Marcos Vidal-Dourado1, Karlo Faria Nunes2, Mirian Salvadori Bittar Guaranha3, Lydia Maria Pereira Giuliano2, Elza Márcia Targas Yacubian3, Gilberto Mastrocola Manzano2. 1. Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Electronic address: dourado@unifesp.br. 2. Department of Neurology and Neurosurgery, Division of Neurology, Section of Clinical Neurophysiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. 3. Department of Neurology and Neurosurgery, Division of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Abstract
OBJECTIVE: This study aimed to evaluate the effects of praxis induction on sensorimotor cortical and transcallosal excitability in juvenile myoclonic epilepsy (JME). METHODS: A total of 36 subjects (18-62years) were included. The JME group was screened by video-electroencephalography neuropsychological protocol and divided into JME without praxis induction [JME-WI (n=12)], JME with praxis-induced seizures or epileptiform discharges [JME-PI (n=10)], and healthy controls (n=14). Motor and somatosensory cortical excitability and transcallosal pathways were evaluated through single-pulse transcranial magnetic stimulation (sTMS) and somatosensory evoked potentials (SEPs). RESULTS: Motor and transcallosal excitabilities tested with sTMS were not different in the motor-dominant or non-dominant hemisphere among groups. Significant differences were found in cortical SEP amplitudes in the P27 component of the non-dominant hemisphere (p=0.03, Cohen's d=0.98), N35 in the dominant hemisphere (p=0.04, Cohen's d=0.96), and P27-35 interpeak amplitude in both somatosensory cortices of the JME-PI group (p=0.03, Cohen's d=0.96; p=0.02, Cohen's d=1.05) when compared with healthy controls. Giant SEPs were observed in two (16.7%) and five (50%) patients of the JME-WI and JME-PI groups, respectively. Cortical latencies did not reveal differences. CONCLUSIONS: Praxis induction was associated with enhanced excitability in the somatosensory cortex of JME patients. SIGNIFICANCE: These findings may help clarifying the less favorable therapeutic response in the JME-PI group and indicate identifying praxis induction as an important determinant in differentiating between JME patients.
OBJECTIVE: This study aimed to evaluate the effects of praxis induction on sensorimotor cortical and transcallosal excitability in juvenile myoclonic epilepsy (JME). METHODS: A total of 36 subjects (18-62years) were included. The JME group was screened by video-electroencephalography neuropsychological protocol and divided into JME without praxis induction [JME-WI (n=12)], JME with praxis-induced seizures or epileptiform discharges [JME-PI (n=10)], and healthy controls (n=14). Motor and somatosensory cortical excitability and transcallosal pathways were evaluated through single-pulse transcranial magnetic stimulation (sTMS) and somatosensory evoked potentials (SEPs). RESULTS: Motor and transcallosal excitabilities tested with sTMS were not different in the motor-dominant or non-dominant hemisphere among groups. Significant differences were found in cortical SEP amplitudes in the P27 component of the non-dominant hemisphere (p=0.03, Cohen's d=0.98), N35 in the dominant hemisphere (p=0.04, Cohen's d=0.96), and P27-35 interpeak amplitude in both somatosensory cortices of the JME-PI group (p=0.03, Cohen's d=0.96; p=0.02, Cohen's d=1.05) when compared with healthy controls. Giant SEPs were observed in two (16.7%) and five (50%) patients of the JME-WI and JME-PI groups, respectively. Cortical latencies did not reveal differences. CONCLUSIONS: Praxis induction was associated with enhanced excitability in the somatosensory cortex of JME patients. SIGNIFICANCE: These findings may help clarifying the less favorable therapeutic response in the JME-PI group and indicate identifying praxis induction as an important determinant in differentiating between JME patients.