Poster Session 09 Program Schedule
02/16/2024
03:30 pm - 04:45 pm
Room: Shubert Complex (Posters 1-60)
Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease
Final Abstract #33
White Matter Fiber Integrity: A Potential Neuroprotective Factor in an 8-Year-Old Female with Refractory Childhood-Onset Temporal Lobe Epilepsy and Autism Spectrum Disorder.
Hala El Bahraoui, Nicklaus Children's Hospital, Miami, United States
Sofia Iglesias Medina, Nicklaus Children's Hospital, Miami, United States
Jacqueline Mahfood, Nicklaus Children's Hospital, Miami, United States
Category: Epilepsy/Seizures
Keyword 1: epilepsy / seizure disorders
Keyword 2: neuropsychological assessment
Keyword 3: neuroimaging: structural connectivity
Objective:
Childhood-onset temporal lobe epilepsy (TLE) is associated with impairment across various neurocognitive domains. Studies have shown that early age-of-onset among individuals with medication-refractory epilepsy is associated with greater vulnerability to the detrimental effects of uncontrolled seizures on cognition. Individuals with a history of in-utero exposure to stimulants and opioids also have been found to be at a higher risk for deficits in executive function, attention, and language. Through the use of Diffusion Tensor Imaging (DTI), studies have found widespread white matter (WM) abnormalities among patients with TLE. These WM tract abnormalities have been correlated with neurocognitive impairments.
The purpose of this case study is to evaluate whether WM integrity is a potential neuroprotective factor that may have contributed to the preservation of cognitive abilities in a pediatric patient with a history of in-utero drug exposure.
Participants and Methods:
A comprehensive neuropsychological battery was completed during a week-long inpatient admission to determine surgical candidacy for refractory epilepsy. Attention, verbal working memory and executive functions were assessed using Wechsler Intelligence Scale for Children-5th edition (WISC-V) Digit Span, Wechsler Individual Achievement Test-4th edition (WIAT-4) Sentence Repetition, Delis-Kaplan Executive Function System (DKEFS) Verbal Fluency and Design Fluency respectively. Additionally, neuroimaging and electroencephalography (EEG) recording was completed.
Results:
Attention, verbal working memory and executive functions were intact, with scores ranging between low average and high average on all measures. No significant WM abnormalities were found, with normal distribution of WM fibers noted across both hemispheres (i.e. corpus callosum, corticospinal tract, and optic tract). Of note, inferior fronto-occipital fasciculi were identified being larger in the right hemisphere and the arcuate fasciculi could not be well identified.
Conclusions:
Individuals with intractable TLE, as well as drug exposure during development are likely to demonstrate cognitive impairments, including attention, working memory and executive functions. According to literature, WM tract abnormalities contribute to neurocognitive deficits by decreasing communication between subcortical and cortical areas of the brain. The current case study revealed an intact neurocognitive profile, in a pediatric patient with in-utero drug exposure and comparable WM integrity between and within both hemispheres. It is our impression that robust WM integrity played a neuroprotective role, aiding in the preservation of her cognitive functioning. Other factors that may have contributed to her positive outcomes include functional reorganization given the early onset of seizure activity. Limitations include unknown genetic factors and an unknown early childhood history that may also play a role in neuroprotection. Future work should further examine the neuroprotective role of WM tracts among a larger more diverse sample.
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