Britta Wandschneider

• MD, PhD
• Medical Doctor at University College London

Objective: To investigate the effects of topiramate (TPM), zonisamide (ZNS), and levetiracetam (LEV) on cognitive network activations in patients with focal epilepsy using an fMRI language task. Methods: In a retrospective, cross-sectional study, we identified patients from our clinical database of verbal fluency fMRI studies who were treated wi...

Objective: We used functional MRI (fMRI) and a left-lateralizing verbal and a right-lateralizing visual-spatial working memory (WM) paradigm to investigate the effects of levetiracetam (LEV) on cognitive network activations in patients with drug-resistant temporal lobe epilepsy (TLE). Methods: In a retrospective study, we compared task-related f...

Sudden unexpected death in epilepsy is a major cause of premature death in people with epilepsy. We aimed to assess whether structural changes potentially attributable to sudden death pathogenesis were present on magnetic resonance imaging in people who subsequently died of sudden unexpected death in epilepsy. In a retrospective, voxel-based analys...

Juvenile myoclonic epilepsy is a heritable idiopathic generalized epilepsy syndrome, characterized by myoclonic jerks and frequently triggered by cognitive effort. Impairment of frontal lobe cognitive functions has been reported in patients with juvenile myoclonic epilepsy and their unaffected siblings. In a recent functional magnetic resonance ima...

Prospective memory (PM) describes the ability to fulfill previously planned intentions and is highly dependent on executive functions. Previous studies have shown deficits in executive functions in patients with juvenile myoclonic epilepsy (JME) and in their unaffected siblings. JME has a strong genetic predisposition and it is hypothesized that co...

BACKGROUND Emerging evidence suggests both local hyper-excitability promoting epilepsy, and synaptic and paracrine mediated integration of Glioblastoma into brain-wide neural networks. In this study we sought clinical evidence of disease progression, and concurrent radiological evidence of differences in remote cortical architecture, in Glioblastom...

Objective Blood–brain barrier dysfunction (BBBD) has been linked to various neurological disorders, including epilepsy. This study aims to utilize dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) to identify and compare brain regions with BBBD in patients with epilepsy (PWE) and healthy individuals. Methods We scanned 50 drug‐resista...

Background and objectives: Neuroimaging studies have so far identified structural changes in individuals with juvenile myoclonic epilepsy (JME) when compared with controls. However, the underlying mechanisms of drug-resistant JME remain unknown. In this study, we aimed at characterizing the structural underpinnings of drug-resistant JME using MRI-...

Background Juvenile myoclonic epilepsy (JME) is associated with cortical thinning of the motor areas. The relative contribution of antiseizure medication to cortical thickness is unknown. We aimed to investigate how valproate influences the cortical morphology of JME. Methods In this cross-sectional study, individuals with JME with and without val...

Importance: Idiopathic generalized epilepsy syndromes in are associated with cortical thinning of the premotor areas. Whether this represents an underlying disease signature, a consequence of seizure activity or is related to anti-seizure medication is unknown. Objective: To investigate valproate-related effects on cortical morphology in people wit...

Juvenile myoclonic epilepsy (JME) is no longer considered a benign condition and can present a significant challenge due to lack of seizure control and concomitant neuropsychological impairment. Its underlying mechanisms remain poorly understood. MRI studies have described structural changes in individuals with idiopathic generalized epilepsy (IGE)...

Artificial intelligence (AI)-based tools are widely employed, but their use for diagnosis and prognosis of neurological disorders is still evolving. Here we analyse a cross-sectional multicentre structural MRI dataset of 696 people with epilepsy and 118 control subjects. We use an innovative machine-learning algorithm, Subtype and Stage Inference,...

Objective The cognitive profile of juvenile absence epilepsy (JAE) remains largely uncharacterized. This study aimed to: (1) elucidate the neuropsychological profile of JAE; (2) identify familial cognitive traits by investigating unaffected JAE siblings; (3) establish the clinical meaningfulness of JAE‐associated cognitive traits; (4) determine whe...

Perampanel, a noncompetitive antagonist of the postsynaptic a‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic (AMPA) receptor, is effective for controlling focal to bilateral tonic–clonic seizures but is also known to increase feelings of anger. Using statistical parametric mapping–derived measures of activation and task‐modulated functional connecti...

Artificial intelligence (AI)-based tools are widely employed, but their use for diagnosis and prognosis of neurological disorders is still evolving. We capitalise on a large-scale, cross-sectional structural MRI dataset of 814 people with epilepsy. We use a recently developed machine-learning algorithm, Subtype and Stage Inference (SuStaIn), to dev...

Objectives/Aims Cognitive impairment is a common comorbidity of epilepsy, and can be more burdensome than seizures themselves. Temporal and frontal lobe epilepsy (TLE, FLE) are accompanied by multi-domain cognitive impairment. While the underlying neural substrates have been extensively investigated in TLE, functional imaging studies in FLE are sca...

Cognitive impairment is a common comorbidity of epilepsy, and adversely impacts people with both frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). While its neural substrates have been extensively investigated in TLE, functional imaging studies in FLE are scarce. In this study, we profiled the neural processes underlying cognitive impai...

Objective The cognitive profile of juvenile absence epilepsy (JAE) remains uncharacterized. This study aimed to: (i) elucidate the neuropsychological profile of JAE; (ii) assess cognitive trait heritability, by investigating unaffected JAE siblings; (iii) determine whether cognitive traits across the idiopathic generalized epilepsy (IGE) spectrum a...

Background In epilepsy, cognitive difficulties are common, partly a consequence of anti-seizure medications (ASM), and cognitive side-effects are often considered to be more disabling than seizures and significantly affect quality of life. Functional MRI during verbal fluency tasks demonstrated impaired frontal activation patterns and failed defaul...

Genetic generalized epilepsy (GGE) syndromes start during childhood or adolescence, and four commonly persist into adulthood, making up 15–20% of all cases of epilepsy in adults. These four GGE syndromes are childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy and epilepsy with generalized tonic–clonic seizures alone....

Cognitive impairment is a common comorbidity of epilepsy, and adversely impacts people with both frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE). While the underlying neural substrates in TLE have been extensively investigated, functional imaging studies in FLE are scarce. In this study, we profiled cognitive dysfunction in FLE, and di...

Objective Juvenile myoclonic epilepsy (JME) is the most common genetic generalized epilepsy syndrome. Myoclonus may relate to motor system hyperexcitability and can be provoked by cognitive activities. To aid genetic mapping in complex neuropsychiatric disorders, recent research has utilized imaging intermediate phenotypes (endophenotypes). Here, w...

In the past 25 years neuroimaging studies have made a significant contribution to further the understanding of the pathophysiology of juvenile myoclonic epilepsy (JME). This article summarizes the key results of these studies and discusses their meaning in the context of genetic alterations and brain development in JME. In summary, JME is a complex...

Genetic generalized epilepsies (GGE), previously called idiopathic generalized epilepsies, constitute about 20% of all epilepsies, and include childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone (CAE, JAE, JME, and GGE-GTCS, respectively). GGE are characterize...

Objective: MRI studies of genetic generalized epilepsies have mainly described group-level changes between patients and healthy controls. To determine the endophenotypic potential of structural MRI in juvenile myoclonic epilepsy (JME), we examined MRI-based cortical morphologic markers in patients and their healthy siblings. Methods: In this pro...

Juvenile myoclonic epilepsy is the most common genetic generalized epilepsy syndrome, characterized by a complex polygenetic aetiology. Structural and functional MRI studies demonstrated mesial or lateral frontal cortical derangements and impaired fronto-cortico-subcortical connectivity in patients and their unaffected siblings. The presence of hip...

Objective The processes underlying sudden unexpected death in epilepsy (SUDEP) remain elusive, but centrally mediated cardiovascular or respiratory collapse is suspected. Volume changes in brain areas mediating recovery from extreme cardiorespiratory challenges may indicate failure mechanisms and allow prospective identification of SUDEP risk. Met...

Importance A functional area associated with the piriform cortex, termed area tempestas, has been implicated in animal studies as having a crucial role in modulating seizures, but similar evidence is limited in humans. Objective To assess whether removal of the piriform cortex is associated with postoperative seizure freedom in patients with tempo...

Imaging Biomarkers in Epilepsy - edited by Andrea Bernasconi January 2019

Imaging Biomarkers in Epilepsy - edited by Andrea Bernasconi January 2019

Cambridge Core - Medical Imaging - Imaging Biomarkers in Epilepsy - edited by Andrea Bernasconi

Introduction Medial temporal lobe epilepsy (mTLE) is the most common refractory focal epilepsy in adults. Around 30%‐40% of patients have prominent memory impairment and experience significant postoperative memory and language decline after surgical treatment. BDNF Val66Met polymorphism has also been associated with cognition and variability in str...

Objective To investigate the effects of sodium channel–blocking antiepileptic drugs (AEDs) on functional magnetic resonance imaging (fMRI) language network activations in patients with focal epilepsy. Methods In a retrospective study, we identified patients who were treated at the time of language fMRI scanning with either carbamazepine (CBZ; n =...

Konventionelle bildgebende Verfahren sind bei Patienten mit idiopathischen generalisierten Epilepsien per definitionem unauffällig. MRT-basierte (Magnetresonanztomographie), morphometrische Verfahren konnten jedoch in Gruppenanalysen subtile strukturelle Veränderungen insbesondere im mesialen Frontallappen, supplementär motorischen Areal und Thalam...

Background: Approximately one third of patients with epilepsy are refractory to medical treatment. Adverse effects associated with anti-epileptic drugs (AEDs) are considered to affect quality of life often more than seizures themselves. Neuroimaging techniques, particularly magnetic resonance imaging (MRI), have proven instrumental in clinical dec...

Epilepsy is one of the most common neurological disorders. Apart from seizures, patients are also affected by epilepsy comorbidities, such as cognitive impairment, side effects of antiepileptic drugs, and an increased risk of dying from sudden death. Within epilepsy research, recent efforts have been made to identify reliable biomarkers to advance...

Functional MRI studies have helped to elucidate underlying mechanisms in complex neurological and neuropsychiatric disorders. Disease processes often involve complex large-scale network interactions, extending beyond the presumed main disease focus. Given both the complexity of the clinical phenotype and the underlying dysfunctional brain circuits,...

Retinal nerve fibre layer (RNFL) thickness is related to the axonal anterior visual pathway and is considered a marker of overall white matter 'integrity'. We hypothesised that RNFL changes would occur in people with epilepsy, independently of vigabatrin exposure, and be related to clinical characteristics of epilepsy. Three hundred people with epi...

Objectives Due to demographic change and high incidence of epilepsy in elderly, the number of elderly with epilepsies is increasing. However, only few studies investigated the impact of epilepsy on quality of life (QoL). We investigated how epilepsy affects different aspects of QoL dependent on the age of the patients and the age of onset of epilep...

Juvenile myoclonic epilepsy (JME) is a clinically and genetically heterogenous, generalized epilepsy syndrome usually starting in adolescence. An age-related, predominantly frontocortical-subcortical network dysfunction is likely to be the substrate of bilateral myoclonic seizures occurring at full consciousness within hours after awakening, which...

The prevalence and incidence of epilepsies in elderly is high. Due to demographic development, the portion of elderly patients with epilepsy will continue to rise over the next decades. In this study, we aimed to investigate seizure semiology, etiology, comorbidity, and therapy in elderly patients dependent on onset of epilepsy and in comparison wi...

Patients with juvenile myoclonic epilepsy (JME) often present with risk-taking behavior, suggestive of frontal lobe dysfunction. Recent studies confirm functional and microstructural changes within the frontal lobes in JME. This study aimed at characterizing decision-making behavior in JME and its neuronal correlates using functional magnetic reson...

Table S1. Clinical details.

Table S2. Neuropsychological test results in patients (learners vs. nonlearners).

Figure S1. Association of working memory networks activation with IGT performance.

Supplementary Materials.

An international workshop on juvenile myoclonic epilepsy (JME) was conducted in Avignon, France in May 2011. During that workshop, a group of 45 experts on JME, together with one of the founding fathers of the syndrome of JME (“Janz syndrome”), Prof. Dr. Dieter Janz from Berlin, reached a consensus on diagnostic criteria and management of JME.The i...

Juvenile myoclonic epilepsy is the most common idiopathic epilepsy syndrome and is considered a benign seizure disorder that responds well to antiepileptic drug treatment, in particular sodium valproate. By definition, routine brain imaging shows no abnormalities, but advanced imaging studies have identified functional and structural abnormalities...

Moderne bildgebende Verfahren bieten neue Möglichkeiten, die Pathomechanismen idopathisch generalisierter Epilepsien (IGE) zu ergründen. Dieser Beitrag fasst aktuelle Studien mit strukturellen und funktionellen MRT-, MR-Spektroskopie und PET-Untersuchungen zusammen und verdeutlicht sie exemplarisch an einigen Studien. In den meisten Studien werden...

Although most children born to women with epilepsy on anticonvulsive medication are healthy, in utero anti-epileptic exposure is associated with an increased risk of congenital malformations. Trying to balance the risk of seizure recurrence and potential malformations, several large prospective pregnancy registries have been founded to allow a syst...

Zusammenfassung Obwohl die meisten Schwangerschaften unter Antiepileptika komplikationslos verlaufen, ist eine In-utero-Exposition mit Antikonvulsiva mit einem erhöhten Fehlbildungsrisiko assoziiert. Um eine sinnvolle Abwägung des Fehlbildungsrisikos im Vergleich zu möglichen Anfallsrezidiven bei Umstellung oder Reduktion der Antiepileptika treffen...