Diffusion Tensor Imaging in Epilepsy With Continuous Spikes and Waves During Sleep

Study Overview
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Brief Summary
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Continuous Spikes and Waves during Sleep (CSWS) is a rare paediatric epileptic encephalopathy. Even if the correlation between the severity of the epilepsy and the cognitive consequences is well established, the mechanisms involved in epileptic cognitive degradation are complex and poorly understood. In CSWS, there are many arguments for the implication of cortical and subcortical cerebral structures. Among them the thalamus seems to play a crucial role. In fact it is strongly implicated in the sleep and this function is determining for learning. Moreover, it is part of the propagation pathway of generalized forms of epilepsy like absences in animal studies. Unfortunately there is no animal model for CSWS to confirm this theory. In human studies, few cases are caused by thalamic injuries but most of the time conventional MRI is normal. Despite few literature on CSWS, some studies reported abnormal functional connectivity especially in the thalamus. The investigators hypothesize that the first utilisation of diffusion tensor imaging (DTI) and tractography will be useful in CSWS to confirm the implication of a cortico-thalamo-cortical network showing an abnormal structural connectivity. The investigators will try to determinate if a particular thalamic nucleus is concerned and demonstrate a link between the disease severity (duration and cognitive consequences) and the importance of structural abnormalities. Using resting state functional MRI (fMRI), the investigators will also try to investigate the default mode network. Its implication was also suggested in the literature.

Detailed Description
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Continuous Spikes and Waves during Sleep (CSWS) is a rare paediatric epileptic encephalopathy. Even if the correlation between the severity of the epilepsy and the cognitive consequences is well established, the mechanisms involved in epileptic cognitive degradation are complex and poorly understood. In CSWS, there are many arguments for the implication of cortical and subcortical cerebral structures. Among them the thalamus seems to play a crucial role. In fact it is strongly implicated in the sleep and this function is determining for learning. Moreover, it is part of the propagation pathway of generalized forms of epilepsy like absences in animal studies. Unfortunately there is no animal model for CSWS to confirm this theory. In human studies, few cases are caused by thalamic injuries but most of the time conventional MRI is normal. Despite few literature on CSWS, some studies reported abnormal functional connectivity especially in the thalamus. The investigators hypothesize that the first utilisation of diffusion tensor imaging (DTI) and tractography will be useful in CSWS to confirm the implication of a cortico-thalamo-cortical network showing an abnormal structural connectivity. The investigators will try to determinate if a particular thalamic nucleus is concerned and demonstrate a link between the disease severity (duration and cognitive consequences) and the importance of structural abnormalities. Using resting state functional MRI (fMRI), the investigators will also try to investigate the default mode network. Its implication was also suggested in the literature.

Official Title
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Diffusion Tensor Imaging of the Thalamo-cortical Network in Epilepsy With Continuous Spikes and Waves During Sleep

Conditions
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Cryptogenic Epilepsy

Intervention / Treatment
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* Other: Continuous spikes and waves during slow sleep (CSWS)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - for the patients, diagnosis of CSWS according to the current diagnostic criteria (ILAE 2001) minimal age of 5 years old written consent to participate in the study from the subjects who could write and/or from the parents or legal representative Exclusion Criteria: rejection of the patient or its legal representative no respect of inclusion criteria

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CSWS patients<br>The data of CSWS patients will be statistically compared to healthy volunteers | Other: Continuous spikes and waves during slow sleep (CSWS)<br> <br> |
| healthy volunteers<br>The data of CSWS patients will be statistically compared to healthy volunteers | Other: Continuous spikes and waves during slow sleep (CSWS)<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Structural connectivity of the thalamo-cortical network | Structural connectivity of the thalamo-cortical network will be assessed using DTI fractional anisotropy. The data of CSWS patients will be statistically compared to healthy volunteers | at day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Some comparisons with electrophysiological and neuropsychological data will be done |  | at day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Continuous spikes, Epilepsy, Nervous system disease, Neuronal plasticity, Diffusion MRI, Functional MRI, waves during slow sleep (CSWS)