Amygdala Volumes in Childhood Absence Epilepsy Epilepsy

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Amygdala Volumes in Childhood Absence
EpilepsyEpilepsy Behavior 16 (2009) 436441

• Schreibman Cohen, A., Daley, M., Siddarth, P.,
  Loesch, IK., Levitt, J., Gurbani, S., Altshuler
  L., Ly R., Shields W. D., and Caplan, R.
• child and adolescents division, Geha Mental
  Health Center, Sackler Faculty of Medicine, Tel
  Aviv University, Israel UCLA David Geffen
  School of Medicine , U.S.A

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Rationale and Aims (Caplan et al., 2009
Bouilleret et al., 2009 Milham et al.,
2005 Plessen et al., 2006 Rosso et al.,
2005)

• CAE
• Anxiety disorders
• ADHD
• Abnormal amygdala
• GAERS (genetic absence epilepsy rats from
  Strasbourg)
• Pediatric mood, anxiety, and ADHD disorders

• Aims
• Amygdala volumes
• CAE vs. normal
• Within CAE
• Psychopathology
• Seizure variables
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

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Methods

• Participants
• 26 CAE and 23 normal children, aged 6.6 15.3
  years
• MRI analysis
• 1.5 T
• Amygdala tracing protocol (Bartzokis et al.,
  1998 Levitt et al., 2001 Daley et al., 2008)
• Psychopathology Seizure Variables
• K-SADS-PL (Kaufman et al., 1997)
• CDI (Kovacs, 1985)
• MASC (March, 1997)
• CBCL (Achenbach, 1991)

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Table 1 Demographic Features of CAE and Control
Groups
CAE Control
N 26 23
Age (SD) (years) 9.31 (1.99) 9.45 (1.95)
Gender Male Female 35 65 52 48
Socioeconomic status High (i-iii) Low (iv-v) 31 69 22 78
Ethnicity Caucasian Non-Caucasian 38 62 26 74
IQ (SD) Full Scale1 Verbal IQ2 Performance IQ 101 (19.62) 100.8 (21.8) 101.8 ( 18.82) 111 (12.83) 113.2 (14.86) 106.3 (11.63)
1t (43.5) 2.07, plt0.05, 2t (44.3) 2.35, plt 0.02
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Seizure-related Variables in CAE Group
Seizure Variables CAE
Age at onset (SD) 6.99 (2.08)
Duration of illness (SD) 2.32 (2.28)
Log seizure frequency (SD) 5.84 (2.95)
Seizure control 15
Antiepileptic drugs None Monotherapy Polytherapy 11.5 61.5 27
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Fig 1 manual tracing in coronal plain
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Results

• Volumes
• CAE normal
• Boys gt girls
• Asymmetry
• ?Seizure frequency (F(1,23) 9.26, p lt .006).
• ADHD lt no psychopathology (Wilcoxon test
  statistic 50, exact plt0.02)
• ADHD lt affective/anxiety (Wilcoxon test
  statistic 73, exact plt0.05)

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Amygdala Volumes and Psychopathology
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Study limitations

• seizure frequency and seizure control.
• exploratory nature, small sample size.
• limited power for the psychopathology analyses.
• higher proportion of girls in the CAE group, and
  IQ differences between the CAE and control groups
• All statistical tests were two-tailed

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Conclusions CAE and Amygdala Development

• Development Severity

• Psychopathology

• ADHD (Lopez et al., 2009 Plessen et al., 2006)
• Confounding effects
• Anxiety depression
• GAERS
• Anxiety predates seizures (Jones et al., 2008)
• Increased amygdala (Bouilleret et al., 2009)

• Similar to CPS (Daley et al., 2008)
• Duration and severity
• Adults with epilepsy (Cendes et al., 1994
  Briellman et al., 2007)
• Seizure frequency in CAE
• R/ L asymmetry (Caviness et al.,1996)