Crespo Pimentel Bernardo, Kuchukhidze Giorgi, Xiao Fenglai, Caciagli Lorenzo, Höfler Julia, Rainer Lucas, Kronbichler Martin, Vollmar Christian, Duncan John S, Trinka Eugen, Koepp Matthias, Wandschneider Britta
Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Salzburg, Austria
Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
J Neurol Neurosurg Psychiatry. 2024 Dec 16;96(1):11-14. doi: 10.1136/jnnp-2024-333703.
Juvenile myoclonic epilepsy (JME) is associated with cortical thinning of the motor areas. The relative contribution of antiseizure medication to cortical thickness is unknown. We aimed to investigate how valproate influences the cortical morphology of JME.
In this cross-sectional study, individuals with JME with and without valproate, with temporal lobe epilepsy (TLE) with valproate and controls were selected through propensity score matching. Participants underwent T1-weighted brain imaging and vertex-wise calculation of cortical thickness.
We matched 36 individuals with JME on valproate with 36 individuals with JME without valproate, 36 controls and 19 individuals with TLE on valproate. JME on valproate showed thinning of the precentral gyri (left and right, p<0.001) compared with controls and thinning of the left precentral gyrus when compared with JME not on valproate (p<0.01) or to TLE on valproate (p<0.001). Valproate dose correlated negatively with the thickness of the precentral gyri, postcentral gyri and superior frontal gyrus in JME (left and right p<0.0001), but not in TLE.
Valproate was associated with JME-specific and dose-dependent thinning of the cortical motor regions. This suggests that valproate is a key modulator of cortical morphology in JME, an effect that may underlie its high efficacy in this syndrome.
青少年肌阵挛性癫痫（JME）与运动区皮质变薄有关。抗癫痫药物对皮质厚度的相对影响尚不清楚。我们旨在研究丙戊酸盐如何影响JME的皮质形态。
在这项横断面研究中，通过倾向得分匹配选择了服用丙戊酸盐和未服用丙戊酸盐的JME患者、服用丙戊酸盐的颞叶癫痫（TLE）患者和对照组。参与者接受了T1加权脑成像和皮质厚度的顶点计算。
我们将36例服用丙戊酸盐的JME患者与36例未服用丙戊酸盐的JME患者、36例对照组和19例服用丙戊酸盐的TLE患者进行了匹配。与对照组相比，服用丙戊酸盐的JME患者中央前回变薄（左右，p<0.001），与未服用丙戊酸盐的JME患者相比，左侧中央前回变薄（p<0.01），与服用丙戊酸盐的TLE患者相比也变薄（p<0.001）。丙戊酸盐剂量与JME患者中央前回、中央后回和额上回厚度呈负相关（左右p<0.0001），但与TLE患者无关。
丙戊酸盐与JME特异性和剂量依赖性的皮质运动区变薄有关。这表明丙戊酸盐是JME皮质形态的关键调节因子，这种作用可能是其在该综合征中高效的基础。
