Li Xin, Chen Qian, Wang Zhongyuan, Wang Xiaoyun, Zhang Wen, Lu Jiaming, Zhang Xin, Wang Zhengge, Zhang Bing
Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
Department of Radiology, the Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China.
Epilepsy Behav. 2023 Mar;140:109100. doi: 10.1016/j.yebeh.2023.109100. Epub 2023 Feb 13.
We aimed to determine whether alterations in spontaneous regional brain activity in those with generalized tonic-clonic seizures (GTCS) and focal to bilateral tonic-clonic seizures (FBTCS) and explore whether the alterations could be used as biomarkers to classify disease subtypes through support vector machine analysis (SVM).
The fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) from resting-state functional magnetic resonance imaging (rs-fMRI) data were extracted from 57 patients with GTCS, 35 patients with FBTCS, and 50 age-matched and sex-matched normal controls (NCs) using the DPARSF 5.0 toolbox. Between-group comparisons were adjusted for covariates (age, sex, and equipment). Correlation analyses between imaging biomarkers and the frequency or duration of seizure activity were calculated using partial correlations. The differential imaging indicators, age, and sex were considered as the discriminative features in the SVM to evaluate classification performance.
The patients with GTCS showed lower fALFF values (voxel p < 0.001, cluster p < 0.05, Gaussian random field corrected, GRF corrected) in the right postcentral gyrus and precentral gyrus and lower ReHo values (GRF corrected) in the middle temporal gyrus than the NCs. The patients with FBTCS showed higher fALFF (GRF corrected) values in the right postcentral and precentral gyrus and higher ReHo (GRF corrected) values in the right postcentral gyrus. Both fALFF (GRF corrected) and ReHo (GRF corrected) values were lower in the right postcentral gyrus and precentral gyrus in the GTCS group than in the FBTCS group. In patients with FBTCS, fALFF values in the right postcentral and precentral gyrus were positively correlated with duration (r = 0.655, p = 0.008, Bonferroni corrected) in the low-duration group, and ReHo values in the right postcentral gyrus were positively correlated with frequency (r = 0.486, p = 0.022, uncorrected) in the low-frequency group. SVM results showed receiver operating characteristic curves of 0.89, 0.87, and 0.76 for the classification between GTCS and NC, between FBTCS and NC, and GTCS and FBTCS, respectively.
This study detected alterations in fALFF and ReHo in the postcentral gyrus and precentral gyrus in patients with GTCS and FBTCS, which might contribute to understanding the pathogenesis, disease classification, and clinical targeted therapy.
我们旨在确定全身强直阵挛性发作（GTCS）和局灶性双侧强直阵挛性发作（FBTCS）患者的自发性局部脑活动是否存在改变，并通过支持向量机分析（SVM）探索这些改变是否可作为疾病亚型分类的生物标志物。
使用DPARSF 5.0工具箱，从57例GTCS患者、35例FBTCS患者以及50例年龄和性别匹配的正常对照（NC）的静息态功能磁共振成像（rs-fMRI）数据中提取低频波动分数幅值（fALFF）和局部一致性（ReHo）。组间比较针对协变量（年龄、性别和设备）进行了调整。使用偏相关计算成像生物标志物与癫痫发作活动频率或持续时间之间的相关性分析。将差异成像指标、年龄和性别作为SVM中的判别特征，以评估分类性能。
与NC相比，GTCS患者右侧中央后回和中央前回的fALFF值较低（体素p < 0.001，簇p < 0.05，高斯随机场校正，GRF校正），颞中回的ReHo值较低（GRF校正）。FBTCS患者右侧中央后回和中央前回的fALFF值较高（GRF校正），右侧中央后回的ReHo值较高（GRF校正）。GTCS组右侧中央后回和中央前回的fALFF（GRF校正）和ReHo（GRF校正）值均低于FBTCS组。在FBTCS患者中，低持续时间组右侧中央后回和中央前回的fALFF值与持续时间呈正相关（r = 0.655，p = 0.008，Bonferroni校正），低频组右侧中央后回的ReHo值与频率呈正相关（r = 0.486，p = 0.022，未校正）。SVM结果显示，GTCS与NC之间、FBTCS与NC之间以及GTCS与FBTCS之间分类的受试者工作特征曲线分别为0.89、0.87和0.76。
本研究检测到GTCS和FBTCS患者中央后回和中央前回的fALFF和ReHo改变，这可能有助于理解发病机制、疾病分类和临床靶向治疗。
