Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Epilepsia. 2022 Aug;63(8):2081-2095. doi: 10.1111/epi.17316. Epub 2022 Jun 25.
Recent work has shown that people with common epilepsies have characteristic patterns of cortical thinning, and that these changes may be progressive over time. Leveraging a large multicenter cross-sectional cohort, we investigated whether regional morphometric changes occur in a sequential manner, and whether these changes in people with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) correlate with clinical features.
We extracted regional measures of cortical thickness, surface area, and subcortical brain volumes from T1-weighted (T1W) magnetic resonance imaging (MRI) scans collected by the ENIGMA-Epilepsy consortium, comprising 804 people with MTLE-HS and 1625 healthy controls from 25 centers. Features with a moderate case-control effect size (Cohen d ≥ .5) were used to train an event-based model (EBM), which estimates a sequence of disease-specific biomarker changes from cross-sectional data and assigns a biomarker-based fine-grained disease stage to individual patients. We tested for associations between EBM disease stage and duration of epilepsy, age at onset, and antiseizure medicine (ASM) resistance.
In MTLE-HS, decrease in ipsilateral hippocampal volume along with increased asymmetry in hippocampal volume was followed by reduced thickness in neocortical regions, reduction in ipsilateral thalamus volume, and finally, increase in ipsilateral lateral ventricle volume. EBM stage was correlated with duration of illness (Spearman ρ = .293, p = 7.03 × 10 ), age at onset (ρ = -.18, p = 9.82 × 10 ), and ASM resistance (area under the curve = .59, p = .043, Mann-Whitney U test). However, associations were driven by cases assigned to EBM Stage 0, which represents MTLE-HS with mild or nondetectable abnormality on T1W MRI.
From cross-sectional MRI, we reconstructed a disease progression model that highlights a sequence of MRI changes that aligns with previous longitudinal studies. This model could be used to stage MTLE-HS subjects in other cohorts and help establish connections between imaging-based progression staging and clinical features.
最近的研究表明，患有常见癫痫的人存在皮质变薄的特征性模式，并且这些变化可能随着时间的推移而逐渐发展。利用一个大型多中心横断面队列，我们研究了区域性形态变化是否以连续的方式发生，以及这些变化在伴有内侧颞叶癫痫和海马硬化（MTLE-HS）的患者中是否与临床特征相关。
我们从 ENIGMA-Epilepsy 联盟收集的 T1 加权（T1W）磁共振成像（MRI）扫描中提取皮质厚度、表面积和皮质下脑体积的区域测量值，这些扫描来自 25 个中心的 804 名 MTLE-HS 患者和 1625 名健康对照者。使用具有中度病例对照效应大小（Cohen d≥.5）的特征来训练基于事件的模型（EBM），该模型从横断面数据中估计一系列疾病特异性生物标志物变化，并为个体患者分配基于生物标志物的精细疾病阶段。我们测试了 EBM 疾病阶段与癫痫持续时间、发病年龄和抗癫痫药物（ASM）耐药性之间的相关性。
在 MTLE-HS 中，同侧海马体积的减少伴随着海马体积的不对称性增加，随后是新皮层区域的厚度减少、同侧丘脑体积的减少，最后是同侧侧脑室体积的增加。EBM 阶段与疾病持续时间（Spearman ρ=.293，p= 7.03×10 ）、发病年龄（ρ= -.18，p= 9.82×10 ）和 ASM 耐药性（曲线下面积=.59，p=.043，Mann-Whitney U 检验）相关。然而，这些相关性是由 EBM 阶段 0 的病例驱动的，EBM 阶段 0 代表在 T1W MRI 上表现为轻度或不可检测异常的 MTLE-HS。
从横断面 MRI 中，我们重建了一个疾病进展模型，该模型突出了与以前的纵向研究一致的 MRI 变化序列。该模型可用于对其他队列中的 MTLE-HS 患者进行分期，并有助于在基于影像学的进展分期和临床特征之间建立联系。
