Clinical, Diffusion Tensor Imaging, EEG and Cognitive Biomarkers of Seizure Control in Patients with Juvenile Myoclonic Epilepsy
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- Category: Vol. 85, December 2017
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Clinical, Diffusion Tensor Imaging, EEG and Cognitive Biomarkers of Seizure Control in Patients with Juvenile Myoclonic Epilepsy, IMAN EL-BANHAWY, NIRMEEN KISHK, KAMEL HAMMOUDA, RAMY EDWARD, AMANI NAWITO, AMR HASSAN, IMAN HASSAN and LOBNA EL-GHONEIMY
Abstract
Background: Juvenile Myoclonic Epilepsy (3MB) is one of most common idiopathic generalized epilepsy syndromes, contributing to approximately 3% to 11% of adolescent and adult cases of epilepsy. Seizure control is extremely variable across patients. Little is known about the factors that govern the disease course and seizure control.
Aim of Work: To study the clinical, neuroanatomical/ neurophysiological, and cognitive biomarkers of seizure control in JME patients.
Subjects and Methods: Forty seven patients with JME were subjected to a series of neuropsychologicai tests, one hour EEG, Diffusion Tensor Imaging (DТД, and tractography. DTI measures assessed Fractional Anisotropy (FA) within the white matter skeleton. Patients were then divided according to the seizure control into controlled (13 patients) and uncontrolled (34 patients) groups. The controlled group, included patients who are fit-free for more than one year; and an uncontrolled group, included patients who had H Generalized Tonic Clonic Seizures (GTCs) over the past year.
Results: TraH Making Test (TMT), among all the cognitive tests, was found to be an independent predicting factor for uncontrolled GTCs (p=О.026). Significant reduction of the FA in the left anterior corpus callosum was found in patients with uncontrolled GTCs (p=0.026). Reduced FA in the left anterior corpus calloaum and left anterior cingulate was found to be a biomarker for uncontrolled myoclonus (0.037, 0.042) respectively. The uncontrolled patients had high spike burst duration and spike density in the EEG with the spike density also representing an independent predicting factor for uncontrolled GTCS.
Conclusion: Reduced FA in DTI and the interictal EEG spike density are potential biomarkers for seizure control in 3MB patients.