Morphometric MRI features are associated with surgical outcome in mesial temporal lobe epilepsy with hippocampal sclerosis

Purpose: Corticoamygdalohippocampectomy (CAH) improves seizure control, quality of life, and decreases mortality for refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). One-third of patients continue having seizures, and it is pivotal to determine structural abnormalities that might influence the postoperative outcome. Studies indicate that nonhippocampal regions may play a role in the epileptogenic network in MTLE-HS and could generate seizures postoperatively. The aim of this study is to analyze areas of atrophy, not always detected on routine MRI, comparing patients who became seizure free (SF) with those non seizure free (NSF) after CAH, in an attempt to establish possible predictors of surgical outcome. Methods:105 patients with refractory MTLE-HS submitted to CAH (59 left MTLE46 males) and 47 controls were enrolled. FreeSurfer was performed for cortical thickness and volume estimation comparing patients to controls and SF versus NSF patients. The final sample after post processing procedures resulted in 99 patients. Results: Cortical thickness analyses showed reductions in left insula in NSF patients compared to those SF. Significant volume reductions in SF patients were present in bilateral thalami, hippocampi and pars opercularis, left parahippocampal gyrus and right temporal pole. In NSF patients reductions were present bilaterally in thalami, hippocampi, entorhinal cortices, superior frontal and supramarginal gyrion the left: superior and middle temporal gyri, temporal pole, parahippocampal gyrus, pars opercularis and middle frontal gyrusand on the right: precentral, superior, middle and inferior temporal gyri. Comparison between SF and NSF patients showed ipsilateral gray matter reductions in the right entorhinal cortex (p = 0.003) and contralateral parahippocampal gyrus (p = 0.05) in right MTLE-HS. Patients NSF had a longer duration of epilepsy than those SF (p = 0.028). Conclusion: NSF patients exhibited more extensive areas of atrophy than SF ones. As entorhinal cortex and parahippocampal gyrus are reduced in NSF patients compared to those SF these structures might be implicated in the network responsible for the maintenance of postoperative seizures. Duration of epilepsy is a predictor of seizure outcome. (C) 2017 Elsevier B.V. All rights reserved.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Univ Fed Sao Paulo UNIFESP, Unidade Pesquisa & Tratamento Epilepsias, Dept Neurol & Neurosurg, Rua Pedro Toledo 650, BR-04039002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Diagnost Imaging, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Psychiat, Rua Borges Lagoa 570, BR-04038000 Sao Paulo, SP, BrazilUniv ABC, Dept Math Computat & Cognit, Ave Estados 5001, BR-09210580 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Unidade Pesquisa & Tratamento Epilepsias, Dept Neurol & Neurosurg, Rua Pedro Toledo 650, BR-04039002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Diagnost Imaging, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Psychiat, Rua Borges Lagoa 570, BR-04038000 Sao Paulo, SP, BrazilWeb of Scienc

Reduced dorso-lateral prefrontal cortex in treatment resistant schizophrenia

Background: Treatment resistance affects up to one third of patients with schizophrenia (SCZ). A better understanding of its biological underlying processes could improve treatment. the aim of this study was to compare cortical thickness between non-resistant SCZ (NR-SCZ), treatment-resistant SCZ (TR-SCZ) patients and healthy controls (HC).Methodology: Structural MRI scans were obtained from 3 groups of individuals: 61 treatment resistant SCZ individuals, 67 non-resistant SCZ and 80 healthy controls. Images were analyzed using cortical surface modelling (implemented in freesurfer package) to identify group differences in cortical thickness. Statistical significant differences were identified using Monte-Carlo simulation method with a corrected p-cluster < 0.01.Results: Patients in the TR-SCZ group showed a widespread reduction in cortical thickness in frontal, parietal, temporal and occipital regions bilaterally. NR-SCZ group had reduced cortex in two regions (left superior frontal cortex and left caudal middle frontal cortex). TR-SCZ group also showed decreased thickness in the left dorsolateral prefrontal cortex (DLPFC) when compared with patients from NR-SCZ group.Conclusions: the reduction in cortical thickness in DLPFC indicates a more severe form of the disease or a specific finding for this group. Alterations in this region should be explored as a putative marker for treatment resistance. Prospective studies, with individuals being followed from first episode psychosis until refractoriness is diagnosed, are needed to clarify these hypotheses. (C) 2013 Elsevier B. V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychiat, Interdiciplinary Lab Clin Neurosci LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, PROESQ Schizophrenia Program, São Paulo, BrazilFed Univ ABC, Ctr Math Computat & Cognit, Santo Andre, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdiciplinary Lab Clin Neurosci LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, PROESQ Schizophrenia Program, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morphol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilFAPESP: 2011/50740-5Web of Scienc

REDUCED WHITE MATTER 'CONNECTIVITY' IN THE SPLENIUM OF THE CORPUS CALLOSUM IN TREATMENT-RESISTANT SCHIZOPHRENIA

Univ Fed Sao Paulo UNIFESP, LiNC, Sao Paulo, BrazilUniv Fed ABC UFABC, Sao Bernardo Do Campos, SP, BrazilUniv Fed Sao Paulo UNIFESP, LiNC, Sao Paulo, BrazilWeb of Scienc

Is there an association between cortical thickness, age of onset, and duration of illness in schizophrenia?

Objective Several studies have shown cortical volume loss in frontotemporal regions in schizophrenia patients, and it is known that these reductions may be associated with disease symptoms and cognitive deficits. the aim of this study was to investigate possible cortical thickness correlations in frontotemporal regions in relation to age at onset and duration of illness.Methods One hundred forty-eight schizophrenia patients (97 males; age and SD 36.30 +/- 10.06) and 87 (57 males; age and SD 36.48 +/- 10.10) age-matched healthy subjects underwent a brain MRI scan. Cortical segmentation and surface statistical analysis were performed using the FreeSurfer software package. Results were corrected for multiple comparisons using the Monte Carlo method considering a cluster-corrected Type I Error of 5%.Results Compared to controls, schizophrenia patients presented significant cortical thinning in the frontotemporal, parietal, and occipital cortices. No correlation between prefrontal cortex thickness and duration of illness in patients with schizophrenia or between frontotemporal cortical thickness and age at onset was found. However, a significant interaction between age and diagnosis was observed on frontal cortical thickness with patients presenting a thinner cortex than expected for age.Conclusion Although there was no correlation between age of onset and duration of illness with brain volume, our findings suggest that there is an accelerated cortical loss in schizophrenia, thus reinforcing the progressive processes of the disease.RocheEli-LillyUniversidade Federal de São Paulo UNIFESP, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Program Esquizofrenia PROESQ, São Paulo, BrazilUniv Fed ABC UFABC, Ctr Math Computat & Cognit, Santo Andre, BrazilUniversidade Federal de São Paulo UNIFESP, Morphol & Genet Dept, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Program Esquizofrenia PROESQ, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Morphol & Genet Dept, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, São Paulo, BrazilWeb of Scienc