Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China.
Shenzhen Graduate School, Peking University, Shenzhen, China.
Prog Neuropsychopharmacol Biol Psychiatry. 2024 Dec 20;135:111110. doi: 10.1016/j.pnpbp.2024.111110. Epub 2024 Jul 26.
Benign childhood epilepsy with centrotemporal spikes (BECTS), a common pediatric epilepsy, may lead to cognitive decline when compounded by Electrical Status Epilepticus during Sleep (ESES). Emerging evidence suggests that disruptions in the Salience Network (SN) contribute significantly to the cognitive deficits observed in BECTS-ESES. Our study rigorously investigates the dynamic functional connectivity (dFC) within the SN and its correlation with cognitive impairments in BECTS-ESES, employing advanced neuroimaging and neuropsychological assessments.
In this research, 45 patients diagnosed with BECTS-ESES and 55 age-matched healthy controls (HCs) participated. We utilized resting-state functional magnetic resonance imaging (fMRI) and Independent Component Analysis (ICA) to identify three fundamental SN nodes: the right Anterior Insula (rAI), left Anterior Insula (lAI), and the Anterior Cingulate Cortex (ACC). A two-sample t-test facilitated the comparison of dFC between these pivotal regions and other brain areas.
Significantly, the BECTS-ESES group demonstrated increased dFC, particularly between the ACC and the right Middle Occipital Gyrus, and from the rAI to the right Superior Parietal Gyrus and Cerebellum, and from the lAI to the left Postcentral Gyrus. Such dFC augmentations provide neural insights potentially explaining the neuropsychological deficits in BECTS-ESES children. Employing comprehensive neuropsychological evaluations, we mapped these dFC disruptions to specific cognitive impairments encompassing memory, executive functioning, language, and attention. Through multiple regression analysis and path analysis, a preliminary but compelling association was discovered linking dFC disturbances directly to cognitive impairments. These findings underscore the critical role of SN disruptions in BECTS-ESES cognitive dysfunctions.
Our cross-sectional design and analytic methods preclude definitive mediation models and causal inferences, leaving the precise nature of dFC's mediating role and its direct impact by BECTS-ESES partially unresolved. Future longitudinal and confirmatory studies are needed to comprehensively delineate these associations.
Our study heralds dFC within the SN as a vital biomarker for cognitive impairment in pediatric epilepsy, advocating for targeted cognitive-specific interventions in managing BECTS-ESES. The preliminary nature of our findings invites further studies to substantiate these associations, offering profound implications for the prognosis and therapeutic strategies in BECTS-ESES, thereby underlining the importance of this research in the field of pediatric neurology and epilepsy management.
良性儿童癫痫伴中央颞区棘波（BECTS）是一种常见的儿科癫痫，如果合并睡眠中癫痫电持续状态（ESES），可能导致认知能力下降。新出现的证据表明，突显网络（SN）的中断对 BECTS-ESES 中观察到的认知缺陷有重要贡献。我们的研究使用先进的神经影像学和神经心理学评估方法，严格研究了 BECTS-ESES 中 SN 的动态功能连接（dFC）及其与认知障碍的相关性。
在这项研究中，我们纳入了 45 名被诊断为 BECTS-ESES 的患者和 55 名年龄匹配的健康对照组（HCs）。我们使用静息态功能磁共振成像（fMRI）和独立成分分析（ICA）来识别三个基本的 SN 节点：右侧前岛叶（rAI）、左侧前岛叶（lAI）和前扣带皮层（ACC）。采用两样本 t 检验比较这些关键区域与其他脑区之间的 dFC。
值得注意的是，BECTS-ESES 组的 dFC 增加，特别是在 ACC 和右侧中枕叶之间，以及 rAI 与右侧顶上回和小脑之间，以及 lAI 与左侧后中央回之间。这种 dFC 的增加提供了神经学上的见解，可能解释了 BECTS-ESES 儿童的神经心理学缺陷。通过全面的神经心理学评估，我们将这些 dFC 破坏与记忆、执行功能、语言和注意力等特定认知缺陷联系起来。通过多元回归分析和路径分析，我们发现了一个初步但有说服力的关联，即 dFC 紊乱与认知障碍直接相关。这些发现强调了 SN 中断在 BECTS-ESES 认知功能障碍中的关键作用。
我们的横断面设计和分析方法排除了明确的中介模型和因果推论，部分解决了 dFC 的中介作用的精确性质及其被 BECTS-ESES 直接影响的问题。未来需要进行纵向和验证性研究，以全面描绘这些关联。
我们的研究预示着 SN 内的 dFC 是儿科癫痫认知障碍的一个重要生物标志物，提倡针对 BECTS-ESES 进行有针对性的认知特异性干预。我们研究结果的初步性质邀请了进一步的研究来证实这些关联，为 BECTS-ESES 的预后和治疗策略提供了深远的意义，强调了这一研究在儿科神经病学和癫痫管理领域的重要性。
