Functional and structural connective disturbance of the primary and default network in patients with generalized tonic-clonic seizures.

OBJECTIVE

The present study aims to investigate the disturbance of functional and structural profiles of patients with generalized tonic-clonic seizures (GTCS).

METHODS

Resting-state fMRI and diffusion tensor imaging (DTI) data was collected from fifty-six patients and sixty-two healthy controls. Degree centrality (DC) of functional connectivity was first calculated and compared between groups using a two-sample t-test. Furthermore, the regions with significant alteration of DC in patients with GTCS were used as nodes to construct the brain network. Functional connectivity (FC) network was constructed using the Person's correlation analysis and structural connectivity (SC) network was obtained using deterministic tractography technology. Gray matter volume (GMV) and cortical thickness (CT) were computed and correlated with connective profiles.

RESULTS

The patients with GTCS showed increased DC in the primary network (PN), including bilateral precentral gyrus, supplementary motor areas (SMA), and visual cortex, and decreased DC in core regions of default mode network (DMN), bilateral anterior insular, and supramarginal gyrus. In the present study, 14 regions were identified to construct networks. In patients, the FC and SC were increased within the sensorimotor network (mainly linking with SMA) and decreased within DMN (mainly linking with the posterior cingulate cortex (PCC)). Except for the decreased FC and SC between cerebellum and SMA, patients demonstrated increased connectivity between DMN and PN. Besides, the insula demonstrated decreased FC with DMN and increased FC with PN, without significant SC alterations in patients with GTCS. Decreased GMV in bilateral thalamus and increased GMV in frontoparietal regions were found in patients. The decreased GMV of thalamus and increased GMV of SMA positively and negatively correlated with the FC between PCC and left superior frontal cortex, the FC between SMA and left precuneus respectively.

CONCLUSION

Hyper-connectivity within PN helps to understand the disturbance of primary functions, especially the motor abnormality in GTCS. The hypo-connectivity within DMN suggested abnormal network organization possibly related to epileptogenesis. Moreover, over-interaction between DMN and PN and unbalanced connectivity between them and insula provided potential evidence reflecting abnormal interactions between primary and high-order function systems.