Identification of different MRI atrophy progression trajectories in epilepsy by subtype and stage inference.

Artificial intelligence (AI)-based tools are widely employed, but their use for diagnosis and prognosis of neurological disorders is still evolving. Here we analyse a cross-sectional multicentre structural MRI dataset of 696 people with epilepsy and 118 control subjects. We use an innovative machine-learning algorithm, Subtype and Stage Inference, to develop a novel data-driven disease taxonomy, whereby epilepsy subtypes correspond to distinct patterns of spatiotemporal progression of brain atrophy.In a discovery cohort of 814 individuals, we identify two subtypes common to focal and idiopathic generalized epilepsies, characterized by progression of grey matter atrophy driven by the cortex or the basal ganglia. A third subtype, only detected in focal epilepsies, was characterized by hippocampal atrophy. We corroborate external validity via an independent cohort of 254 people and confirm that the basal ganglia subtype is associated with the most severe epilepsy.Our findings suggest fundamental processes underlying the progression of epilepsy-related brain atrophy. We deliver a novel MRI- and AI-guided epilepsy taxonomy, which could be used for individualized prognostics and targeted therapeutics.

Aberrant functional connectivity associated with drug response in patients with newly diagnosed epilepsy.

OBJECTIVE: To analyze the local functional activity and connectivity features of the brain associated with drug response inpatients newly diagnosed with epilepsy (NDE) who are naïve to anti-seizure medication (ASM). METHODS: Recruited patients, underwent functional magnetic resonance imaging at baseline, and were assigned to the well-controlled (WC, n = 28) or uncontrolled (UC, n = 11) groups based on their response to ASM. Healthy participants were included in the control group (HC, n = 29). The amplitudes of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) were used to measure local functional activity, and voxel-wise degree centrality (DC) and seed-based functional connectivity (FC) were used to evaluate the connecting intensity of the brain areas. RESULTS: Compared to the HC and WC groups, the UC group had higher ALFF values in the left posterior central gyrus (PoCG.L) and left inferior temporal gyrus (ITG.L) and higher DC in the bilateral PoCG (Gaussian random field correction, voxel-level P < 0.001, and cluster-level P < 0.05). Both PoCG and ITG.L in the UC group showed stronger FC with multiple brain regions, mainly located in the occipital and temporal lobes, compared to the HC or WC group, while the WC group showed decreased or similar FC compared to the HC group. INTERPRETATION: Excessive enhancement of brain functional activity or connecting intensity in ASM-naïve patients with NDE may be associated with a higher risk of poor drug response.

In vivo characterization of magnetic resonance imaging-based T1w/T2w ratios reveals myelin-related changes in temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) is the most common type of intractable epilepsy in adults. Although brain myelination alterations have been observed in TLE, it remains unclear how the myelination network changes in TLE. This study developed a novel method in characterization of myelination structural covariance network (mSCN) by T1-weighted and T2-weighted magnetic resonance imaging (MRI). The mSCNs were estimated in 42 left TLE (LTLE), 42 right TLE (RTLE) patients, and 41 healthy controls (HCs). The topology of mSCN was analyzed by graph theory. Voxel-wise comparisons of myelination laterality were also examined among the three groups. Compared to HC, both patient groups showed decreased myelination in frontotemporal regions, amygdala, and thalamus; however, the LTLE showed lower myelination in left medial temporal regions than RTLE. Moreover, the LTLE exhibited decreased global efficiency compared with HC and more increased connections than RTLE. The laterality in putamen was differently altered between the two patient groups: higher laterality at posterior putamen in LTLE and higher laterality at anterior putamen in RTLE. The putamen may play a transfer station role in damage spreading induced by epileptic seizures from the hippocampus. This study provided a novel workflow by combination of T1-weighted and T2-weighted MRI to investigate in vivo the myelin-related microstructural feature in epileptic patients first time. Disconnections of mSCN implicate that TLE is a system disorder with widespread disruptions at regional and network levels.

Postoperative seizure and memory outcome of temporal lobe epilepsy with hippocampal sclerosis: A systematic review.

We conducted a systematic review and meta-analysis to evaluate postoperative seizure and memory outcomes of temporal lobe epilepsy with different hippocampal sclerosis (HS) subtypes classified by International League Against Epilepsy (ILAE) Consensus Guidelines in 2013. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Library from January 1, 2013 to August 6, 2023. Observational studies reporting seizure and memory outcomes among different HS subtypes were included. We used the Newcastle-Ottawa scale to assess the risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to grade the quality of evidence. Seizure freedom and improved outcome (Engel 1 or ILAE class 1-2) ≥1 year after surgery were defined as the primary and secondary seizure outcome. A random-effects meta-analysis by DerSimonian and Laird method was performed to obtain pooled risk ratio (RRs) with 95% confidence interval (CIs). The memory impairment was narratively reviewed because of various evaluation tools. Fifteen cohort studies with 2485 patients were eligible for the meta-analysis of seizure outcome. Six cohorts with detailed information on postoperative memory outcome were included. The pooled RRs of seizure freedom, with moderate to substantial heterogeneity, were .98 (95% CI = .84-1.15) between HS type 2 and type 1, 1.11 (95% CI = .82-1.52) between type 3 and type 1, and .80 (95% CI = .62-1.03) between the no-HS and HS groups. No significant difference of improved outcome was found between different subtypes (p > .05). The quality of evidence was deemed to be low to very low according to GRADE. The long-term seizure outcome (≥5 years after surgery) and memory impairment remained controversial.

Cortical remodeling before and after successful temporal lobe epilepsy surgery.

OBJECTIVES: To explore dynamic alterations of cortical thickness before and after successful anterior temporal lobectomy (ATL) in patients with unilateral mesial temporal lobe epilepsy (mTLE). MATERIALS AND METHODS: High-resolution T1-weighted MRI was obtained in 28 mTLE patients who achieved seizure freedom for at least 24 months after ATL and 29 healthy controls. Patients were scanned at five timepoints, including before surgery, 3, 6, 12 and 24 months after surgery. Preoperative cortical thickness of mTLE patients were compared with healthy controls. Dynamic alterations of cortical thickness before and after surgery were compared among five scans using linear mixed models. RESULTS: Patients with mTLE showed cortical thinning pre-surgically in ipsilateral entorhinal cortex, parahippocampal gyrus, inferior parietal cortex, lateral occipital cortex; contralateral pericalcarine cortex (PCC); and bilateral caudal middle frontal gyrus (cMFG), paracentral lobule, precentral gyrus (PCG), superior parietal cortex. Cortical thickening was observed in contralateral rostral anterior cingulate cortex (rACC). Patients showed postsurgical cortical thinning in ipsilateral temporal lobe, fusiform gyrus, caudal anterior cingulate cortex, lingual gyrus, and insula. Ipsilateral cMFG, PCC, and contralateral PCG showed significant cortical thickening after surgery. In addition, contralateral rACC showed cortical thickening at 3 months follow-up, however, with obvious cortical thinning at 24 months follow-up. CONCLUSIONS: Mesial temporal lobe epilepsy patients showed widespread cortical thinning before and after anterior temporal lobectomy. Progressive cortical thinning mainly existed in neighboring regions of resection. Postoperative cortical thickening may indicate cortical remodeling after successful surgery.

Altered Resting State Networks Before and After Temporal Lobe Epilepsy Surgery.

OBJECTIVES: To explore the resting state networks (RSNs) alterations in patients with unilateral mesial temporal lobe epilepsy (mTLE) before and after successful surgery. METHODS: Resting-state functional MRI and T1-weighted structural MRI were obtained in 37 mTLE patients who achieved seizure freedom after anterior temporal lobectomy. Patients were scanned before surgery and at two years after surgery. Twenty-eight age- and sex-matched healthy controls were scanned once. Functional connectivity (FC) changes within and between ten common RSNs before and after surgery, and FC changes between hippocampus and RSNs were explored. RESULTS: Before surgery, decreased FC was found within visual network and basal ganglia network, while after surgery, FC within basal ganglia network further decreased but FC within sensorimotor network and dorsal attention network increased. Before surgery, between-network FC related to basal ganglia network, visual network and dorsal attention network decreased, while between-network FC related to default mode network increased. After surgery, between-network FC related to visual network and dorsal attention network significantly increased. In addition, before surgery, ipsilateral hippocampus showed decreased FC with visual network, basal ganglia network, sensorimotor network, default mode network and frontoparietal network, while contralateral rostral hippocampus showed increased FC with salience network. After surgery, no obvious FC changes were found between contralateral hippocampus and these RSNs. CONCLUSION: MTLE patients showed significant RSNs alterations before and after surgery. Basal ganglia network showed progressive decline in functional connectivity. Successful surgery may lead to RSNs reorganization. These results provide preliminary evidence for postoperative functional remodeling at whole-brain-network level.

Gut flora and metabolism are altered in epilepsy and partially restored after ketogenic diets.

OBJECTIVE: The aim of this study was to investigate the composition of the intestinal microbiota and its association with fecal short chain fatty acids (SCFAs) in children with drug refractory epilepsy (DRE) before and after treatment with a ketogenic diet (KD). METHODS: Herein, we conducted a cross-sectional study of 12 children with DRE and 12 matched healthy controls to compare the changes in fecal microbiomes and SCFAs. Disease cohort also underwent analysis before and after 6 months of KD treatment. RESULTS: A higher microbial alpha diversity and a significant increase in Actinobacteria at the phylum level and Enterococcus, Anaerostipes, Bifidobacterium, Bacteroides, and Blautia at the genus level were observed in the children with DRE. The abundance of the eight epileptic-associated genera was reversed after six months of KD treatment with decreases in Bifidobacterium, Akkermansia, Enterococcaceae and Actinomyces and increases in Subdoligranulum, Dialister, Alloprevotella (p < 0.05). In particular, we identified some taxa that were more prevalent in patients with an inadequate response to KD than in those with an adequate response. Further, a significant correlation was observed between the change in the microbiome genera after KD treatment. The SCFA content in the fecal after 6 months of KD treatment increased and was highly correlated with the gut bacteria. SIGNIFICANCES: Dysbiosis of the microbiome could be involved in the pathogenesis of DRE in children, which can be relieved by a KD to a large extent. Gut microbiota and microbial metabolism could contribute to the antiseizure effect of KD.

Dynamic gray matter and intrinsic activity changes after epilepsy surgery.

OBJECTIVES: To explore the dynamic changes of gray matter volume and intrinsic brain activity following anterior temporal lobectomy (ATL) in patients with unilateral mesial temporal lobe epilepsy (mTLE) who achieved seizure-free for 2 years. MATERIALS AND METHODS: High-resolution T1-weighted MRI and resting-state functional MRI data were obtained in ten mTLE patients at five serial timepoints: before surgery, 3, 6, 12, and 24 months after surgery. The gray matter volume (GMV) and amplitude of low-frequency fluctuations (ALFF) were compared among the five scans to depict the dynamic changes after ATL. RESULTS: After successful ATL, GMV decreased in several ipsilateral brain regions: ipsilateral insula, thalamus, and putamen showed gradual gray matter atrophy from 3 to 24 months, while ipsilateral superior temporal gyrus, middle temporal gyrus, inferior temporal gyrus, middle occipital gyrus, inferior occipital gyrus, caudate nucleus, lingual gyrus, and fusiform gyrus showed significant GMV decrease at 3 months follow-up, without further changes. Ipsilateral insula showed gradual ALFF decrease from 3 to 24 months after surgery. Ipsilateral superior temporal gyrus showed ALFF decrease at 3 months follow-up, without further changes. Ipsilateral thalamus and cerebellar vermis showed obvious ALFF increase after surgery. CONCLUSIONS: Surgical resection may lead to a short-term reduction of gray matter volume and intrinsic brain activity in neighboring regions, while the progressive gray matter atrophy may be due to possible intrinsic mechanism of mTLE. Dynamic ALFF changes provide evidence that disrupted focal spontaneous activities were reorganized after successful surgery.

Divergent Anatomical Correlates and Functional Network Connectivity Patterns in Temporal Lobe Epilepsy with and Without Depression.

Epilepsy and depression were proposed to facilitate each other reciprocally through common neurobiological anomalies, especially the prefrontal-limbic-subcortical abnormalities. Yet neuroimaging patterns of higher-order cognitive networks and neuroanatomical correlates were rarely compared in temporal lobe epilepsy patients with (TLE-D) and without depression (TLE-N). We collected T1-weighted structural and resting-state functional MRI data from 20 TLE-D, 31 TLE-N and 20 healthy controls (HCs) and performed analyses including hippocampal volume (HCV), cortical thickness, gray matter volume (GMV) and whole-brain functional network connectivity (FNC) across three groups. Imaging differences were related to clinical and psychological measurements. TLE-D demonstrated disrupted functional role of subcortical (SUB) and higher-order cognitive networks compared to TLE-N and HCs. In TLE-D, GMV in the right supplementary motor area (SMA) and FNC between the dorsal attention (DAN) and SUB were attenuated compared to TLE-N and HCs, FNC between SUB and the visual network (VIS) decreased compared to HCs. GMV in the right SMA was negatively correlated with depression severity and some symptoms. Combined, explicit emotion regulation may be impaired in TLE-D. Meanwhile, compared to HCs, TLE-N showed smaller HCVs, TLE-D and TLE-N showed smaller GMV in the medial orbital frontal gyrus and right hippocampus and hippocampal gyrus, possibly implying predisposition of epileptic activities to co-morbid depression. Our findings suggest distinct anatomical and FNC patterns in TLE-D and TLE-N. More than prefrontal-limbic-subcortical anomalies, disrupted higher-order cognitive network may contribute to depression in TLE, providing new potential treatment targets for depression and calling attention to relation between cognitive dysfunction and co-morbid depression.

Real-time effects of interictal spikes on hippocampus and amygdala functional connectivity in unilateral temporal lobe epilepsy: An EEG-fMRI study.

OBJECTIVE: To explore the real-time effects of interictal epileptiform discharges (IEDs) on hippocampus and amygdala functional connectivity (FC) in unilateral temporal lobe epilepsy (TLE). METHODS: Patients with unilateral TLE were recruited and underwent simultaneous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) scanning. Simultaneous EEG was used to define the prespike (10 s before spike) and postspike (10 s after spike) periods. Dynamic FC analysis was applied using the left/right hippocampus and amygdala separately as a seed region to map the network alterations after IED occurrence. RESULTS: A total of 261 IED events (133 left, 128 right) from 21 patients with unilateral TLE (10 left, 11 right) were analyzed. Left IEDs had a greater influence on the hippocampus-seeded networks, whereas right IEDs affected the amygdala-seeded networks more. Left IEDs disconnected the ipsilateral hippocampus and the default mode network, which might be related to cognitive impairment in TLE. The reward-emotion network (more of the prefrontal-limbic system) and visual network also showed FC changes after left IEDs. The reward-emotion network (more of the reward system) was coactivated after right IEDs, indicating a possible mechanism of forced normalization. SIGNIFICANCE: This study directly linked the disrupted functional networks in TLE to epileptic activities and offered a unique tool for future research to investigate mechanisms of comorbidities in TLE.

Long-term cognitive and neuropsychiatric outcomes in patients with anti-NMDAR encephalitis.

OBJECTIVES: To evaluate the long-term cognitive or neuropsychiatric outcomes and potential risk factors associated with prolonged cognitive deficits or neuropsychiatric symptoms in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. METHODS: In this cohort follow-up study, patients with a definitive diagnosis of anti-NMDAR encephalitis from the inpatient of West China Hospital between June 2012 and December 2017 were included and underwent a prospective cognitive and neuropsychiatric assessment every 3 months by cognitive impairment rating scale, Neuropsychiatric Inventory (NPI) and/or Montreal Cognitive Assessment. RESULTS: Up to 97.5% patients had severe cognitive deficits and neuropsychiatric symptoms in acute phase. Decreasing proportion of patients with prolonged cognitive deficits was observed and time dependent. At 2 years' follow-up, 7.8% of patients with cognitive deficits were unable to complete some previous activities or return to work. The risk factors associated with persistent cognitive deficits included age of disease onset over 40 years old (HR, 1.77; 95% CI, 1.11-2.82; P = .01) and with clinical relapses (HR, 2.22; 95% CI, 1.21-4.09; P = .02). The predictors of prolonged neuropsychiatric symptoms included clinical relapses (HR, 2.79; 95% CI, 1.21-6.43; P = .02). Among the 12 neuropsychiatric symptoms of NPI, irritability was shown as the most prevalent and persistent. CONCLUSIONS: Combined cognitive and neuropsychiatric assessment and intervention are essential elements of comprehensive care of anti-NMDAR encephalitis.

Neurologists' attitudes toward driving among persons with epilepsy in China: A pilot electronic survey.

PURPOSE AND METHODS: Persons with epilepsy (PWE) remain completely and permanently prohibited from driving in China currently. Previous studies have shown that a considerable proportion of PWE with uncontrolled seizures in China continue to drive motor vehicles. Discrepancy between Chinese policy and driving practices for PWE is potentially concerning. We conducted a preliminary online electronic questionnaire (e-questionnaire) survey among neurologists in China aiming to explore neurologists' attitudes toward the issue of driving among PWE. RESULTS: A total of 358 neurologists completed the e-questionnaire with a response rate of 75.8%. 50.3% of neurologists stated that they knew the driving restriction law in China. With respect to reporting of cases to relevant driving authorities, 82.4% of neurologists never directly report PWE, and 90.8% consider that it is PWE's responsibility to report themselves. 87.4% of physicians surveyed indicated that the lack of clearly-articulated guidelines is a major impediment to their routine discussions of driving fitness for PWE. Subgroup analysis indicated that 76.2% of epileptologists were of the opinion that persons with well-controlled epilepsy should be allowed to drive versus 56.2% of general neurologists (P < 0.05). CONCLUSION: Currently, neurologists in China have a low awareness of the legal driving restriction for PWE and have highly varying practices with respect to counseling PWE about driving. According to our preliminary results, a clearly-articulated published national document for medical fitness for driving in China is necessary in order to standardize physicians' practices.

Mismatch negativity is abnormal but not lateralizing in temporal lobe epilepsy.

We investigated the changes of mismatch negativity (MMN) in patients with temporal lobe epilepsy (TLE) and explored the possible role of MMN in lateralizing their seizure focus. Thirty patients with TLE and thirty healthy controls were included. MMN was elicited in each subject. Patients with TLE were divided into three subgroups: unilateral left TLE; unilateral right TLE, and bilateral TLE. MMN amplitudes and latencies were compared between the patients with TLE and the control group, and also among the three subgroups of TLE, using repeated measures analyses of variance (ANOVA). To assess the lateralizing value of MMN, MMN latencies and amplitudes at the mastoid sites between the ipsilateral and contralateral sides of epileptic focus in patients with unilateral TLE were compared using t-test. Compared with controls, each subgroup of patients with TLE had longer latencies of MMN at both fronto-central and mastoid sites, but the amplitudes of MMN were not significantly different. The amplitudes and latencies of MMN were not significantly different between the ipsilateral and contralateral sides of seizure focus at mastoid sites. The present findings of prolonged latencies of MMN are suggestive of cognitive impairment in TLE. Both the mastoid sites and the fronto-central sites are involved, which likely reflect widespread cortical abnormalities in TLE. However, the changes of MMN during the interictal phase are not useful for lateralizing the seizure focus in patients with TLE.

Assessment of Utilization and Cost-Effectiveness of Telemedicine Program in Western Regions of China: A 12-Year Study of 249 Hospitals Across 112 Cities.

BACKGROUND: The imbalance in healthcare between urban and rural areas is still a problem in China. In recent decades, China has aimed to develop telemedicine. We assessed the implementation, utilization, and cost-effectiveness of a large telemedicine program across western China. MATERIALS AND METHODS: In 2002-2013, a government-sponsored major telemedicine program was established by West China Hospital of Sichuan University (hub), covering 249 spoke hospitals in 112 cities throughout western China and in 40 medical expertise areas. We analyzed the cross-sectional data from 11,987 consultations conducted at West China Hospital using the telemedicine network over a 12-year period. The types of diseases as well as the diagnosis and treatment changes were assessed. We also performed a cost-savings analysis and a one-way sensitivity analysis. RESULTS: Of the 11,987 teleconsultations, we noted that neoplasms (19.4%), injuries (13.9%), and circulatory diseases (10.3%) were the three most common diagnoses. Teleconsultations resulted in a change of diagnosis in 4,772 (39.8%) patients, and 3,707 (77.7%) of them underwent major diagnosis changes. Moreover, it led to a change of treatment in 6,591 (55.0%) patients, including 3,677 (55.8%) changes not linked to diagnosis changes. The telemedicine network resulted in an estimated net saving of $2,364,525 (if the patients traveled to the hub) or $3,759,014 (if the specialists traveled to the spoke hospitals). CONCLUSIONS: The introduction of telemedicine in China, linking highly specialized major hospitals (hub) with hundreds of small rural hospitals (spoke), can greatly improve the quality, efficiency, and cost-effectiveness of healthcare delivery and utilization. This new Internet-based healthcare model should be utilized more widely in developing countries.

BOLD responses related to focal spikes and widespread bilateral synchronous discharges generated in the frontal lobe.

OBJECTIVE: To investigate whether specific frontal regions have a tendency to generate widespread bilateral synchronous discharges (WBSDs) and others focal spikes and to determine the regions most involved when WBSDs occur; to assess the relationships between the extent of electroencephalography (EEG) discharges and the extent of metabolic changes measured by EEG/functional magnetic resonance imaging (fMRI). METHODS: Thirty-seven patients with interictal epileptic discharges (IEDs) with frontocentral predominance underwent EEG/fMRI. Patients were divided into a Focal (20 patients) group with focal frontal spikes and a WBSD group (17 patients). Maps of hemodynamic responses related to IEDs were compared between the two groups. RESULTS: The mean number ± SD of IEDs in the Focal group was 137.5 ± 38.1 and in the WBSD group, 73.5 ± 16.6 (p = 0.07). The volume of hemodynamic responses in the WBSD group was significantly larger than in the Focal group (mean, 243.3 ± 41.1 versus 114.8 ± 27.4 cm(3), p = 0.01). Maximum hemodynamic responses occurred in both groups in the following regions: dorsolateral prefrontal, mesial prefrontal, cingulate, and supplementary motor cortices. Maxima in premotor and motor cortex, frontal operculum, frontopolar, and orbitofrontal regions were found only in the Focal group, and maxima in thalamus and caudate only occurred in the WBSD group. Thalamic responses were significantly more common in the WBSD group (14/17) than in the Focal group (7/20), p = 0.004. Deactivation in the default mode network was significantly more common in the WBSD group (14/17) than in the Focal group (10/20), p = 0.04. SIGNIFICANCE: The spatial distribution and extent of blood oxygen level-dependent (BOLD) responses correlate well with electrophysiologic changes. Focal frontal spikes and WBSDs are not region specific in the frontal lobe, and the same frontal region can generate focal and generalized discharges. This suggests that widespread discharges reflect widespread epileptogenicity rather than a focal discharge located in a region favorable to spreading. The thalamus plays an important role in bilateral synchronization.

Altered Functional Connectivity Patterns of the Insular Subregions in Psychogenic Nonepileptic Seizures.

Neuroimaging studies have demonstrated that psychogenic nonepileptic seizures (PNES) are characterized by unstable cognitive-emotional and motor system, which is engaged in hyperactivity of limbic regions and sensorimotor area. The insula, which is a part of the limbic system, includes various subregions with some distinct connectivity patterns separately. However, whether these insular subregions show different connectivity patterns respectively in PNES remains largely unknown. We aimed to investigate the functional connectivity (FC) of insular subregions in PNES and extend the understanding of the complex pathophysiological mechanisms of this disease. A resting-state FC based on the insular subregions were conducted in 18 patients and 20 healthy controls. We examined the differences in FC values between PNES patients and controls using two sample t test. Our results showed patients had significantly stronger FC between insular subregions and sensorimotor network, lingual gyrus, superior parietal gyrus and putamen, which suggested a hyperlink pattern of insular subregions involved in abnormal emotion regulation, cognitive processes and motor function in PNES. Pearson correlation analysis between the mean FC values within abnormal regions and the frequency of PNES further indicated PNES exhibited abnormal functional organization whose stressful emotion of patients have great direct influence on their motor functions. The differentially impaired functional connectivity patterns of insular subregions might provide new insights into the complex neurological mechanism of PNES.

Clinical characteristics and prognosis of mah-jong-induced epilepsy: A cohort review of 56 patients.

OBJECTIVE: The objective of this study was to investigate the clinical characteristics of reflex epilepsy elicited by playing mah-jong in Western China. METHODS: Consecutive patients with reflex epilepsy triggered by mah-jong from Jan 2011 to April 2014 were recruited at West China Hospital. Each patient underwent EEG recording and brain MRI scan. All clinical data were reviewed. Each patient had at least 12 months of follow-up. RESULTS: Fifty-six patients were included, with majority of them being male (52/56, 92.9%). Mean age was 43.9 ± 10.0 years. Mean age at seizure onset was 35.1 ± 16.3 years. Mean duration of reflex epilepsy was 4.0 ± 2.2 years. The mean follow-up time was 32.0 ± 13.2 months. Seventeen patients (30.4%) took antiepileptic drugs. Regardless of the medication, all 14 patients who avoided playing mah-jong reached seizure freedom, and 22 of the 42 patients (52.4%) who still played mah-jong continued to have seizures (p<0.05). CONCLUSIONS: Reflex epilepsy induced by mah-jong is a unique type of epilepsy in the Chinese population and usually occurs in adults after a long time lag of playing mah-jong. Avoiding the triggers is the most effective treatment for epilepsy.

Altered attention networks in benign childhood epilepsy with centrotemporal spikes (BECTS): A resting-state fMRI study.

It is noteworthy that some children with benign childhood epilepsy with centrotemporal spikes (BECTS) show attention problems despite their favorable seizure outcome. Resting-state functional magnetic resonance imaging (fMRI) is a method widely used to detect brain network alterations in neuropsychiatric diseases. We used resting-state functional magnetic resonance imaging (fMRI) to investigate specific brain networks related to attention deficit in children with BECTS. Resting-state fMRI was performed in patients with BECTS with ADHD (n=15) and those with BECTS without ADHD (n=15) and in healthy controls (n=15). Unbiased seed-based whole-brain functional connectivity analysis was used to study the connectivity pattern of three resting-state networks, including the ventral attention network (VAN) and the dorsal attention network (DAN) and the default mode network (DMN). Patients with BECTS with ADHD displayed decreased functional connectivity in the DAN compared with other two groups, while patients with BECTS without ADHD showed increased functional connectivity in the DAN. Moreover, we found increased functional connectivity in the VAN and in the DMN in patients with BECTS with or without ADHD when comparing with controls. These results showed that the newly-diagnosed children with BECTS displayed brain activity alterations in the ventral and dorsal attention networks. The difference in the extent of impairment in the dorsal attention network of patients with BECTS with ADHD and patients with BECTS without ADHD may lead to improved understanding of the underlying neuropathophysiology and treatment of BECTS with ADHD and BECTS without ADHD.

Validation of the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) in West China.

OBJECTIVE: We aimed to validate the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) for Chinese people with epilepsy (PWE). METHODS: The NDDI-E was translated into a Chinese version. A consecutive cohort of PWE from West China Hospital was recruited to test the reliability and validity of the Chinese version of the NDDI-E (C-NDDI-E). Each patient underwent the Mini International Neuropsychiatric Interview (MINI) and C-NDDI-E. RESULTS: A total of 202 PWE completed the psychiatric evaluation. The C-NDDI-E was easily comprehended and quickly completed by all participants. Fifty-four patients (26.7%) had current major depressive disorder (MDD) according to the MINI criteria. The Cronbach's α coefficient for the C-NDDI-E was 0.825. Receiver operating characteristic analyses showed an area under the curve of 0.936 (95% CI=0.904-0.968). At a cutoff score of >12, the C-NDDI-E had a sensitivity of 0.926, a specificity of 0.804, a positive predictive value of 0.633, and a negative predictive value of 0.967. CONCLUSION: The C-NDDI-E is a valuable instrument for screening MDD in Chinese PWE.