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Tuberous sclerosis complex: white matter disruption is associated with persistent seizures


White matter is diffusely altered in tuberous sclerosis complex ( TSC ), and these alterations appear to be more evident in subjects with a more severe neurologic phenotype.
However, little is known on the correlation between white matter alterations and epilepsy in tuberous sclerosis complex.

The aims of this study were to evaluate the effects of early onset and refractory seizures on white matter by using diffusion tensor imaging ( DTI ).

Researchers enrolled 20 children with tuberous sclerosis complex and epilepsy onset in the first 3 years of life and grouped them according to seizure persistence or freedom.

All patients underwent brain MRI with DTI. Specific ROIs were placed to generate tracks to calculate fractional anisotropy ( FA ) and apparent diffusion coefficient ( ADC ).

Children with persistent seizures presented an overall reduced fractional anisotropy, with statistically significant differences on the cingulum ( right p=0.003, left p=0.016 ), the left cerebral peduncle ( p=0.020 ), the superior cerebellar peduncles ( right p=0.008, left p=0.002 ), the posterior limbs of internal capsule ( right p=0.037, left p=0.015 ), the external capsule ( right p=0.018, left p=0.031 ), the inferior frontooccipital fasciculus ( right p=0.010, left p=0.026 ), and the temporal trunk ( right p=0.017, left p=0.001 ).

In conclusion, the study demonstrated that children with persistent seizures present more significant alterations of brain connectivity in areas crucial for global cognitive maturation, executive functions, and verbal abilities, implying a higher risk of cognitive impairment, attention-deficit hyperactivity disorder, and autism. ( Xagena )

Moavero R et al, Epilepsy Behav 2016;60:63-67

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