Asymmetrical cortical surface area decrease in epilepsy patients with postictal generalized electroencephalography suppression

Author:

Zhao Chenyang1ORCID,Tang Yingying1,Xiao Yuan23,Jiang Ping2345ORCID,Zhang Ziyi6,Gong Qiyong235,Zhou Dong1ORCID

Affiliation:

1. Department of Neurology, West China Hospital of Sichuan University , Chengdu 610041, Sichuan , China

2. Department of Radiology and Huaxi MR Research Center (HMRRC) , Functional and Molecular Imaging Key Laboratory of Sichuan Province, , Chengdu 610041, Sichuan , China

3. West China Hospital, Sichuan University , Functional and Molecular Imaging Key Laboratory of Sichuan Province, , Chengdu 610041, Sichuan , China

4. West China Medical Publishers, West China Hospital, Sichuan University , Chengdu 610041, Sichuan , China

5. Research Unit of Psychoradiology, Chinese Academy of Medical Sciences , Chengdu 610041, Sichuan , China

6. West China School of Public Health, Sichuan University , Chengdu 610041, Sichuan , China

Abstract

Abstract Postictal generalized electroencephalographic suppression is a possible electroencephalographic marker for sudden unexpected death in epilepsy. We aimed to investigate the cortical surface area abnormalities in epilepsy patients with postictal generalized electroencephalographic suppression. We retrospectively included 30 epilepsy patients with postictal generalized electroencephalographic suppression (PGES+), 21 epilepsy patients without postictal generalized electroencephalographic suppression (PGES−), and 30 healthy controls. Surface-based analysis on high-resolution T1-weighted images was conducted and cortical surface areas were compared among the three groups, alongside correlation analyses with seizure-related clinical variables. Compared with PGES− group, we identified reduced surface area in the bilateral insula with more extensive distribution in the right hemisphere in PGES+ group. The reduced right insular surface area was associated with younger seizure-onset age. When compared with healthy controls, PGES− group presented reduced surface area in the left caudal middle frontal gyrus; PGES+ group presented more widespread surface area reductions in the right posterior cingulate gyrus, left postcentral gyrus, middle frontal gyrus, and middle temporal gyrus. Our results suggested cortical microstructural impairment in patients with postictal generalized electroencephalographic suppression. The significant surface area reductions in the insular cortex supported the autonomic network involvement in the pathology of postictal generalized electroencephalographic suppression, and its right-sided predominance suggested the potential shared abnormal brain network for postictal generalized electroencephalographic suppression and sudden unexpected death in epilepsy.

Funder

National Natural Science Foundation of China

Clinical Research Fund

West China Hospital, Sichuan University

Natural Science Foundation of Sichuan Province

Publisher

Oxford University Press (OUP)

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