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Cortical Source Analysis of High-Density EEG Recordings in Children
Published on: June 30, 2014
Brain gray matter changes in children at risk for sudden unexpected death in epilepsy
Bhaswati Roy1, Jennifer A Ogren2, Luke A Allen3
1Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Insights
Sudden Unexpected Death in Epilepsy (SUDEP) risk in children is linked to brain volume changes, particularly in areas regulating breathing and blood pressure. These pediatric brain alterations differ from adult SUDEP patterns and correlate with seizure frequency.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Epilepsy Research
Background:
- Sudden Unexpected Death in Epilepsy (SUDEP) risk factors are known in adults but not well-defined in children.
- Understanding pediatric brain changes associated with SUDEP risk is crucial for early intervention.
Purpose of the Study:
- To investigate regional brain volume differences in children with epilepsy at high risk for SUDEP compared to healthy children.
- To explore the relationship between focal seizure frequency and brain volume alterations in pediatric epilepsy.
Main Methods:
- T1-weighted MRI scans were used to analyze regional brain volumes in 21 children with epilepsy (high SUDEP risk) and 62 controls.
- Gray matter volumes were compared between groups using SPM12, controlling for age, sex, and BMI.
- Partial correlations examined the relationship between regional brain volumes and focal seizure frequency.
Main Results:
- Children with epilepsy showed increased gray matter volume in areas like the cerebellum and hippocampus, and decreased volume in the posterior thalamus and temporal cortices.
- Significant positive correlations were found between focal seizure frequency and gray matter volume in the cingulate, insula, and putamen.
- Observed volume changes in pediatric epilepsy, such as cerebellar increases, differed in direction from those seen in adults at risk for SUDEP.
Conclusions:
- Pediatric epilepsy patients at risk for SUDEP exhibit distinct brain volume changes compared to adults.
- These brain regions are critical for autonomic functions, including breathing and blood pressure regulation.
- Volume increases in pediatric epilepsy may indicate inflammatory processes, potentially leading to tissue loss seen in adults with sustained seizure activity.
Background:
Potential failing adult brain sites, stratified by risk, mediating Sudden Unexpected Death in Epilepsy (SUDEP) have been described, but are unknown in children.
Methods:
We examined regional brain volumes using T1-weighted MRI images in 21 children with epilepsy at high SUDEP risk and 62 healthy children, together with SUDEP risk scores, calculated from focal seizure frequency. Gray matter tissue type was partitioned, maps normalized, smoothed, and compared between groups (SPM12; ANCOVA; covariates, age, sex, and BMI). Partial correlations between regional volumes and seizure frequency were examined (SPM12, covariates, age, sex, and BMI); 67% were at high risk for SUDEP.
Results:
The cerebellar cortex, hippocampus, amygdala, putamen, cingulate, thalamus, and para-hippocampal gyrus showed increased gray matter volumes in epilepsy, and decreased volumes in the posterior thalamus, lingual gyrus, and temporal cortices. The cingulate, insula, and putamen showed significant positive relationships with focal seizure frequency indices using whole-brain voxel-by-voxel partial correlations. Tissue volume changes in selected sites differed in direction from adults; particularly, cerebellar sites, key for hypotensive recovery, increased rather than adult declines.
Conclusion:
The volume increases may represent expansion by inflammatory or other processes that, with sustained repetitive seizure discharge, lead to tissue volume declines described earlier in adults.
Impact:
Children with epilepsy, who are at risk for Sudden Unexplained Death, show changes in brain volume that often differ in direction of change from adults at risk for SUDEP. Sites of volume change play significant roles in mediating breathing and blood pressure, and include areas that serve recovery from prolonged apnea and marked loss of blood pressure. The extent of volume changes correlated with focal seizure frequency. Although the underlying processes contributing to regional volume changes remain speculative, regions of tissue swelling in pediatric brain areas may represent transitory conditions that later lead to tissue loss in the adult condition.
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