Xu Cuiping, Qi Lei, Wang Xueyuan, Schaper Frédéric L W V J, Wu Di, Yu Tao, Yan Xiaoming, Jin Guangyuan, Wang Qiao, Wang Xiaopeng, Huang Xinqi, Wang Yuke, Chen Yuanhong, Liu Jinghui, Wang Yuping, Horn Andreas, Fisher Robert S, Ren Liankun
National Center for Neurological Disorders, Beijing, China; Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China.
National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China.
Brain Stimul. 2023 Sep-Oct;16(5):1302-1309. doi: 10.1016/j.brs.2023.08.020. Epub 2023 Aug 24.
Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) is an effective treatment for refractory epilepsy; however, seizure outcome varies among individuals. Identifying a reliable noninvasive biomarker to predict good responders would be helpful.
To test whether the functional connectivity between the ANT-DBS sites and the seizure foci correlates with effective seizure control in refractory epilepsy.
We performed a proof-of-concept pilot study of patients with focal refractory epilepsy receiving ANT-DBS. Using normative human connectome data derived from 1000 healthy participants, we investigated whether intrinsic functional connectivity between the seizure foci and the DBS site was associated with seizure outcome. We repeated this analysis controlling for the extent of seizure foci, distance between the seizure foci and DBS site, and using functional connectivity of the ANT instead of the DBS site to test the contribution of variance in DBS sites.
Eighteen patients with two or more seizure foci were included. Greater functional connectivity between the seizure foci and the DBS site correlated with more favorable outcome. The degree of functional connectivity accounted for significant variance in clinical outcomes (DBS site: |r| = 0.773, p < 0.001 vs ANT-atlas: |r| = 0.715, p = 0.001), which remained significant when controlling for the extent of the seizure foci (|r| = 0.773, p < 0.001) and the distance between the seizure foci and DBS site (|r| = 0.777, p < 0.001). Significant correlations were independent of variance in the DBS sites (|r| = 0.148, p = 0.57).
These findings suggest that functional connectomic profile is a potential reliable non-invasive biomarker to predict ANT-DBS outcomes. Accordingly, the identification of ANT responders could decrease the surgical risk for patients who may not benefit and optimize the cost-effective allocation of health care resources.
丘脑前核深部脑刺激（ANT-DBS）是治疗难治性癫痫的一种有效方法；然而，个体间的癫痫发作结果存在差异。识别一种可靠的非侵入性生物标志物来预测良好反应者将有所帮助。
测试ANT-DBS部位与癫痫病灶之间的功能连接是否与难治性癫痫的有效癫痫控制相关。
我们对接受ANT-DBS的局灶性难治性癫痫患者进行了一项概念验证性初步研究。使用来自1000名健康参与者的标准化人类连接组数据，我们研究了癫痫病灶与DBS部位之间的内在功能连接是否与癫痫发作结果相关。我们重复了这项分析，控制癫痫病灶的范围、癫痫病灶与DBS部位之间的距离，并使用ANT而非DBS部位的功能连接来测试DBS部位差异的贡献。
纳入了18名有两个或更多癫痫病灶的患者。癫痫病灶与DBS部位之间更强的功能连接与更有利的结果相关。功能连接程度在临床结果中占显著差异（DBS部位：|r| = 0.773，p < 0.001；与ANT图谱相比：|r| = 0.715，p = 0.001），在控制癫痫病灶范围（|r| = 0.773，p < 0.001）和癫痫病灶与DBS部位之间的距离（|r| = 0.777，p < 0.001）时，该差异仍然显著。显著相关性独立于DBS部位的差异（|r| = 0.148，p = 0.57）。
这些发现表明，功能连接组图谱是预测ANT-DBS结果的一种潜在可靠非侵入性生物标志物。因此，识别ANT反应者可以降低对可能无获益患者的手术风险，并优化卫生保健资源的成本效益分配。
