Wang Kangrun, Xie Fangfang, Liu Chaorong, Tan Langzi, He Jialinzi, Hu Ping, Zhang Min, Wang Ge, Chen Fenghua, Xiao Bo, Liao Weihua, Long Lili
Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.
Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
Epilepsia. 2022 Feb;63(2):463-473. doi: 10.1111/epi.17142. Epub 2021 Dec 7.
This work was undertaken to study the functional connectivity differences between non-seizure-free and seizure-free patients with temporal lobe epilepsy (TLE) and to identify imaging predictors for drug responsiveness in TLE.
In this prospective study, 52 patients with TLE who presented undetermined antiseizure medication responsiveness and 55 demographically matched healthy controls were sequentially recruited from Xiangya Hospital. Functional magnetic resonance imaging data were acquired during a Chinese version of the verbal fluency task. The patients were followed up until the outcome could be classified. The subject groups were compared in terms of activation profile, task-residual functional connectivity (trFC), and generalized psychophysiological interaction (gPPI) analyses. Moreover, we extracted imaging characteristics for logistic regression and receiver operating characteristic evaluation.
With a mean follow-up of 1.1 years, we identified 27 non-seizure-free patients and 19 seizure-free patients in the final analyses. The Chinese character verbal fluency task successfully activated the language network and cognitive control network (CCN) and deactivated the default mode network (DMN). In the non-seizure-freedom group, the trFC between the hippocampus and bilateral brain networks was attenuated (p < .05, familywise error corrected). For the gPPI analysis, group differences were mainly located in the precuneus, middle frontal gyrus, and inferior parietal lobule (p < .001, uncorrected; k ≥ 10). The regression model presented high accuracy when predicting non-seizure-free patients (area under the curve = .879, 95% confidence interval = .761-.998).
In patients with TLE who would not achieve seizure freedom with current antiseizure medications, the functional connectivity between the hippocampus and central nodes of the DMN, CCN, and language network was disrupted, leading to language decline. Independent of hippocampal sclerosis, abnormalities, especially the effective connectivity from the hippocampus to the DMN, were predictive biomarkers of drug responsiveness in patients with TLE.
本研究旨在探讨颞叶癫痫（TLE）患者中未实现无癫痫发作和已实现无癫痫发作患者之间的功能连接差异，并确定TLE患者药物反应性的影像学预测指标。
在这项前瞻性研究中，从湘雅医院连续招募了52例抗癫痫药物反应性未确定的TLE患者和55例人口统计学匹配的健康对照。在中文版言语流畅性任务期间采集功能磁共振成像数据。对患者进行随访，直至可以对结果进行分类。比较各受试者组的激活模式、任务残余功能连接（trFC）和广义心理生理交互作用（gPPI）分析。此外，我们提取影像学特征进行逻辑回归和受试者工作特征评估。
平均随访1.1年，最终分析中确定了27例未实现无癫痫发作的患者和19例已实现无癫痫发作的患者。汉字言语流畅性任务成功激活了语言网络和认知控制网络（CCN），并抑制了默认模式网络（DMN）。在未实现无癫痫发作组中，海马体与双侧脑网络之间的trFC减弱（p <.05，经家族性错误校正）。对于gPPI分析，组间差异主要位于楔前叶、额中回和顶下小叶（p <.001，未校正；k≥10）。预测未实现无癫痫发作患者时，回归模型具有较高的准确性（曲线下面积=.879，95%置信区间=.761-.998）。
在当前抗癫痫药物治疗无法实现无癫痫发作的TLE患者中，海马体与DMN、CCN和语言网络的中心节点之间的功能连接被破坏，导致语言功能下降。独立于海马硬化，异常情况，尤其是从海马体到DMN的有效连接，是TLE患者药物反应性的预测生物标志物。
