Xie Hua, Illapani Venkata Sita Priyanka, Vezina L Gilbert, Gholipour Taha, Oluigbo Chima, Gaillard William D, Cohen Nathan T
Center for Neuroscience Research, Children's National Hospital, The George Washington University School of Medicine, Washington, DC, USA.
Department of Neurosciences, University of California San Diego, San Diego, CA, USA.
Ann Neurol. 2024 Aug 27. doi: 10.1002/ana.27069.
To determine common network alterations in focal cortical dysplasia pharmacoresistant epilepsy (FCD-PRE) using functional connectivity analysis of resting-state functional magnetic resonance imaging (rsfMRI).
This is a retrospective imaging cohort from Children's National Hospital (Washington, DC, USA) from January, 2011 to January, 2022. Patients with 3-T MRI-confirmed FCD-PRE underwent rsfMRI as part of routine clinical care. Patients were included if they were age 5-22 years at the time of the scan, and had a minimum of 18 months of follow-up. Healthy, typically-developing controls were included from Children's National Hospital (n = 16) and matched from Human Connectome Project-Development public dataset (n = 100).
A total of 42 FCD-PRE patients (20 M:22 F, aged 14.2 ± 4.1 years) and 116 healthy controls (56 M:60 F, aged 13.7 ± 3.3 years) with rsfMRI were included. Seed-based functional connectivity maps were generated for each FCD, and each seed was used to generate a patient-specific z-scored connectivity map on 116 controls. FCD-PRE patients had mutual altered connectivity in regions of dorsal attention, default mode, and control networks. Functional connectivity was diminished within the FCD dominant functional network, as well as in homotopic regions. Cluster specific connectivity patterns varied by pathological subtype. Higher FCD connectivity to the limbic network was associated with increased odds of Engel I outcome.
This study demonstrates diminished functional connectivity patterns in FCD-PRE, which may represent a neuromarker for the disease, independent of FCD location, involving the dorsal attention, default mode, and control functional networks. Higher connectivity to the limbic network is associated with a seizure-free outcome. Future multicenter, prospective studies are needed to allow for much earlier detection of signatures of treatment-resistant epilepsy. ANN NEUROL 2024.
利用静息态功能磁共振成像（rsfMRI）的功能连接分析确定局灶性皮质发育不良药物难治性癫痫（FCD-PRE）中常见的网络改变。
这是一项来自美国华盛顿特区儿童国家医院的回顾性成像队列研究，时间跨度为2011年1月至2022年1月。经3-T磁共振成像确诊为FCD-PRE的患者在常规临床护理中接受了rsfMRI检查。纳入标准为扫描时年龄在5至22岁之间，且至少有18个月的随访期。健康的、发育正常的对照者来自儿童国家医院（n = 16），并从人类连接组计划-发育公共数据集中匹配（n = 100）。
共纳入42例有rsfMRI数据的FCD-PRE患者（20例男性：22例女性，年龄14.2±4.1岁）和116例健康对照者（56例男性：60例女性，年龄13.7±3.3岁）。为每个FCD生成基于种子点的功能连接图，并使用每个种子点在116例对照者上生成患者特异性的z评分连接图。FCD-PRE患者在背侧注意、默认模式和控制网络区域存在相互改变的连接性。FCD优势功能网络内以及同位区域的功能连接性降低。特定簇的连接模式因病理亚型而异。FCD与边缘网络的连接性越高，Engel I级预后的几率越高。
本研究表明FCD-PRE中功能连接模式减弱，这可能代表该疾病的一种神经标志物，与FCD位置无关，涉及背侧注意、默认模式和控制功能网络。与边缘网络的连接性越高与无癫痫发作的预后相关。未来需要多中心前瞻性研究，以便更早地检测出药物难治性癫痫的特征。《神经病学年鉴》2024年。
