title: Focal structural changes and cognitive dysfunction in juvenile myoclonic epilepsy.
abstract: OBJECTIVE
  The aim of this study was to determine if there were focal cortical abnormalities in juvenile myoclonic epilepsy (JME) using neuropsychological investigations and MRI.
  
  
  METHODS
  Twenty-eight patients with JME and a large sample of healthy controls were assessed using a series of neuropsychological tests as well as structural and diffusion tensor MRI (DTI). DTI measures assessed fractional anisotropy (FA) within a white matter skeleton.
  
  
  RESULTS
  Neuropsychological testing indicated subtle dysfunctions in verbal fluency, comprehension, and expression, as well as nonverbal memory and mental flexibility. Utilizing whole-brain voxel-based morphometry for gray matter MRI data and tract-based spatial statistics for white matter diffusion MRI data, we found reductions in gray matter volume (GMV) in the supplementary motor area and posterior cingulate cortex and reductions in FA in underlying white matter of the corpus callosum. Supplementary motor area FA predicted scores in word naming tasks and expression scores. Posterior cingulate cortex GMV and FA predicted cognitive inhibition scores on the mental flexibility task.
  
  
  CONCLUSIONS
  The neuropsychological, structural, and tractography results implicate mesial frontal cortex, especially the supplementary motor area, and posterior cingulate cortex in JME.
authors.affiliation: Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: J
authors.initials: J
authors.lastname: O'Muircheartaigh
authors.forename: C
authors.initials: C
authors.lastname: Vollmar
authors.forename: G J
authors.initials: GJ
authors.lastname: Barker
authors.forename: V
authors.initials: V
authors.lastname: Kumari
authors.forename: M R
authors.initials: MR
authors.lastname: Symms
authors.forename: P
authors.initials: P
authors.lastname: Thompson
authors.forename: J S
authors.initials: JS
authors.lastname: Duncan
authors.forename: M J
authors.initials: MJ
authors.lastname: Koepp
authors.forename: M P
authors.initials: MP
authors.lastname: Richardson
mesh_terms: D000328:Adult; D016880:Anisotropy; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D056324:Diffusion Tensor Imaging / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020190:Myoclonic Epilepsy, Juvenile / Q000150:complications* / Q000473:pathology*; D009483:Neuropsychological Tests