLAB2017/SPM12.
The PhR group presented shorter duration of epilepsy (P = 0.016) and follow-up (P < 0.001) compared to the FL group. The PhR group showed higher levels (median = 20) on the BAI and BDI. Myoclonic seizures were the most difficult to control, as 50% of subjects persisted with them at last appointment, compared to generalized tonic-clonic seizures and absence seizures (<40%). Patients with concurrent anxiety and depression symptoms were 7.7 times more likely to exhibit pharmacoresistant seizures, although an increase of 1 year of epilepsy duration was associated with a decrease in the odds of presenting pharmacoresistance by a factor of 0.9. Overall, FC was altered between default mode network (DMN) and visuospatial/dorsal attention. However, only the positive group displayed abnormal FC between DMN and left executive control network, and between salience and visuospatial/dorsal attention.
Our findings may help clinicians to have a better understanding of GGE clinical course and increase attention to the potential relationship of psychopathologies and brain connectivity.
分析遗传全面性癫痫（GGE）的终身轨迹，并探讨焦虑和抑郁症状对静息态功能连接（FC）的影响。
根据药物反应，将 74 名 GGE 患者分为无发作（12 例）、药物抵抗（PhR；14 例）和波动（FL；48 例）。54 名患者完成了贝克抑郁量表（BDI）和贝克焦虑量表（BAI）的评估，38 名患者还进行了 3T 静息态功能磁共振成像。这 38 名患者进一步分为阳性组（13 例同时存在抑郁和焦虑症状）和阴性组（21 例无症状患者和 4 例仅有轻度焦虑或抑郁症状）。为了分析静息态网络的 FC，我们匹配了 38 名健康无症状志愿者，并使用运行在 MATLAB2017/SPM12 上的 UF2C 工具包。
PhR 组癫痫发作持续时间（P=0.016）和随访时间（P<0.001）均短于 FL 组。PhR 组 BAI 和 BDI 的评分更高（中位数=20）。肌阵挛性发作最难控制，50%的患者在最后一次就诊时仍有发作，而全面强直阵挛发作和失神发作则不到 40%（P<0.001）。同时存在焦虑和抑郁症状的患者出现药物抵抗性发作的可能性是无此症状患者的 7.7 倍，而癫痫发作持续时间增加 1 年，出现药物抵抗的几率则降低 0.9 倍。总体而言，默认模式网络（DMN）和视空间/背侧注意网络之间的 FC 发生了改变。然而，只有阳性组显示 DMN 与左侧执行控制网络之间以及突显网络与视空间/背侧注意网络之间的 FC 异常。
我们的发现可能有助于临床医生更好地了解 GGE 的临床病程，并提高对精神病理学和大脑连接之间潜在关系的关注。
