Cargando…

Increased facial asymmetry in focal epilepsies associated with unilateral lesions

The epilepsies are now conceptualized as network disruptions: focal epilepsies are considered to have network alterations in the hemisphere of seizure onset, whilst generalized epilepsies are considered to have bi-hemispheric network changes. Increasingly, many epilepsies are also considered to be n...

Descripción completa

Detalles Bibliográficos
Autores principales: Balestrini, Simona, Lopez, Seymour M, Chinthapalli, Krishna, Sargsyan, Narek, Demurtas, Rita, Vos, Sjoerd, Altmann, Andre, Suttie, Michael, Hammond, Peter, Sisodiya, Sanjay M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244637/
https://www.ncbi.nlm.nih.gov/pubmed/34222868
http://dx.doi.org/10.1093/braincomms/fcab068
_version_ 1783715970146107392
author Balestrini, Simona
Lopez, Seymour M
Chinthapalli, Krishna
Sargsyan, Narek
Demurtas, Rita
Vos, Sjoerd
Altmann, Andre
Suttie, Michael
Hammond, Peter
Sisodiya, Sanjay M
author_facet Balestrini, Simona
Lopez, Seymour M
Chinthapalli, Krishna
Sargsyan, Narek
Demurtas, Rita
Vos, Sjoerd
Altmann, Andre
Suttie, Michael
Hammond, Peter
Sisodiya, Sanjay M
author_sort Balestrini, Simona
collection PubMed
description The epilepsies are now conceptualized as network disruptions: focal epilepsies are considered to have network alterations in the hemisphere of seizure onset, whilst generalized epilepsies are considered to have bi-hemispheric network changes. Increasingly, many epilepsies are also considered to be neurodevelopmental disorders, with early changes in the brain underpinning seizure biology. The development of the structure of the face is influenced by complex molecular interactions between surface ectoderm and underlying developing forebrain and neural crest cells. This influence is likely to continue postnatally, given the evidence of facial growth changes over time in humans until at least 18 years of age. In this case–control study, we hypothesized that people with lateralized focal epilepsies (i.e. unilateral network changes) have an increased degree of facial asymmetry, compared with people with generalized epilepsies or controls without epilepsy. We applied three-dimensional stereophotogrammetry and dense surface models to evaluate facial asymmetry in people with epilepsy, aiming to generate new tools to explore pathophysiological mechanisms in epilepsy. We analysed neuroimaging data to explore the correlation between face and brain asymmetry. We consecutively recruited 859 people with epilepsy attending the epilepsy clinics at a tertiary referral centre. We used dense surface modelling of the full face and signature analyses of three-dimensional facial photographs to analyse facial differences between 378 cases and 205 healthy controls. Neuroimaging around the time of the facial photograph was available for 234 cases. We computed the brain asymmetry index between contralateral regions. Cases with focal symptomatic epilepsy associated with unilateral lesions showed greater facial asymmetry compared to controls (P = 0.0001, two-sample t-test). This finding was confirmed by linear regression analysis after controlling for age and gender. We also found a significant correlation between duration of illness and the brain asymmetry index of total average cortical thickness (r = −0.19, P = 0.0075) but not for total average surface area (r = 0.06, P = 0.3968). There was no significant correlation between facial asymmetry and asymmetry of regional cortical thickness or surface area. We propose that the greater facial asymmetry in cases with focal epilepsy caused by unilateral abnormality might be explained by early unilateral network disruption, and that this is independent of underlying brain asymmetry. Three-dimensional stereophotogrammetry and dense surface modelling are a novel powerful phenotyping tool in epilepsy that may permit greater understanding of pathophysiology in epilepsy, and generate further insights into the development of cerebral networks underlying epilepsy, and the genetics of facial and neural development.
format Online
Article
Text
id pubmed-8244637
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-82446372021-07-01 Increased facial asymmetry in focal epilepsies associated with unilateral lesions Balestrini, Simona Lopez, Seymour M Chinthapalli, Krishna Sargsyan, Narek Demurtas, Rita Vos, Sjoerd Altmann, Andre Suttie, Michael Hammond, Peter Sisodiya, Sanjay M Brain Commun Original Article The epilepsies are now conceptualized as network disruptions: focal epilepsies are considered to have network alterations in the hemisphere of seizure onset, whilst generalized epilepsies are considered to have bi-hemispheric network changes. Increasingly, many epilepsies are also considered to be neurodevelopmental disorders, with early changes in the brain underpinning seizure biology. The development of the structure of the face is influenced by complex molecular interactions between surface ectoderm and underlying developing forebrain and neural crest cells. This influence is likely to continue postnatally, given the evidence of facial growth changes over time in humans until at least 18 years of age. In this case–control study, we hypothesized that people with lateralized focal epilepsies (i.e. unilateral network changes) have an increased degree of facial asymmetry, compared with people with generalized epilepsies or controls without epilepsy. We applied three-dimensional stereophotogrammetry and dense surface models to evaluate facial asymmetry in people with epilepsy, aiming to generate new tools to explore pathophysiological mechanisms in epilepsy. We analysed neuroimaging data to explore the correlation between face and brain asymmetry. We consecutively recruited 859 people with epilepsy attending the epilepsy clinics at a tertiary referral centre. We used dense surface modelling of the full face and signature analyses of three-dimensional facial photographs to analyse facial differences between 378 cases and 205 healthy controls. Neuroimaging around the time of the facial photograph was available for 234 cases. We computed the brain asymmetry index between contralateral regions. Cases with focal symptomatic epilepsy associated with unilateral lesions showed greater facial asymmetry compared to controls (P = 0.0001, two-sample t-test). This finding was confirmed by linear regression analysis after controlling for age and gender. We also found a significant correlation between duration of illness and the brain asymmetry index of total average cortical thickness (r = −0.19, P = 0.0075) but not for total average surface area (r = 0.06, P = 0.3968). There was no significant correlation between facial asymmetry and asymmetry of regional cortical thickness or surface area. We propose that the greater facial asymmetry in cases with focal epilepsy caused by unilateral abnormality might be explained by early unilateral network disruption, and that this is independent of underlying brain asymmetry. Three-dimensional stereophotogrammetry and dense surface modelling are a novel powerful phenotyping tool in epilepsy that may permit greater understanding of pathophysiology in epilepsy, and generate further insights into the development of cerebral networks underlying epilepsy, and the genetics of facial and neural development. Oxford University Press 2021-04-19 /pmc/articles/PMC8244637/ /pubmed/34222868 http://dx.doi.org/10.1093/braincomms/fcab068 Text en © The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Balestrini, Simona
Lopez, Seymour M
Chinthapalli, Krishna
Sargsyan, Narek
Demurtas, Rita
Vos, Sjoerd
Altmann, Andre
Suttie, Michael
Hammond, Peter
Sisodiya, Sanjay M
Increased facial asymmetry in focal epilepsies associated with unilateral lesions
title Increased facial asymmetry in focal epilepsies associated with unilateral lesions
title_full Increased facial asymmetry in focal epilepsies associated with unilateral lesions
title_fullStr Increased facial asymmetry in focal epilepsies associated with unilateral lesions
title_full_unstemmed Increased facial asymmetry in focal epilepsies associated with unilateral lesions
title_short Increased facial asymmetry in focal epilepsies associated with unilateral lesions
title_sort increased facial asymmetry in focal epilepsies associated with unilateral lesions
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244637/
https://www.ncbi.nlm.nih.gov/pubmed/34222868
http://dx.doi.org/10.1093/braincomms/fcab068
work_keys_str_mv AT balestrinisimona increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT lopezseymourm increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT chinthapallikrishna increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT sargsyannarek increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT demurtasrita increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT vossjoerd increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT altmannandre increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT suttiemichael increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT hammondpeter increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions
AT sisodiyasanjaym increasedfacialasymmetryinfocalepilepsiesassociatedwithunilaterallesions