title: Impaired attention and network connectivity in childhood absence epilepsy.
abstract: Patients with childhood absence epilepsy (CAE) often demonstrate impaired interictal attention, even with control of their seizures. No previous study has investigated the brain networks involved in this impairment. We used the continuous performance task (CPT) of attentional vigilance and the repetitive tapping task (RTT), a control motor task, to examine interictal attention in 26 children with CAE and 22 matched healthy controls. Each subject underwent simultaneous 3T functional magnetic resonance imaging-electroencephalography (fMRI-EEG) and CPT/RTT testing. Areas of activation on fMRI during the CPT task were correlated with behavioral performance and used as seed regions for resting functional connectivity analysis. All behavioral measures reflecting inattention were significantly higher in patients. Correlation analysis revealed that impairment on all measures of inattention on the CPT task was associated with decreased medial frontal cortex (MFC) activation during CPT. In addition, analysis of resting functional connectivity revealed an overall decrease within an 'attention network' in patients relative to controls. Patients demonstrated significantly impaired connectivity between the right anterior insula/frontal operculum (In/FO) and MFC relative to controls. Our results suggest that there is impaired function in an attention network comprising anterior In/FO and MFC in patients with CAE. These findings provide an anatomical and functional basis for impaired interictal attention in CAE, which may allow the development of improved treatments targeted at these networks.
authors.affiliation: Department of Neurosurgery, Barrow Neurosurgical Institute, 350 Thomas Rd, Phoenix, AZ 85023, USA.
authors.forename: Brendan D
authors.initials: BD
authors.lastname: Killory
authors.forename: Xiaoxiao
authors.initials: X
authors.lastname: Bai
authors.forename: Michiro
authors.initials: M
authors.lastname: Negishi
authors.forename: Clemente
authors.initials: C
authors.lastname: Vega
authors.forename: Marisa N
authors.initials: MN
authors.lastname: Spann
authors.forename: Matthew
authors.initials: M
authors.lastname: Vestal
authors.forename: Jennifer
authors.initials: J
authors.lastname: Guo
authors.forename: Rachel
authors.initials: R
authors.lastname: Berman
authors.forename: Nathan
authors.initials: N
authors.lastname: Danielson
authors.forename: Jerry
authors.initials: J
authors.lastname: Trejo
authors.forename: David
authors.initials: D
authors.lastname: Shisler
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Novotny
authors.forename: R Todd
authors.initials: RT
authors.lastname: Constable
authors.forename: Hal
authors.initials: H
authors.lastname: Blumenfeld
mesh_terms: D000293:Adolescent; D001288:Attention / Q000502:physiology*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D002648:Child; D004569:Electroencephalography; D004832:Epilepsy, Absence / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000503:physiopathology*; D011597:Psychomotor Performance / Q000502:physiology; D012815:Signal Processing, Computer-Assisted; D055815:Young Adult