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Related Concept Videos

Epilepsy and Seizures: Overview01:24

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Epilepsy is a chronic neurological disease marked by recurrent, unpredictable seizures. These seizures are caused by abnormal electrical discharges in the brain, leading to behavior, sensation, or consciousness alterations. They can also cause transient impairment of awareness, interfering with daily activities.
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
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Focal Seizures
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Cortical disconnection in temporal lobe epilepsy.

Ezequiel Gleichgerrcht1, Tanja S Kellermann1, Daniel L Drane2

  • 1Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.

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|August 9, 2021
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Summary

Cortical disconnection, a loss of white matter (WM) connections, is prevalent in temporal lobe epilepsy (TLE). This disconnection, particularly in limbic structures, impacts verbal memory performance in TLE patients.

Keywords:
Connectometry analysisTemporal lobe epilepsyTractography

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Area of Science:

  • Neurology
  • Neuroimaging
  • Epilepsy Research

Background:

  • Cortical disconnection, characterized by reduced gray matter function due to white matter (WM) connection loss, is a critical neurological concept.
  • While WM damage is known in temporal lobe epilepsy (TLE), the precise anatomical distribution of cortical disconnection in TLE remains incompletely understood.

Purpose of the Study:

  • To investigate the anatomical distribution of cortical disconnection in patients with temporal lobe epilepsy (TLE).
  • To identify specific white matter (WM) pathways affected in TLE and their corresponding gray matter connections.
  • To explore the relationship between patterns of cortical disconnection and verbal memory performance in TLE.

Main Methods:

  • Utilized a group connectometry diffusion imaging tractography approach in 221 participants (64 left-TLE, 55 right-TLE, 102 controls).
  • Identified WM fibers with reduced integrity in TLE participants.
  • Mapped the anatomical distribution of gray matter endpoints of abnormal WM fibers to characterize disconnection patterns.

Main Results:

  • Identified multiple WM pathways with reduced integrity in both left- and right-TLE.
  • Observed extensive cortical disconnection predominantly involving limbic structures.
  • Found that disconnection of the left cingulum, thalamus, bilateral putamen, and amygdala correlated with lower immediate verbal recall, even after controlling for medial temporal gray matter atrophy.

Conclusions:

  • Cortical disconnection is a widespread and often underestimated phenomenon in temporal lobe epilepsy (TLE).
  • Disconnection of limbic structures, extending beyond the medial temporal regions, significantly relates to verbal memory deficits in TLE.
  • Findings highlight the importance of assessing broader patterns of cortical disconnection for understanding cognitive impairments in TLE.