Authors :
Presenting Author: Sonya Leikin, BS – Children's National Hospital
Priyanka Venkata Sita Illapani, MSc – Children's National Hospital
Samantha Werner, MA – Children's National Hospital
Hua Xie, PhD – Children's National Hospital
Arini Bhargava, BS – Carnegie Mellon University
Lauren Reppert, BS – Texas Children's
Andrew Poliakov, PhD – Seattle Children's Hospital
Hannah Goldstein, MD – Seattle Children's Hospital
Kristina Patrick, PhD – Seattle Children's
Daniel Drane, PhD – Emory University School of Medicine
Kartik Reddy, MD – Emory University School of Medicine
Donald Bearden, PhD, ABPP-CN – University of Tennessee Health Science Center and Le Bonheur Children's Hospital
Carla Ammons, PhD – Childrens Healthcare of Atlanta
Eswar Damaraju, MS – Children's Hospital of Atlanta
Carrie McDonald, PhD – University of California, San Diego
Chima Oluigbo, MD – Children's National Hospital, George Washington University
Sara Inati, PhD – National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
William Theodore, MD – National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
Marcin Gierdalski, PhD – Children's National Hospital
Hayley Loblein, PhD – Children's National Hospital
Madison Berl, PhD – Children's National Hospital
William Gaillard, MD – Children's National Hospital
Leigh Sepeta, PhD – Children's National Hospital
Rationale:
Temporal lobe epilepsy (TLE) disrupts the hippocampus: a memory region vulnerable to seizures and stress (Dahmen et al., 2018). Lower socioeconomic status is tied to smaller hippocampal volume in typically developing children (Taylor et al., 2020), but is unexplored in epilepsy. Neighborhood poverty is tied to cognition in epilepsy, but not to brain structure (Schraegle et al., 2023; Busch et al., 2023). We demonstrate how seizure laterality and hippocampal size influence memory (Aim 1), and how neighborhood disadvantage moderates these effects (Aim 2).Methods:
Our study used a pediatric neuroimaging consortium and the Pediatric Epilepsy Research Consortium with data from three sites (Children’s National Hospital, Seattle Children’s, and Emory). Standardized tests were used to measure memory, and scores were collapsed across equal measures (e.g., WMS, CVLT, WRAML2, CMS, NEPSY). We extracted Freesurfer based hippocampal parcellations and their volumes. Neighborhood-level disadvantage was measured using the Childhood Opportunity Index (COI) Version 3, a standardized composite of neighborhood resources (lower scores indicate less advantage) A sample of focal unilateral epilepsy patients was used (median age 13.4). For Aim 1, in a sample of 83 patients a mixed-effects model was run to study memory performance with epilepsy lateralization (left vs right) as a fixed factor, hippocampal volumes (adjusted for intracranial volume) as a continuous factor, and hemisphere (left vs right) as a repeated measure and fixed factor. In a subsample of 61 patients at Children’s National Hospital, COI Overall score was added as an additional continuous factor. All mixed models were conducted using SPSS.
Results:
For Aim 1, seizure side (F(1,157.797)=6.643, p=0.011), hippocampal size (F(1,157.797)=8.404, p=0.004), and their interaction (F(1,157.929)=6.613, p=0.011) effected total list recall. Larger hippocampi were associated to better performance in left-sided epilepsy only (F(1,90)=13.20, p< .001). Similarly, for delayed list recall, the interaction of seizure side and hippocampal size was significant (F(1,121.252)=6.751, p=0.011). Post hoc tests showed larger hippocampal size was associated with better delayed recall only in left-sided epilepsy only (F(1,70)=9.415, p=0.003). For Aim 2, epilepsy side (F(1,105.543)=4.422, p=0.038) and a interaction between epilepsy side, overall COI, and hippocampal volume (F(1,105.261)=4.520, p=0.036) effected immediate story recall. Post hoc tests found that higher COI was associated with better performance in left-sided epilepsy (Estimate = 0.687, p =.045), especially in those with smaller hippocampi (Estimate = –237.77, p =.054).
Conclusions:
Memory in pediatric epilepsy is shaped by seizure laterality and hippocampal size, with more pronounced effects in left-sided epilepsy, indicating lateralized vulnerability for memory. Neighborhood-level disadvantage, measured by COI, interacts with these factors to influence verbal memory, highlighting a novel finding: the joint effect of brain and neighborhood context on cognition in epilepsy.
Funding:
K23 Grant - 5K23NS093152-04
AES Infrastructure Grant- Infrastructure for Pediatric Neuroimaging Consortium