脑桥功能连接障碍在癫痫手术后可能会恢复。
Brainstem Functional Connectivity Disturbances in Epilepsy may Recover After Successful Surgery.
机构信息
Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.
Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee.
出版信息
Neurosurgery. 2020 Mar 1;86(3):417-428. doi: 10.1093/neuros/nyz128.
BACKGROUND
Focal seizures in temporal lobe epilepsy (TLE) are associated with widespread brain network perturbations and neurocognitive problems.
OBJECTIVE
To determine whether brainstem connectivity disturbances improve with successful epilepsy surgery, as recent work has demonstrated decreased brainstem connectivity in TLE that is related to disease severity and neurocognitive profile.
METHODS
We evaluated 15 adult TLE patients before and after (>1 yr; mean, 3.4 yr) surgery, and 15 matched control subjects using magnetic resonance imaging to measure functional and structural connectivity of ascending reticular activating system (ARAS) structures, including cuneiform/subcuneiform nuclei (CSC), pedunculopontine nucleus (PPN), and ventral tegmental area (VTA).
RESULTS
TLE patients who achieved long-term postoperative seizure freedom (10 of 15) demonstrated increases in functional connectivity between ARAS structures and fronto-parietal-insular neocortex compared to preoperative baseline (P = .01, Kruskal-Wallis), with postoperative connectivity patterns resembling controls' connectivity. No functional connectivity changes were detected in 5 patients with persistent seizures after surgery (P = .9, Kruskal-Wallis). Among seizure-free postoperative patients, larger increases in CSC, PPN, and VTA functional connectivity were observed in individuals with more frequent seizures before surgery (P < .05 for each, Spearman's rho). Larger postoperative increases in PPN functional connectivity were seen in patients with lower baseline verbal IQ (P = .03, Spearman's rho) or verbal memory (P = .04, Mann-Whitney U). No changes in ARAS structural connectivity were detected after successful surgery.
CONCLUSION
ARAS functional connectivity disturbances are present in TLE but may recover after successful epilepsy surgery. Larger increases in postoperative connectivity may be seen in individuals with more severe disease at baseline.
背景
颞叶癫痫（TLE）中的局灶性发作与广泛的大脑网络扰动和神经认知问题有关。
目的
确定是否成功的癫痫手术后脑干连接性紊乱会得到改善，因为最近的研究表明 TLE 中的脑干连接性降低与疾病严重程度和神经认知特征有关。
方法
我们使用磁共振成像评估了 15 名成年 TLE 患者手术前后（> 1 年；平均 3.4 年），并与 15 名匹配的对照组进行了评估，以测量包括楔束/楔前核（CSC）、脑桥被盖核（PPN）和腹侧被盖区（VTA）在内的上行网状激活系统（ARAS）结构的功能和结构连接性。
结果
10 例 TLE 患者（15 例中的 10 例）术后长期无发作，与术前基线相比，ARAS 结构与额顶岛新皮层之间的功能连接增加（P = 0.01，Kruskal-Wallis），术后连接模式类似于对照组的连接模式。5 例手术后仍有持续性发作的患者未检测到功能连接变化（P = 0.9，Kruskal-Wallis）。在术后无发作的患者中，术前发作更频繁的患者 CSC、PPN 和 VTA 功能连接增加更大（P < 0.05，Spearman's rho）。术后 PPN 功能连接增加更大的患者基线言语智商（P = 0.03，Spearman's rho）或言语记忆（P = 0.04，Mann-Whitney U）较低。成功手术后未检测到 ARAS 结构连接的变化。
结论
TLE 中存在 ARAS 功能连接紊乱，但成功的癫痫手术后可能会恢复。术后连接性增加更大的患者可能基线疾病更严重。
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