Η αλλοίωση της παγίωσης της μνήμης κατά τον ύπνο επιβαρύνει την νευρογνωστική συνοσηρότητα στην ρολάνδειο επιληψία

Abstract

Our aim in this essay is to expand the concepts and the research designs used to explore neurocognitive comorbidity in benign epilepsy with centrotemporal spikes (BECTS). We review the latest data from the fields of neuroplasticity, sleep-related memory consolidation, epilepsy, and neurocognitive comorbidity in BECTS. We argue that the field needs to move beyond the assessment of daytime neurocognitive functioning and the over-reliance on seizure data. We suggest two additional foci: a) the interictal presentation of children with BECTS, and data on interictal epileptiform spikes (IES) in particular, and b) sleep-related memory consolidation (S-RMC). IES interfere with S-RMC in two distinct ways. First, they alter the spatiotemporal coupling of the three cardinal oscillations involved. Second, IES undergo sleep-related consolidation processes utilizing mechanisms that were considered to be "reserved" for adaptive material of high relevance to the organism. Together, the two aforementioned processes adversely affect particular brain networks and eventually present as daytime neurocognitive comorbidity. Links have been made between functional differentiations in specific neuronal networks and BECTS neurocognitive deficits. For instance, alterations in frontal lobe connectivity affect attention and higher cognitive skills. Moreover, alterations in functional connectivity of the right inferior temporal cortex and the bilateral primary auditory cortex contribute to language processing difficulties. Finally, alterations in the perisylvian network are expected to adversely impact communication skills. Reducing the frequency of IES, might potentially reduce the disturbance of the S-RMC, hence improving the child's neurocognitive presentation. This is a new prevention and treatment locum in BECTS. Another novel therapeutic target could be preventing the sleep-related consolidation of IES. Key findings of the impact of altered S-RMC on neurocognitive comorbidity in BECTS need to be channeled to front-line practitioners, along with efforts for better controlling excessive epileptiform activity during sleep. In this fast developing field, there is an urgent need to develop novel multidisciplinary methodologies so that each discipline can benefit from the progress made in any of the others.