title: Extrafrontal structural changes in juvenile myoclonic epilepsy: a topographic analysis of combined structural and microstructural brain imaging.
abstract: OBJECTIVE
  An increasing amount of evidence has demonstrated that juvenile myoclonic epilepsy (JME) is associated with structural abnormalities in not only the thalamofrontal system but its adjacent regions such as temporal or parieto-occipital areas. The goal of this study was to systematically characterize morphological changes and the subsequent pathophysiological implications in JME patients using the combined structural and diffusion tensor MRI analysis.
  
  
  METHODS
  Comparisons of white matter (WM) water diffusivity and gray matter (GM) cortical thickness were analyzed with tract-based spatial statistics (TBSS) and a Constrained Laplacian-based Anatomic Segmentation with Proximity (CLASP) algorithm, respectively. Additionally, volumes of the bilateral thalami and hippocampi were obtained using manual volumetry (MV).
  
  
  RESULTS
  Compared with 22 normal controls, 18 patients with JME exhibited WM alterations in the antero-superior corona radiata, corpus callosum, both centro-parietal regions, and the left temporal lobe. JME patients also had reduced GM thickness (right paracentral lobule, precuneus, dorsolateral parietal and inferior temporal cortex; left dorsolateral frontal and anterior temporal areas). Furthermore, MV analyses revealed a significant volume reduction in the bilateral thalami and hippocampi.
  
  
  CONCLUSIONS
  In addition to structural changes in the thalamofrontal system, there was a conspicuous alteration of WM diffusivity in widespread extra-frontal areas and an associated decreased GM thickness in temporoparietal regions, including a significant reduction of hippocampal volume. These findings suggest that the pathophysiology of JME may be not confined to the thalamofrontal circuit but may also involve extensive areas of the extra-frontal network which encompasses temporo-parietal regions.
authors.affiliation: Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea; Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Lim
authors.affiliation: Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea; Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
authors.forename: Woojun
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea.
authors.forename: Oh-Hun
authors.initials: OH
authors.lastname: Kwon
authors.affiliation: Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea.
authors.forename: Seun
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea; Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea. Electronic address: sonogung@catholic.ac.kr.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Shon
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005260:Female; D066128:Gray Matter / Q000473:pathology; D006801:Humans; D008297:Male; D020190:Myoclonic Epilepsy, Juvenile / Q000473:pathology* / Q000503:physiopathology; D009929:Organ Size; D066127:White Matter / Q000473:pathology; D055815:Young Adult
keywords: Cortical thickness; Diffusion tensor imagine; Hippocampal atrophy; Juvenile myoclonic epilepsy; Water diffusivity