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Resting-state fMRI revealed different brain activities responding to valproic acid and levetiracetam in benign epilepsy with central-temporal spikes

  • Magnetic Resonance
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Abstract

Objectives

Our aim was to investigate regional difference in brain activities in response to antiepileptic drug (AED) medications in benign epilepsy with central-temporal spikes (BECTS) using resting-state functional magnetic resonance imaging (fMRI).

Methods

Fifty-seven patients with BECTS underwent resting-state fMRI scans after receiving either valproic acid (VPA) (n = 15), levetiracetam (LEV) (n = 21), or no medication (n = 21). fMRI regional homogeneity (ReHo) parameter among the three groups of patients were compared and were correlated with total doses of AED in the two medicated groups.

Results

Compared with patients on no-medication, patients receiving either VPA or LEV showed decreased ReHo in the central-temporal region, frontal cortex, and thalamus. In particular, the VPA group showed greater ReHo decrease in the thalamus and milder in cortices and caudate heads compared with the LEV group. In addition, the VPA group demonstrated a negative correlation between ReHo values in the central-temporal region and medication dose.

Conclusion

Both VPA and LEV inhibit resting-state neural activity in the central-temporal region, which is the main epileptogenic focus of BECTS. VPA reduced brain activity in the cortical epileptogenic regions and thalamus evenly, whereas LEV reduced brain activity predominantly in the cortices. Interestingly, VPA showed a cumulative effect on inhibiting brain activity in the epileptogenic regions in BECTS.

Key Points

• Regional differences in brain activity in response to different AEDs in BECTS.

• AEDs inhibit resting-state neural activity in epileptogenic and subcortical regions in BECTS.

• Valproic acid effect on the cortical epileptogenic regions and thalamus evenly.

• Levetiracetam effect seen predominantly in cortices.

• Valproic acid has a cumulative effect on inhibiting brain activity in epileptogenic regions.

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Abbreviations

BECTS:

benign epilepsy with central-temporal spikes

AED:

Antiepileptic drug

VPA:

Valproic acid

LEV:

Levetiracetam

ReHo:

Regional homogeneity

EEG-fMRI:

Simultaneous electroencephalogram and functional magnetic resonance imaging

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Acknowledgements

We thank Prof. Allen Song from Duke University and Prof. Pierre Sirois from Laval University for helpful discussions. The scientific guarantors of this publication are Guang Ming Lu and Zhi Qiang Zhang. This research was approved by the local medical ethics committee, and written informed consent was obtained from each participant. This study received funding from the Natural Science Foundation of China (Grant nos. 81422022, 81271553, 81401402, 81471653, 81201078, and 81201155), 863 project (Grant nos. 2014BAI04B05 and 2015AA020505), the Wellcome Trust (Grant no. 101253/Z/13/Z), and the China Postdoctoral Science Foundation (Grant no. 2013 M532229).

One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Study participants or cohorts have not been previously reported.

Methodology: retrospective, cross-sectional study, performed at one institution.

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Authors and Affiliations

  1. Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China

    Qirui Zhang, Zhiqiang Zhang, Qiang Xu, Han Wu, Zhipeng Li & Guangming Lu

  2. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, China

    Fang Yang & Qian Li

  3. Department of Neurology, Nanjing Children’s Hospital, Nanjing, 210029, China

    Zheng Hu

  4. Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium

    Mantini Dante

  5. Laboratory of Molecular Medicine, Suzhou University, Suzhou, 215000, China

    Kai Li

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  1. Qirui Zhang
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Correspondence to Zhiqiang Zhang or Guangming Lu.

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Zhang, Q., Yang, F., Hu, Z. et al. Resting-state fMRI revealed different brain activities responding to valproic acid and levetiracetam in benign epilepsy with central-temporal spikes. Eur Radiol 27, 2137–2145 (2017). https://doi.org/10.1007/s00330-016-4531-z

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