Depression in temporal lobe epilepsy surgery patients : an FDG-PET study

Summary: Purpose: Depression is common in temporal lobe epilepsy (TLE) and after temporal lobectomy, and its etiology is obscure. In nonepileptic depression (including depression associated with other neurologic disorders), a consistent PET imaging finding is frontal lobe hypometabolism. Many TLE patients have hypometabolism involving frontal regions. Thus in data available from routine clinical assessments in an epilepsy surgery unit, we tested the hypothesis that the pattern of hypometabolism, particularly in the frontal lobe, may be associated with the depression seen in patients with TLE and TLE surgery.

Methods: We studied 23 medically refractory TLE patients who underwent anterior temporal lobectomy and who had preoperative FDG-PET scanning. All patients had pre- and postoperative psychiatric assessment. By using statistical parametric mapping (SPM-99), patterns of hypometabolism were compared between patients who had a preoperative history of depression (n = 9) versus those who did not (n = 14) and between those in whom postoperative depression developed (n = 13) versus those in whom it did not (n = 10). A significant region of hypometabolism was set at p < 0.001 for a cluster of ≥20 contiguous voxels.

Results: Patients with a history of depression at any time preoperatively showed focal hypometabolism in ipsilateral orbitofrontal cortex compared with those who did not (t= 4.64; p < 0.001). Patients in whom depression developed postoperatively also showed hypometabolism in the ipsilateral orbitofrontal region (t= 5.10; p < 0.001).

Conclusions: Although this study is methodologically limited, and other explanations merit consideration, orbitofrontal cortex dysfunction, already implicated in the pathophysiology of nonepileptic depression, may also be relevant to the depression of TLE and temporal lobectomy.

Phineas Gage

In 1848, as the result of a bizarre accident, Phineas Gage had most of the left frontal lobe of his brain destroyed. Although his surviving the injury by some 11.5 years made him a considerable medical curiosity, it was the changes to his behavior that made him important in the neurosciences. Gage's is actually one of the most important cases in the history of the neurosciences: it revealed for the first time that complex functions might be localized in the brain. Its status is indexed by its still being cited in about two-thirds of all psychology and related neuroscience textbooks and by the fact that studies were still being undertaken some 150 years after the accident to establish which parts of Gage's brain were damaged.

Changes in SWB following injury to different brain lobes

A neurological substrate for subjective wellbeing (SWB) has received little research attention.
Purpose This study was designed to conduct exploratory investigation into the neuroanatomical correlates of SWB, by monitoring the SWB of a head-injured population over a six-month period.
Method Seventy people with head injury (HI), aged 10–65, were studied. The SWB of each participant was measured, and computed tomography (CT) scans were analysed to obtain regional brain injury location (BIL).
Results SWB was associated with BIL. However, the hypothesis that individuals with left frontal injury would report lower SWB was not supported. Instead, it was observed that participants with injury to their right frontal lobe reported higher SWB than individuals with injury to other regions of the brain.
Conclusions This study provides initial exploration into the neuroanatomical correlates of SWB.

Multitasking: multiple, domain-specific cognitive functions in a virtual environment

Multitasking among three or more different tasks is a ubiquitous requirement of everyday cognition, yet rarely is it addressed in research on healthy adults who have had no specific training in multitasking skills. Participants completed a set of diverse subtasks within a simulated shopping mall and office environment, the Edinburgh Virtual Errands Test (EVET). The aim was to investigate how different cognitive functions, such as planning, retrospective and prospective memory, and visuospatial and verbal working memory, contribute to everyday multitasking. Subtasks were chosen to be diverse, and predictions were derived from a statistical model of everyday multitasking impairments associated with frontal-lobe lesions (Burgess, Veitch, de Lacy Costello, & Shallice, 2000b). Multiple regression indicated significant independent contributions from measures of retrospective memory, visuospatial working memory, and online planning, but not from independent measures of prospective memory or verbal working memory. Structural equation modelling showed that the best fit to the data arose from three underlying constructs, with Memory and Planning having a weak link, but with both having a strong directional pathway to an Intent construct that reflected implementation of intentions. Participants who followed their preprepared plan achieved higher scores than those who altered their plan during multitask performance. This was true regardless of whether the plan was efficient or poor. These results substantially develop and extend the Burgess et al. (2000b) model to healthy adults and yield new insight into the poorly understood area of everyday multitasking. The findings also point to the utility of using virtual environments for investigating this form of complex human cognition.

Multitasking, working memory and remembering intentions

Multitasking refers to the performance of a range of tasks that have to be completed within a limited time period. it differs from dual task paradigms in that tasks are performed not in parallel, but by interleaving, switching from one to the other. it differs also from task switching paradigms in that the time scale is very much longer, multiple different tasks are involved, and most tasks have a clear end point. Multitasking has been studied extensively with particular sets of experts such as in aviation and in the military, and impairments of multitasking performance have been studied in patients with frontal lobe lesions. Much less is known as to how multitasking is achieved in healthy adults who have not had specific training in the necessary skills. This paper will provide a brief review of research on everyday multitasking, and summarise the results of some recent experiments on simulated everyday tasks chosen to require advance and on-line planning, retrospective memory, prospective memory, and visual, spatial and verbal short-term memory.

MRI-negative PET-positive temporal lobe epilepsy (TLE) and mesial TLE differ with quantitative MRI and PET: a case control study

Background: 'MRI negative PET positive temporal lobe epilepsy' represents a substantial minority of temporal lobe epilepsy (TLE). Clinicopathological and qualitative imaging differences from mesial temporal lobe epilepsy are reported. We aimed to compare TLE with hippocampal sclerosis (HS+ve) and non lesional TLE without HS (HS-ve) on MRI, with respect to quantitative FDG-PET and MRI measures.

Methods: 30 consecutive HS-ve patients with well-lateralised EEG were compared with 30 age- and sex-matched HS+ve patients with well-lateralised EEG. Cerebral, cortical lobar and hippocampal volumetric and co-registered FDG-PET metabolic analyses were performed.

Results: There was no difference in whole brain, cerebral or cerebral cortical volumes. Both groups showed marginally smaller cerebral volumes ipsilateral to epileptogenic side (HS-ve 0.99, p = 0.02, HS+ve 0.98, p < 0.001). In HS+ve, the ratio of epileptogenic cerebrum to whole brain volume was less (p = 0.02); the ratio of epileptogenic cerebral cortex to whole brain in the HS+ve group approached significance (p = 0.06). Relative volume deficits were seen in HS+ve in insular and temporal lobes. Both groups showed marked ipsilateral hypometabolism (p < 0.001), most marked in temporal cortex. Mean hypointensity was more marked in epileptogenic-to-contralateral hippocampus in HS+ve (ratio: 0.86 vs 0.95, p < 0.001). The mean FDG-PET ratio of ipsilateral to contralateral cerebral cortex however was low in both groups (ratio: HS-ve 0.97, p < 0.0001; HS+ve 0.98, p = 0.003), and more marked in HS-ve across all lobes except insula.

Conclusion: Overall, HS+ve patients showed more hippocampal, but also marginally more ipsilateral cerebral and cerebrocortical atrophy, greater ipsilateral hippocampal hypometabolism but similar ipsilateral cerebral cortical hypometabolism, confirming structural and functional differences between these groups.

Hippocampal deformation mapping in MRI-negative PET-positive temporal lobe epilepsy

Objectives: To compare hippocampal surface structure, using large deformation high dimensional mapping (HDM-LD), in subjects with temporal lobe epilepsy (TLE) with (HS+ve) and without (HS−ve) hippocampal sclerosis.

Methods: The study included 30 HS−ve subjects matched with 30 HS+ve subjects from the previously reported epilepsy patient cohort. To control for normal right–left asymmetries of hippocampal surface structure, subjects were regrouped based on laterality of onset of epileptic seizures and presence of HS. Gender ratio, age, duration of epilepsy and seizure frequency were calculated for each of the four groups. Final HDM-LD surface maps of the right and left TLE groups were compared to define differences in subregional hippocampal involvement within the groups.

Results: There were no significant differences in comparisons of the left TLE (left HS−ve compared with HS+ve) or right TLE (right HS−ve compared with HS+ve) groups with respect to age, duration of epilepsy or seizure severity scores. HDM-LD maps showed accentuated surface changes over the lateral hippocampal surface, in the region of the Sommer sector, in the hippocampi affected by HS. However, HS−ve hippocampi showed maximal surface changes in a different pattern, and did not involve the region of Sommer sector.

Conclusion: We conclude that differences in segmental volume loss between the HS−ve and HS+ve groups are suggestive that the underlying pathophysiology of hippocampal changes in the two groups is different, and not related to chronic seizure duration or severity.

Sequential 123-I-iododexetimide scans in temporal lobe epilepsy: comparison with neuroimaging scans (MR imaging and 18-F-FDG-PET imaging)

Purpose Muscarinic acetylcholine receptors (mAChRs) play an important role in the generation of seizures. Single-photon emission computed tomography (SPECT) with ¹²³I-iododexetimide (IDEX) depicts tracer uptake by mAChRs. Our aims were to: (a) determine the optimum time for interictal IDEX SPECT imaging; (b) determine the accuracy of IDEX scans in the localisation of seizure foci when compared with video EEG and MR imaging in patients with temporal lobe epilepsy (TLE); (c) characterise the distribution of IDEX binding in the temporal lobes and (d) compare IDEX SPECT and ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in identifying seizure foci.
Methods We performed sequential scans using IDEX SPECT imaging at 0, 3, 6 and 24 h in 12 consecutive patients with refractory TLE undergoing assessment for epilepsy surgery. Visual and region of interest analyses of the mesial, lateral and polar regions of the temporal lobes were used to compare IDEX SPECT, FDG PET and MR imaging in seizure onset localisation.
Results The 6-h IDEX scan (92%; κappa=0.83, p=0.003) was superior to the 0-h (36%; kappa=0.01, p>0.05), 3-h (55%;κappa=0.13, p>0.05) and 24-h IDEX scans in identifying the temporal lobe of seizure origin. The 6-h IDEX scan correctly predicted the temporal lobe of seizure origin in two patients who required intracranial EEG recordings to define the seizure onset. Reduced ligand binding was most marked at the temporal pole and mesial temporal structures. IDEX SPECT was superior to interictal FDG PET (75%; κappa=0.66, p=0.023) in seizure onset localisation. MR imaging was non-localising in two patients in whom it was normal and in another patient in whom there was bilateral symmetrical hippocampal atrophy.
Conclusion The 6-h IDEX SPECT scan is a viable alternative to FDG PET imaging in seizure onset localisation in TLE.

Bathymetry and frontal system interactions influence seasonal foraging movements of lactating subantarctic fur seals from Marion Island

Sixteen lactating subantarctic fur seals Arctocephalus tropicalis were satellite-tracked during the winter of 2006 (n = 6), summer of 2006/07 (n = 6) and autumn/winter (n = 4) of 2007, from Marion Island, Southern Ocean. Despite varied individual movement patterns, a favoured foraging area lay to the northeast of the island. In contrast to findings for populations at similar latitudes, seals from Marion Island did not undertake short overnight foraging trips, but trips consistently went beyond 300 km from the island. This aligns with the at-sea duration of lactating seals’ foraging trips from temperate Amsterdam Island, but differs from subantarctic Crozet and Macquarie islands. Time spent at sea, maximum distances travelled and movement variation of tracks from the island varied seasonally. Faecal analysis suggests the diet comprised primarily myctophid fish with limited seasonal variation. Well-defined areas of restricted movement coincided with significant bathymetric features to the west/northwest of the Crozet Plateau, with the Del Caño Rise clearly being important. Positive and negative sea-surface height anomalies (compared to the mean) appeared to be preferred by most seals across seasons. Higher summer sea-surface temperatures correlated with the movements of some seals. Higher chlorophyll a concentrations dictated transit and foraging areas during summer. Bathymetrically influenced oceanographic variables likely explain these preferred long-distance eastward movements. The Îles Crozet and Marion island subantarctic fur seals differ in their foraging ecology despite being neighbours. Conversely, the subantarctic fur seal populations from the distant Amsterdam and Marion islands appear to be similarly influenced by such environmental factors.