Highlights
- •Children with SeLECTS show reduced performance on language assessments.
- •Language assessment scores are worse in children with active SeLECTS than those in children in remission.
- •White matter micro- and macrostructure are abnormal in regions constituting language networks in SeLECTS.
- •Connectivity between language network nodes is abnormal in SeLECTS.
Abstract
Introduction
Self-limited epilepsy with centrotemporal spikes is a transient developmental epilepsy
with a seizure onset zone localized to the centrotemporal cortex that commonly impacts
aspects of language function. To better understand the relationship between these
anatomical findings and symptoms, we characterized the language profile and white
matter microstructural and macrostructural features in a cohort of children with SeLECTS.
Methods
Children with active SeLECTS (n = 13), resolved SeLECTS (n = 12), and controls (n = 17) underwent high-resolution MRIs including diffusion tensor imaging sequences
and multiple standardized neuropsychological measures of language function. We identified
the superficial white matter abutting the inferior rolandic cortex and superior temporal
gyrus using a cortical parcellation atlas and derived the arcuate fasciculus connecting
them using probabilistic tractography. We compared white matter microstructural characteristics
(axial, radial and mean diffusivity, and fractional anisotropy) between groups in
each region, and tested for linear relationships between diffusivity metrics in these
regions and language scores on neuropsychological testing.
Results
We found significant differences in several language modalities in children with SeLECTS
compared to controls. Children with SeLECTS performed worse on assessments of phonological
awareness (p = 0.045) and verbal comprehension (p = 0.050). Reduced performance was more pronounced in children with active SeLECTS
compared to controls, namely, phonological awareness (p = 0.028), verbal comprehension (p = 0.028), and verbal category fluency (p = 0.031), with trends toward worse performance also observed in verbal letter fluency
(p = 0.052), and the expressive one-word picture vocabulary test (p = 0.068). Children with active SeLECTS perform worse than children with SeLECTS in
remission on tests of verbal category fluency (p = 0.009), verbal letter fluency (p = 0.006), and the expressive one-word picture vocabulary test (p = 0.045). We also found abnormal superficial white matter microstructure in centrotemporal
ROIs in children with SeLECTS, characterized by increased diffusivity and fractional
anisotropy compared to controls (AD p = 0.014, RD p = 0.028, MD p = 0.020, and FA p = 0.024). Structural connectivity of the arcuate fasciculus connecting perisylvian
cortical regions was lower in children with SeLECTS (p = 0.045), and in the arcuate fasciculus children with SeLECTS had increased diffusivity
(AD p = 0.007, RD p = 0.006, MD p = 0.016), with no difference in fractional anisotropy (p = 0.22). However, linear tests comparing white matter microstructure in areas constituting
language networks and language performance did not withstand correction for multiple
comparisons in this sample, although a trend was seen between FA in the arcuate fasciculus
and verbal category fluency (p = 0.047) and the expressive one-word picture vocabulary test (p = 0.036).
Conclusion
We found impaired language development in children with SeLECTS, particularly in those
with active SeLECTS, as well as abnormalities in the superficial centrotemporal white
matter as well as the fibers connecting these regions, the arcuate fasciculus. Although
relationships between language performance and white matter abnormalities did not
pass correction for multiple comparisons, taken together, these results provide evidence
of atypical white matter maturation in fibers involved in language processing, which
may contribute to the aspects of language function that are commonly affected by the
disorder.
Keywords
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Article info
Publication history
Published online: May 18, 2023
Accepted:
May 5,
2023
Received in revised form:
May 4,
2023
Received:
February 10,
2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
