Persistent uncrossed corticospinal connections in patients with intractable focal epilepsy

Harper L Kaye; Roman Gersner; Aaron D Boes; Alvaro Pascual-Leone; Alexander Rotenberg

doi:10.1016/j.yebeh.2017.07.013

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Persistent uncrossed corticospinal connections in patients with intractable focal epilepsy

Journal article

Peer reviewed

Persistent uncrossed corticospinal connections in patients with intractable focal epilepsy

Harper L Kaye, Roman Gersner, Aaron D Boes, Alvaro Pascual-Leone and Alexander Rotenberg

Epilepsy & behavior, Vol.75, pp.66-71

10/2017

DOI: 10.1016/j.yebeh.2017.07.013

PMCID: PMC5882467

PMID: 28830029

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https://www.ncbi.nlm.nih.gov/pmc/articles/5882467View

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Abstract

Corticospinal connections may be bilateral at birth, but a predominantly unilateral and crossed pattern develops by the toddler years. Acquired injury can alter the normal development of laterality such that uncrossed corticospinal connections persist, particularly if the injury is early in life and involves the motor system. Whether other developmental insults, such as childhood epilepsy, affect the development of crossed laterality in the motor system is unknown, although this topic has relevance for understanding the broader impact of epilepsy on brain development. Accordingly, in a cohort of children with intractable focal epilepsy, we tested by neuronavigated transcranial magnetic stimulation (nTMS) whether childhood epilepsy is associated with persistent uncrossed corticospinal connections. Specifically, we hypothesized that in contrast to early-life neuroclastic corticospinal tract injury that induces preservation of uncrossed corticospinal connections in the contralesional hemisphere, uncrossed corticospinal connections will be preserved in the epileptic hemisphere where the corticospinal tract is intact, but overstimulated by ongoing seizures and epileptic interictal discharges. Motor cortex mapping was performed by nTMS as part of a clinical presurgical evaluation, and the analysis was limited to patients with radiographically intact motor cortices and corticospinal tracts. Given that foot motor cortex representation is often bilateral, we focused on the lateralization for the tibialis anterior muscle cortical motor representation and its relation to the seizure focus. We demonstrate preserved uncrossed corticospinal connections for the tibialis anterior region of the hemisphere affected by the epilepsy. These findings indicate a pathologically preserved immature motor lateralization in patients with epilepsy and suggest that developmental processes associated with hemispheric lateralization are affected by epilepsy.

Corticospinal tract

Motor pathway maturation

Transcranial magnetic stimulation

Intractable epilepsy

Motor lateralization

Details

Title: Subtitle: Persistent uncrossed corticospinal connections in patients with intractable focal epilepsy
Creators: Harper L Kaye - Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
Roman Gersner - Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
Aaron D Boes - Neuromodulation Program, Division of Pediatric Neurology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
Alvaro Pascual-Leone - Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
Alexander Rotenberg - Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
Resource Type: Journal article
Publication Details: Epilepsy & behavior, Vol.75, pp.66-71
DOI: 10.1016/j.yebeh.2017.07.013
PMID: 28830029
PMCID: PMC5882467
NLM abbreviation: Epilepsy Behav
ISSN: 1525-5050
eISSN: 1525-5069
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100000025, name: NIMH, award: R01100186; DOI: 10.13039/100006823, name: Boston Children's Hospital; DOI: 10.13039/100000065, name: NINDS, award: R01NS088583; DOI: 10.13039/100000073, name: Autism speaks; name: Football Players Health Study; name: Assimon Family; name: Sage Pharmaceuticals; name: Eisai Pharmaceuticals; DOI: 10.13039/100011495, name: Massachusetts Life Sciences Center; name: Neuroelectrics; DOI: 10.13039/100004337, name: Roche; DOI: 10.13039/100004336, name: Novartis; DOI: 10.13039/100015428, name: Brainsway; DOI: 10.13039/100001479, name: Sidney R. Baer, Jr. Foundation; DOI: 10.13039/100000002, name: NIH, award: R21 NS082870, R01HD069776, R01NS073601, R21 MH099196, R21 NS085491, R21 HD07616; DOI: 10.13039/100007299, name: Harvard Catalyst; DOI: 10.13039/100007299, name: Harvard Clinical and Translational Science Center, award: UL1 RR025758
Language: English
Date published: 10/2017
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurology; Psychiatry; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Neurology (Pediatrics)
Record Identifier: 9984070154302771

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