voxel-based morphometry
در نشریات گروه پزشکی-
Context:
Functional neurological disorder (FND) is common in neurology outpatient clinics, affecting approximately 6% of neurology patients. Functional neurological disorder is characterized by motor and sensory symptoms that cannot be explained by organic or structural neurological issues. These symptoms often mimic those of recognized neurological conditions, making diagnosis and treatment complex.
Evidence Acquisition:
This study presents a comprehensive voxel-wise meta-analysis of structural brain changes in FND to explore potential quantitative measurements that could serve as biomarkers for different FND types. In this investigation, we systematically queried prominent academic databases using specific keywords: "FND", "somatization disorder", and "voxel-based morphometry (VBM) ". Additionally, we employed the BrainMap database to identify VBM data pertaining to FND. Our meta-analysis, performed using ES-SDM software, examined grey matter (GM) changes in FND patients. We also assessed the robustness of the results via Jackknife analysis and investigated unexplained variability using heterogeneity analysis.
ResultsOur meta-analysis revealed both positive and negative GM volumetric changes in different brain areas across various FND types. The robustness of the results was confirmed, and the assessment of bias and publication bias yielded no significant concerns.
ConclusionsThese findings offer valuable insights into the neuroanatomical basis of diverse functional disorders, providing potential biomarkers. Moreover, the identified regions are associated with pain modulation, emotional processing, and cognitive functions, contributing to a better understanding of FND pathophysiology.
Keywords: Functional Neurological Disorder, Voxel-Based Morphometry, Structural Brain Changes, Biomarkers -
Purpose
Sodium Valproate (VPA) is one of the first-generation Antiepileptic Drugs (AEDs) which mediates epileptic activities by releasing stimulators of Gamma-Aminobutyric Acid (GABA) and is greatly used to treat partial and generalized seizures. Lamotrigine )LTG( is commonly used as AEDs that are widely utilized in first-line monotherapy or in combination with other AEDs. Our specific goal was to compare these two AEDs with different molecular mechanisms on both cortical and subcortical brain structures, along with cognitive performance and dysfunctions.
Materials and MethodsWe conducted a retrospective study comparing LTG with sodium VPA, both administrated as monotherapy. Twenty patients with a confirmed generalized-epilepsy tonic-clonic seizure who had been treated at least 6 months with LTG (n=8) and Sodium VPA (n=12) were retrospectively recruited. We also included 12 age, gender, and education-matched Healthy Controls (HC). We evaluated cognitive performances. All participants underwent a Magnetic Resonance Imaging (MRI) scanner and T1-weighted MR images were acquired. Voxel-based morphometric alterations in the brain cortex, as well as subcortical structures, were inspected using Statistical Parametric Mapping (SPM) software.
ResultsThe cognitive performance was revealed inferior in patients on Sodium VPA. Poor performance was associated with significant volume reduction in insula bilaterally, and subcortical structures of thalamus, cerebellum, and hippocampus compared to the HC. Comparing patients on LTG to HC revealed significant volume reduction in the anterior cingulate cortex in concordance with slight cognitive dysfunctions.
ConclusionThese findings suggested that different molecular mechanisms of Antiepileptic Drugs (AEDs) may affect brain structures and cognition with different severity levels, presumably with more adverse effects induced by GABA mediations from sodium VPA.
Keywords: Sodium Valproate, Lamotrigine, Antiepileptic Drugs, Idiopathic Generalized Epilepsy, CognitivePerformance, Voxel Based Morphometry
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