title: Frontal lobe connectivity and cognitive impairment in pediatric frontal lobe epilepsy.
abstract: OBJECTIVE
  Cognitive impairment is frequent in children with frontal lobe epilepsy (FLE), but its etiology is unknown. With functional magnetic resonance imaging (fMRI), we have explored the relationship between brain activation, functional connectivity, and cognitive functioning in a cohort of pediatric patients with FLE and healthy controls.
  
  
  METHODS
  Thirty-two children aged 8-13 years with FLE of unknown cause and 41 healthy age-matched controls underwent neuropsychological assessment and structural and functional brain MRI. We investigated to which extent brain regions activated in response to a working memory task and assessed functional connectivity between distant brain regions. Data of patients were compared to controls, and patients were grouped as cognitively impaired or unimpaired.
  
  
  RESULTS
  Children with FLE showed a global decrease in functional brain connectivity compared to healthy controls, whereas brain activation patterns in children with FLE remained relatively intact. Children with FLE complicated by cognitive impairment typically showed a decrease in frontal lobe connectivity. This decreased frontal lobe connectivity comprised both connections within the frontal lobe as well as connections from the frontal lobe to the parietal lobe, temporal lobe, cerebellum, and basal ganglia.
  
  
  CONCLUSIONS
  Decreased functional frontal lobe connectivity is associated with cognitive impairment in pediatric FLE. The importance of impairment of functional integrity within the frontal lobe network, as well as its connections to distant areas, provides new insights in the etiology of the broad-range cognitive impairments in children with FLE.
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands. hilde.braakman@gmail.com
authors.forename: Hilde M H
authors.initials: HM
authors.lastname: Braakman
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Vaessen
authors.forename: Jacobus F A
authors.initials: JF
authors.lastname: Jansen
authors.forename: Mariette H J A
authors.initials: MH
authors.lastname: Debeij-van Hall
authors.forename: Anton
authors.initials: A
authors.lastname: de Louw
authors.forename: Paul A M
authors.initials: PA
authors.lastname: Hofman
authors.forename: Johan S H
authors.initials: JS
authors.lastname: Vles
authors.forename: Albert P
authors.initials: AP
authors.lastname: Aldenkamp
authors.forename: Walter H
authors.initials: WH
authors.lastname: Backes
mesh_terms: D000293:Adolescent; D002648:Child; D003072:Cognition Disorders / Q000453:epidemiology* / Q000503:physiopathology* / Q000523:psychology; D015331:Cohort Studies; D017034:Epilepsy, Frontal Lobe / Q000453:epidemiology* / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005625:Frontal Lobe / Q000502:physiology*; D006801:Humans; D008297:Male; D009415:Nerve Net / Q000502:physiology*; D009434:Neural Pathways / Q000502:physiology; D010775:Photic Stimulation / Q000379:methods; D011597:Psychomotor Performance / Q000502:physiology; D012042:Registries