Global Socioeconomic Context and Brain Ageing in Epilepsy: an ENIGMA-Epilepsy study.
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Pardoe Heath R, Devinsky Orrin, Bbiomed Hons Jemima Robson, Ireland Molly, Absil Julie, Altmann Andre, Alvim Marina Km, Arienzo Donatello, Ballerini Alice, Barbi Elisa, Bartolini Emanuele, Bauer Tobias, Bernasconi Andrea, Bernasconi Neda, Bernhardt Boris, Blackmon Karen, Bonanni Paolo, Bonilha Leonardo, Bosco Paolo, Bunyamin Jacob, Caligiuri Maria Eugenia, Cendes Fernando, Christin Raphaël, Concha Luis, Courtney Merran R, Cruces Raul R, Danieli Alberto, Davis Kathryn A, Depondt Chantal, Dugan Patricia, Duma Gian Marco, Duncan John S, Engel Jerome, Atuesta Carolina Ferreira, Focke Niels Kn, Fortunato Francesco, Gagliardo Cesare, Galovic Marian, Gambardella Antonio, Gholipour Taha, Gleichgerrcht Ezequiel, Guerrini Renzo, Gule M V, Heide Ev-Christin, Inati Sara, Ives-Deliperi Victoria, Jackson Graeme D, Jacobs Sarah, Jahanshad Neda, Kleen Jonathan K, Kotikalapudi Raviteja, Koubeissi Mohamad Zakaria, Labate Angelo, Larivère Sara, Lenge Matteo, Martins Helena, Mascalchi Mario, Meletti Stefano, Moloney Patrick B, O'Brien Terence J, Owens-Walton Conor, Parodi Costanza, Riva Antonella, Roth Rebecca W, Royer Jessica, Rüber Theodor, Saba Luca, Sammarra Ilaria, Scárdua-Silva Lucas, Schubert Kai Michael, Sepeta Leigh, Severino Mariasavina, Sinclair Ben, Sinha Nishant, Staba Richard J, Stein Dan J, Stein Joel M, Stoub Travis R, Striano Pasquale, Surges Rainer, Terziev Robert, Thomopoulos Sophia I, Tondelli Manuela, Tortora Domenico, Vacca Sebastiano, Vaudano Anna Elisabetta, Vivash Lucy, Williams Kimberley C, Yasuda Clarissa L, Zhang Zhiqiang, Kaestner Erik, Thompson Paul M, Sisodiya Sanjay M, McDonald Carrie R
Аннотация
METHODS: Structural MRI and clinical data were collected from 26 epilepsy centres across 12 countries in the Americas, Australia, Europe, Asia and Africa. MRI-based age estimates were estimated using a previously developed prediction model trained on 29,175 healthy subjects. Brain predicted age difference (BrainPAD) was calculated as the difference between MRI-predicted brain age and chronological age. National gross domestic product (GDP) per capita and income inequality (Gini index) were obtained from the World Bank. Associations between BrainPAD and epilepsy subtype (temporal lobe epilepsy, extratemporal epilepsy, and genetic generalised epilepsy), national socioeconomic context (GDP per capita and Gini index), age and sex were assessed using regression models.
RESULTS: We analyzed 2,109 individuals with epilepsy and 1,041 healthy non-epilepsy controls (57% female; median age = 35; range 17-83). BrainPAD was higher in epilepsy than controls (β 4.2 years, SE 0.4; t=10.6), with increases ranging from 2.5 to 6 years across subtypes. Male sex was associated with 1 year higher BrainPAD relative to females (SE 0.33, t=3.12). There were no main effects of GDP or Gini index; however, significant interactions between were observed. The effect of epilepsy on BrainPAD was greater in countries with lower GDP per capita (t=-2.74) and higher income inequality (t=2.72).
CONCLUSIONS: Clinical factors and socioeconomic context both influence brain structural ageing in epilepsy. These findings highlight the importance of geographic and economic diversity in neuroimaging research and underscore the relevance of global socioeconomic context when interpreting brain health measures.