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Late-onset unexplained epilepsy (LOUE) involves widespread brain changes, including reduced cortical thickness and deep gray matter volumes. These alterations are linked to cognitive deficits, suggesting a potential continuum with neurodegenerative diseases.

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Area of Science:

  • Neurology
  • Neuroimaging
  • Cognitive Neuroscience

Background:

  • Epilepsy incidence is bimodal, with a second peak after age 55.
  • Late-onset unexplained epilepsy (LOUE) often lacks identifiable causes, with prior imaging suggesting mesiotemporal atrophy.
  • Understanding structural brain alterations in LOUE is crucial for diagnosis and management.

Purpose of the Study:

  • To quantify whole-brain cortical and deep gray matter alterations in LOUE.
  • To investigate the association between these structural changes and cognitive/clinical measures in LOUE patients.

Main Methods:

  • Prospective recruitment of LOUE patients and comparison with healthy older adults.
  • Utilized 3T structural MRI to extract cortical thickness and deep gray matter volumes.
  • Employed linear models for group comparisons and correlation analyses with cognitive and clinical data.

Main Results:

  • LOUE patients exhibited reduced cortical thickness in sensory/mesiotemporal regions and decreased pallidum/putamen volumes.
  • Structural reductions correlated with poorer performance on fluency and memory tasks.
  • Increased thickness in the inferior frontal gyrus and thalamic volume were observed, particularly in patients with focal seizures.

Conclusions:

  • LOUE is associated with more extensive brain structural changes than previously understood.
  • These changes are linked to cognitive vulnerabilities, indicating potential overlap with neurodegenerative processes.
  • Findings suggest LOUE may represent a spectrum between epilepsy and neurodegeneration.