Date of Award
January 2012
Document Type
Thesis
Degree Name
Medical Doctor (MD)
Department
Medicine
First Advisor
Hal Blumenfeld
Subject Area(s)
Medicine
Abstract
Childhood Absence Epilepsy (CAE) is a common cause of pediatric epilepsy characterized by brief episodes of impaired consciousness accompanied by 3-4 Hz generalized spike-wave discharges on EEG. CAE is also known to cause interictal impairment of attention even when seizures are controlled. No studies have yet investigated the neural network dysfunction responsible for these cognitive deficits. In this study we used functional MRI data to define an attention network and measure any alterations in this network in children with absence epilepsy. We used the Continuous Performance Task (CPT), a test of attentional vigilance, and the Repetitive Tapping Task, a motor control test, on 26 patients and 22 matched healthy controls with simultaneous fMRI and EEG recording. This fMRI data was correlated with behavioral performance and used to identify attention regions of interest. According to all performance variables of inattention, the CAE patients performed more poorly than controls on CPT. Areas of activation on fMRI during CPT included the medial frontal cortex (MFC) and bilateral insula/frontal opercula (In/FO). Worse performance on CPT according to all measures of inattention was correlated with decreased fMRI activation in the MFC. The MFC and bilateral In/FO were then used to define an "attention network" which was explored using resting functional connectivity analysis. CAE patients were found to have significantly decreased functional connectivity between the MFC and right anterior In/FO relative to controls. These findings suggest that the function of this attention network is impaired in patients with CAE. Our results provide a functional and anatomic basis for the interictal impairments observed in CAE patients and may allow for the development of improved targeted therapies aimed at these networks.
Recommended Citation
Shisler, David, "Impaired Interictal Network Functional Connectivity In Childhood Absence Epilepsy" (2012). Yale Medicine Thesis Digital Library. 1763.
https://elischolar.library.yale.edu/ymtdl/1763
Comments
This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.