Cognitive and Psychiatric Comorbidities in Epilepsy: Insights from Neuroimaging Research

About this Research Topic

Background

Epilepsy, with a point prevalence of 1%, is one of the most common chronic neurological disorders. Apart from seizures, patients’ quality of life and socio-economic outcome are significantly influenced by psychiatric comorbidities, such as mood disorders and anxiety, and cognitive impairment, affecting several domains of higher cognitive function, including attention, memory, language, and executive functions. Psychiatric comorbidities are traditionally rated as a “complication” of epilepsy, but are also a risk factor to develop epilepsy. Recent studies have identified depression as a clinical predictor of epileptogenesis after traumatic brain injury, but also of non-responsiveness to Anti-Epileptic Drug (AED) treatment and failure of epilepsy surgery. In parallel, mechanisms of cognitive deficits in epilepsy are likely multifactorial, with relation to genetic and neurodevelopmental factors, specific epilepsy syndrome and epileptic networks, disease activity and severity, and “side-effects” related to treatment with antiepileptic drugs or epilepsy surgery. Recent data even suggest an overlap of epilepsy with neurodegenerative conditions, such as Alzheimer’s disease.

Advanced structural and functional imaging methodologies provide techniques to study network organization in complex neurological diseases. So far, imaging studies have helped elucidate how epilepsy affects the brain on a network level, with an impact on brain regions and related functions remotely from the primary seizure focus. Task-based functional MRI (fMRI) enables the testing of specific cognitive functions in patients, has the potential to predict cognitive outcome after epilepsy surgery, and allows the assessment of specific antiepileptic drugs effects on cognition (via so called pharmaco-fMRI studies). Combining electroencephalography and fMRI (EEG-fMRI) can shed light on the interaction of epileptic discharges and cognitive processes. Multimodal structural imaging also offers in vivo markers of cortical development that may help to understand distinct behavioral phenotypes in epilepsy syndromes with presumed genetic/neurodevelopmental underpinnings. Although imaging studies have substantially advanced our knowledge in recent years, mechanisms of cognitive impairment in various epilepsy syndromes are still not fully understood, warranting further research in the field. Similarly, advanced imaging studies may help elucidate pathological mechanisms underlying the bidirectional relationship between psychiatric disorders and epilepsy, with the potential to identify biomarkers of epileptogenesis.

In this Research Topic, we aim to achieve an overview and better understanding of cognitive dysfunction and psychiatric comorbidities in epilepsy, informed by advanced neuroimaging methodologies. We aim to cover these topics in various epilepsy syndromes, i.e. focal and idiopathic generalized epilepsies, and to relate these findings to measures of disease severity, treatment effects/side-effects and outcome prediction.

We mainly welcome submissions of the following article types: Brief Research Report, Case Report, Clinical Trial, Hypothesis and Theory, Methods, Mini Review, Opinion, Original Research, Perspective, Review and Systematic Review.

Topic editor Dr Clarissa Lin Yasuda has received honoraria from UCB Pharma. All other topic editors declare no competing interests with regards to the Research Topic subject.

Keywords: epilepsy, cognition, mood disorders, functional MRI, structural MRI

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