Abstracts

Rationale: Patients with childhood absence epilepsy (CAE) frequently demonstrate impaired interictal attention despite pharmacological control of their seizures. To date, no study has investigated the brain networks involved in this impairment. Methods: We tested attentional vigilance in 26 patients and 22 matched controls using the Continuous Performance Task (CPT). Each subject underwent simultaneous 3T fMRI-EEG and behavioral testing. Areas of activation on fMRI during task were correlated with measures of attention and were used as seed regions in a resting functional connectivity analysis. Results: Relative to controls, patients demonstrated impaired attention on behavioral testing. This impairment correlated with decreased medial frontal activation during CPT. Analysis revealed an overall trend towards decreased resting functional connectivity between areas of task activation in patients relative to controls. Patients demonstrated significantly impaired connectivity between the right anterior insula/frontal operculum and medial frontal lobes (p=0.016). Conclusions: CAE patients demonstrate impaired attention on behavioral testing, and our fMRI results reveal disruption in an attention network comprised of an anterior insula/frontal operculum and medial frontal cortex. These findings provide an anatomical and functional origin for interictal impaired attention in CAE, which could potentially lead to treatments targeting these networks.