Faculty Collaboration Database

Association of neighborhood deprivation with white matter connectome abnormalities in temporal lobe epilepsy. Epilepsia 2023 Sep;64(9):2484-2498

Date

06/28/2023

Pubmed ID

37376741

Pubmed Central ID

PMC10530287

DOI

10.1111/epi.17702

Scopus ID

2-s2.0-85164792241 (requires institutional sign-in at Scopus site)

Abstract

OBJECTIVE: Social determinants of health, including the effects of neighborhood disadvantage, impact epilepsy prevalence, treatment, and outcomes. This study characterized the association between aberrant white matter connectivity in temporal lobe epilepsy (TLE) and disadvantage using a US census-based neighborhood disadvantage metric, the Area Deprivation Index (ADI), derived from measures of income, education, employment, and housing quality.

METHODS: Participants including 74 TLE patients (47 male, mean age = 39.2 years) and 45 healthy controls (27 male, mean age = 31.9 years) from the Epilepsy Connectome Project were classified into ADI-defined low and high disadvantage groups. Graph theoretic metrics were applied to multishell connectome diffusion-weighted imaging (DWI) measurements to derive 162 × 162 structural connectivity matrices (SCMs). The SCMs were harmonized using neuroCombat to account for interscanner differences. Threshold-free network-based statistics were used for analysis, and findings were correlated with ADI quintile metrics. A decrease in cross-sectional area (CSA) indicates reduced white matter integrity.

RESULTS: Sex- and age-adjusted CSA in TLE groups was significantly reduced compared to controls regardless of disadvantage status, revealing discrete aberrant white matter tract connectivity abnormalities in addition to apparent differences in graph measures of connectivity and network-based statistics. When comparing broadly defined disadvantaged TLE groups, differences were at trend level. Sensitivity analyses of ADI quintile extremes revealed significantly lower CSA in the most compared to least disadvantaged TLE group.

SIGNIFICANCE: Our findings demonstrate (1) the general impact of TLE on DWI connectome status is larger than the association with neighborhood disadvantage; however, (2) neighborhood disadvantage, indexed by ADI, revealed modest relationships with white matter structure and integrity on sensitivity analysis in TLE. Further studies are needed to explore this relationship and determine whether the white matter relationship with ADI is driven by social drift or environmental influences on brain development. Understanding the etiology and course of the disadvantage-brain integrity relationship may serve to inform care, management, and policy for patients.

Author List

Chu DY, Adluru N, Nair VA, Choi T, Adluru A, Garcia-Ramos C, Dabbs K, Mathis J, Nencka AS, Gundlach C, Conant L, Binder JR, Meyerand ME, Alexander AL, Struck AF, Hermann B, Prabhakaran V

Authors

Jeffrey R. Binder MD Professor in the Neurology department at Medical College of Wisconsin
Andrew S. Nencka PhD Director, Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Brain
Connectome
Diffusion Tensor Imaging
Epilepsy, Temporal Lobe
Humans
Male
White Matter