Full-Length Original Research
Risk-taking behavior in juvenile myoclonic epilepsy
Article first published online: 18 OCT 2013
© 2013 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Volume 54, Issue 12, pages 2158–2165, December 2013
How to Cite
Epilepsia, 54(12):2158–2165, 2013
- Issue published online: 4 DEC 2013
- Article first published online: 18 OCT 2013
- Manuscript Accepted: 12 SEP 2013
- Wellcome Trust. Grant Number: 079474
- Big Lottery Fund
- Wolfson Trust, and the Epilepsy Society
- Department of Health's NIHR Biomedical Research Centres' funding scheme
- DFG fellowship
- Frontal lobe function;
- Functional imaging;
- Working memory
Patients with juvenile myoclonic epilepsy (JME) often present with risk-taking behavior, suggestive of frontal lobe dysfunction. Recent studies confirm functional and microstructural changes within the frontal lobes in JME. This study aimed at characterizing decision-making behavior in JME and its neuronal correlates using functional magnetic resonance imaging (fMRI).
We investigated impulsivity in 21 JME patients and 11 controls using the Iowa Gambling Task (IGT), which measures decision making under ambiguity. Performance on the IGT was correlated with activation patterns during an fMRI working memory task.
Both patients and controls learned throughout the task. Post hoc analysis revealed a greater proportion of patients with seizures than seizure-free patients having difficulties in advantageous decision making, but no difference in performance between seizure-free patients and controls. Functional imaging of working memory networks showed that overall poor IGT performance was associated with an increased activation in the dorsolateral prefrontal cortex (DLPFC) in JME patients. Impaired learning during the task and ongoing seizures were associated with bilateral medial prefrontal cortex (PFC) and presupplementary motor area, right superior frontal gyrus, and left DLPFC activation.
Our study provides evidence that patients with JME and ongoing seizures learn significantly less from previous experience. Interictal dysfunction within “normal” working memory networks, specifically, within the DLPFC and medial PFC structures, may affect their ability to learn.