J Clin Neurol.  2019 Oct;15(4):502-510. 10.3988/jcn.2019.15.4.502.

Language-Related White-Matter-Tract Deficits in Children with Benign Epilepsy with Centrotemporal Spikes: A Retrospective Study

• Kim HH
• Chung GH
• Park SH
• Kim SJ

• KMID: 2467760
• DOI: http://doi.org/10.3988/jcn.2019.15.4.502

Abstract

BACKGROUND AND PURPOSE
Benign epilepsy with centrotemporal spikes (BECTS) is one of the most common pediatric epilepsies, and it generally has a good prognosis. However, recent research has indicated that the epileptic activity of BECTS can cause cognitive defects such as language, visuospatial, and auditory verbal memory deficits. This study assessed language-delivery deficits in BECTS patients using diffusion-tensor magnetic resonance imaging (DTI).
METHODS
T1-weighted MRI, DTI, and language tests were conducted in 16 BECTS patients and 16 age-matched controls. DTI data were analyzed using the TRActs Constrained by Underlying Anatomy tool in FreeSurfer 5.3, and 18 major white-matter tracts were extracted, which included 4 language-related tracts: the inferior longitudinal fasciculus, superior longitudinal fasciculus-parietal terminations, superior longitudinal fasciculus-temporal terminations, and uncinate fasciculus (UNC). Language tests included the Korean version of the Receptive and Expressive Vocabulary Test, Test of Problem-Solving Abilities (TOPS), and the mean length of utterance in words.
RESULTS
The BECTS group exhibited decreased mean fractional anisotropy and increased mean radial diffusivity, with significant differences in both the superior longitudinal fasciculus and the left UNC (p<0.05), which are the language-related white-matter tracts in the dual-loop model. The TOPS language test scores were significantly lower in the BECTS group than in the control group (p<0.05).
CONCLUSIONS
It appears that BECTS patients can exhibit language deficits. Seizure activities of BECTS could alter DTI scalar values in the language-related white-matter tracts.

Keyword

diffusion-tensor imaging; language test; dual-loop model

MeSH Terms

Anisotropy
Child*
Cognition Disorders
Epilepsy
Epilepsy, Rolandic*
Humans
Language Tests
Magnetic Resonance Imaging
Memory Disorders
Prognosis
Retrospective Studies*
Seizures

Figure

• 

  Fig. 1 Imaging view of the 18 reconstructed cerebral tracts in a control subject. A: Coronal view. B: Sagittal view. C: Axial view. D: Three-dimensional view. ATR: anterior thalamic radiation, CAB: cingulum-angular bundle, CCG: cingulum-cingulate-gyrus bundle, CST: cortical spinal tract, FMAJOR: corpus callosum-forceps major, FMINOR: corpus callosum-forceps minor, ILF: inferior longitudinal fasciculus, SLFP: superior longitudinal fasciculus-parietal terminations, SLFT: superior longitudinal fasciculus-temporal terminations, UNC: uncinate fasciculus.

• 

  Fig. 2 Flow chart of the study participants. BECTS: benign epilepsy with centrotemporal spikes, NRS: numeric rating scale.

• 

  Fig. 3 Comparison of diffusion-tensor MRI scalar values of the 18 major white-matter tracts in the BECTS and control groups. Data indicate group mean and standard-error values. A: Mean FA of BECTS group was decreased in dorsal stream of language related white-matter-tract. B: There was no difference between control and BECTS groups in mean AD. C and D: Mean MD and RD of BECTS group were increased in dorsal stream of language related white-matter-tract. *Significant at p<0.05 (uncorrected), †Significant correlation after Bonferroni correction (p<0.05/18=0.003). AD: axial diffusivity, ATR: anterior thalamic radiation, BECTS: benign epilepsy with centrotemporal spikes, CAB: cingulum-angular bundle, CCG: cingulum-cingulate gyrus bundle, CST: cortical spinal tract, FA: fractional anisotropy, FMAJOR: corpus callosum-forceps major, FMINOR: corpus callosum-forceps minor, ILF: inferior longitudinal fasciculus, Lt: left, MD: mean diffusivity, RD: radial diffusivity, Rt: right, SLFP: superior longitudinal fasciculus-parietal terminations, SLFT: superior longitudinal fasciculus-temporal terminations, UNC: uncinate fasciculus.

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