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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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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DOI: https://doi.org/10.1007/s00330-016-4531-z