Changes in Gray Matter Morphology and White Matter Microstructure Across the Adult Lifespan in People With Temporal Lobe Epilepsy.

Background And Objectives: Temporal lobe epilepsy (TLE) is commonly associated with mesiotemporal pathology and widespread alterations of gray and white matter structures. Evidence supports a progressive condition, although the temporal evolution of TLE is poorly defined. In this ENIGMA-Epilepsy study, we aim to investigate structural alterations in gray and white matter across the adult lifespan in patients with TLE by charting both gray and white matter changes and explore the covariance of age-related alterations in both compartments.

Impact of Epilepsy on Productivity and Quality of Life: The Australian Epilepsy Project.

Background And Objectives: Epilepsy occurs in 4% of Australians over their lifetime. European studies show that over 75% of epilepsy-related health care costs are indirect, with 80% due to absenteeism. In Australia, studies capturing absenteeism in epilepsy are limited and presenteeism data are unavailable.

Task demands shape network interactions during reading and visual form processing.

Current theories of reading, based largely on lesion studies, propose that left fusiform gyrus (FusG) is a crucial hub linking visual inputs into the perisylvian language system. However, FusG is also involved in visual form processing more generally, raising the question of whether its engagement with language cortex and other relevant brain regions changes according to task demands, and whether this flexibility is linked to reading proficiency. To answer these questions, we exploit a large, pre-existing, reading-based language fMRI dataset, in which pseudoword rhyming and visuospatial form processing are contrasted.

Robust-tedana: An automated denoising pipeline for multi-echo fMRI data.

Multi-echo functional Magnetic Resonance Imaging (fMRI) data are acquired by recording image volumes at multiple echo times and can be used to improve the separation of neural activity from noise. TE-Dependent ANAlysis (tedana) is an open-source software tailored to denoising of multi-echo fMRI data. The efficacy of denoising can however be inconsistent, often necessitating manual inspection that precludes its application in large-scale studies where processing is ideally fully automated.

Twins with temporal lobe epilepsy: genetic contributions to hippocampal sclerosis and other subtypes.

Temporal lobe epilepsy is the most common focal epilepsy in adults. While temporal lobe epilepsy was historically perceived to have a largely acquired aetiology, growing evidence points to important genetic contributions. There are several temporal lobe epilepsy subtypes, including mesial temporal lobe epilepsy with or without hippocampal sclerosis, but the relative genetic contributions to each of these subtypes have not been directly studied.

Toward responsible artificial intelligence in medicine: Reflections from the Australian epilepsy project.

Artificial intelligence (AI) is a multidisciplinary scientific field that uses machines to solve real-world problems and predict outcomes. Despite the current enthusiasm about AI's potential as a clinical support tool, there is also a growing awareness and concern about the potentially harmful effects of AI. Because AI will likely impact expert-based decision-making in medicine, it is critical to consider the issues that AI raises in medical research.

Progressive Myoclonus Epilepsy: Distinctive MRI Changes in Cerebellar and Motor Networks.

Objective: Progressive myoclonus epilepsy (PME) is a rare generalized epilepsy syndrome with a well-characterized genetic basis. The brain networks that are affected to give rise to the distinctive symptoms of PME are less well understood.

Methods: Eleven individuals with PME with a confirmed genetic diagnosis and 22 controls were studied.

Reflex "toothbrushing" epilepsy: Seizure freedom after focal ablation assisted by ictal fMRI.

A 22-year-old female presented with drug-resistant focal motor seizures with onset at age 14. This manifested as daily episodes of right facial dystonia triggered by toothbrushing, but also by eating, talking, and strenuous exercise. On ictal scalp EEG, there was low-voltage fast activity over the left pericentral area.

Towards precision MRI biomarkers in epilepsy with normative modelling.

Epilepsy is recognized as one of the leading targets for precision medicine, following on from the successes in cancer therapy, due to its substantial clinical heterogeneity and divergent therapeutic options. To bring personalized care to the epilepsies, there is a need for appropriate precision biomarkers that can identify disease processes or predict treatment outcomes at the individual patient level. Neuroimaging techniques, including MRI, have been transformative for clinical practice, particularly in medically refractory focal epilepsies.

Verbal paired associates learning lateralizes left hippocampal sclerosis in temporal lobe epilepsy.

Objective: Left hippocampal sclerosis (HS) is associated with verbal-specific memory impairment. This association is well established for word list learning tasks, and there is some evidence that this may also be relevant to verbal paired associates learning (PAL), though the evidence is limited. We aimed to evaluate the utility of verbal PAL as a marker for left HS, compare this with word list learning, and derive cutoff scores to facilitate clinical application.

Memory compromise at extended delays in people with new-onset epilepsy.

Objective: Memory is one of the most sensitive markers of cognitive compromise in people with new-onset epilepsy. Nonetheless, around half of these cases score within the normal range on standard memory testing. Here we explore whether memory retention at a 1-week delay reveals otherwise undetected memory compromise in such individuals, and how it relates to subjective memory complaints and mood.

Applications of teleneuropsychology to the screening and monitoring of epilepsy.

Epilepsy is an inherently dynamic disease and neuropsychology plays a key role in the formulation, monitoring and management of the condition. Teleneuropsychology provides an opportunity for neuropsychology to increase its accessibility, reach and efficiency, using focussed assessments to target epilepsy relevant domains at critical timepoints in the disease trajectory. Neuropsychologists working with epilepsy have, however, been comparatively slow to adopt telehealth methods.

Perisylvian and Hippocampal Anomalies in Individuals With Pathogenic Variants.

Background And Objectives: Pathogenic variants in are associated with a spectrum of epilepsy-aphasia syndromes (EASs). Seizures as well as speech and language disorders occur frequently but vary widely in severity, both between individuals and across the life span. The link between this phenotypic spectrum and brain characteristics is unknown.

A WORLDWIDE ENIGMA STUDY ON EPILEPSY-RELATED GRAY AND WHITE MATTER COMPROMISE ACROSS THE ADULT LIFESPAN.

Objectives: Temporal lobe epilepsy (TLE) is commonly associated with mesiotemporal pathology and widespread alterations of grey and white matter structures. Evidence supports a progressive condition although the temporal evolution of TLE is poorly defined. This ENIGMA-Epilepsy study utilized multimodal magnetic resonance imaging (MRI) data to investigate structural alterations in TLE patients across the adult lifespan.

Work productivity, quality of life, and care needs: An unfolding epilepsy burden revealed in the Australian Epilepsy Project pilot study.

Objective: Epilepsy is a common and serious neurological disorder. This cross-sectional analysis addresses the burden of epilepsy at different stages of the disease.

Methods: This pilot study is embedded within the Australian Epilepsy Project (AEP), aiming to provide epilepsy support through a national network of dedicated sites.

Cognitive and psychological dysfunction is present after a first seizure, prior to epilepsy diagnosis and treatment at a First Seizure Clinic.

Objective: Neuropsychological comorbidities found in chronic epilepsy have also been reported earlier in the disease course. However, recurrent seizures, antiseizure medication (ASM), and adjustment to a chronic diagnosis remain potential confounds of this literature. It thus remains unclear whether these comorbidities are primary or secondary attributes of epilepsy.

Exploring individual fixel-based white matter abnormalities in epilepsy.

Diffusion MRI has provided insight into the widespread structural connectivity changes that characterize epilepsies. Although syndrome-specific white matter abnormalities have been demonstrated, studies to date have predominantly relied on statistical comparisons between patient and control groups. For diffusion MRI techniques to be of clinical value, they should be able to detect white matter microstructural changes in individual patients.

Impact of epilepsy surgery on quality of life: Systematic review and meta-analysis.

Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug-resistant epilepsy (DRE) who undergo epilepsy surgery, and to explore clinicodemographic factors associated with these changes. We conducted a systematic review and meta-analysis using Medline, Embase, and Cochrane Central Register of Controlled Trials.

Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults.

Background And Objectives: Surgical and neurostimulator treatments are effective for reducing seizure burden in selected individuals living with drug-resistant epilepsy (DRE). We aimed to determine the presence and key model determinants for cost-effectiveness of these interventions, compared with medical management alone, to assist with decisions about resource allocation.

Methods: A systematic literature search was conducted on June 1, 2022, using MEDLINE, EMBASE, the NHS Economic Evaluation Database, and the Cost-Effectiveness Analysis database.

White matter abnormalities characterize the acute stage of sports-related mild traumatic brain injury.

Sports-related concussion, a form of mild traumatic brain injury, is characterized by transient disturbances of brain function. There is increasing evidence that functional brain changes may be driven by subtle abnormalities in white matter microstructure, and diffusion MRI has been instrumental in demonstrating these white matter abnormalities . However, the reported location and direction of the observed white matter changes in mild traumatic brain injury are variable, likely attributable to the inherent limitations of the white matter models used.

Structural network alterations in focal and generalized epilepsy assessed in a worldwide ENIGMA study follow axes of epilepsy risk gene expression.

Epilepsy is associated with genetic risk factors and cortico-subcortical network alterations, but associations between neurobiological mechanisms and macroscale connectomics remain unclear. This multisite ENIGMA-Epilepsy study examined whole-brain structural covariance networks in patients with epilepsy and related findings to postmortem epilepsy risk gene expression patterns. Brain network analysis included 578 adults with temporal lobe epilepsy (TLE), 288 adults with idiopathic generalized epilepsy (IGE), and 1328 healthy controls from 18 centres worldwide.