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Gray and White Matter Volumes and Cognitive Dysfunction in Drug-Naïve Newly Diagnosed Pediatric Epilepsy
Jung Hwa Lee1, Song E Kim2, Chang-hyun Park2
1Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul 158-710, Republic of Korea ; Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 630-723, Republic of Korea.
Insights
Pediatric epilepsy patients show early cognitive deficits, linked to brain structure changes. These neuroanatomical alterations in gray and white matter affect cognitive functions even before epilepsy medication begins.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Cognitive Psychology
Background:
- Cognitive dysfunction is common in epilepsy patients, even early in the disease.
- The relationship between structural brain changes and cognitive status in newly diagnosed, drug-naïve pediatric epilepsy is not fully understood.
Purpose of the Study:
- To investigate the association between structural brain findings and neuropsychological status in drug-naïve, newly diagnosed pediatric epilepsy patients.
- To identify early neuroanatomical alterations in gray matter (GM) and white matter (WM) related to cognitive deficits.
Main Methods:
- Thirty newly diagnosed pediatric epilepsy patients and 25 healthy controls (aged 7-16) underwent neuropsychological testing (K-WISC-III, Stroop, TMT).
- Optimized voxel-based morphometry (VBM) was used to analyze regional gray matter (GM) and white matter (WM) volumes.
Main Results:
- Epilepsy patients exhibited lower performance in verbal intelligence, freedom from distractibility, and executive functions.
- Cognitive deficits correlated with regional VBM findings in both GM and WM, with distinct patterns.
- Gray matter (GM) volume differences were prominent in bilateral frontal regions.
Conclusions:
- Early-stage pediatric epilepsy is associated with cognitive dysfunction and neuroanatomical alterations in both gray and white matter.
- These changes appear related to the neurocognitive developmental process rather than long-standing disease or medication.
- Structural brain alterations in early epilepsy can impact cognitive functions before the initiation of anti-epileptic drug (AED) treatment.
Abstract:
Epilepsy patients often have cognitive dysfunction even at early stages of disease. We investigated the relationship between structural findings and neuropsychological status in drug-naïve newly diagnosed pediatric epilepsy patients. Thirty newly diagnosed pediatric epilepsy patients and 25 healthy control subjects aged 7~16 years were enrolled, who were assessed by the Korean version of the Wechsler Intelligence Scale for Children (K-WISC-III), the Stroop test, and the trail making test (TMT). Optimized voxel-based morphometry (VBM) was performed for both Gray Matter (GM) and White Matter (WM) volumes. Lower performance levels of verbal intelligence quotient, freedom from distractibility, and executive function were observed in epilepsy group. Interestingly, poor performance in these cognitive subdomains was correlated with regional VBM findings involving both GM and WM volumes, but with different patterns between groups. GM volumes revealed clear differences predominantly in the bilateral frontal regions. These findings indicate that certain cognitive functions may be affected in the early stage of epilepsy, not related to the long-standing epilepsy or medication, but more related to the neurocognitive developmental process in this age. Epilepsy can lead to neuroanatomical alterations in both GM and WM, which may affect cognitive functions, during early stages even before commencement of AED medication.
