From the Farber Institute for Neuroscience (Q.Z., A.A., S.S.J., M.R.S., J.I.T.), Department of Neurology, Thomas Jefferson University, Philadelphia; Department of Biomedical Engineering (S.H.), Drexel University, Philadelphia, PA; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison.
Neurology. 2024 Oct 8;103(7):e209800. doi: 10.1212/WNL.0000000000209800. Epub 2024 Sep 9.
Despite their temporal lobe pathology, a significant subgroup of patients with temporal lobe epilepsy (TLE) is able to maintain normative cognitive functioning. In this study, we identify patients with TLE with intact vs impaired neurocognitive profiles and interrogate for the presence of both normative and highly individual intrinsic connectivity networks (ICNs)-all toward understanding the transition from impaired to intact neurocognitive status.
This retrospective cross-sectional study included patients with TLE and matched healthy controls (HCs) from the Thomas Jefferson Comprehensive Epilepsy Center. Functional MRI data were decomposed using independent component analysis to obtain individualized ICNs. In this article, we calculated the degree of match between individualized ICNs and canonical ICNs (e.g., 17 resting-state networks by Yeo et al.) and divided each participant's ICNs into normative or non-normative status based on the degree of match.
100 patients with TLE (mean age 42.0 [SD: 13.7] years, 47 women) and 92 HCs were included in this study. We found that the individualized networks matched to the canonical networks less well in the cognitively impaired (n = 24) compared with the cognitively intact (n = 63) patients with TLE by 2-way mixed-measures analysis of variance (impaired vs intact mean difference [MD] -0.165 [-0.317, -0.013], = 0.028). The cognitively impaired patients showed significant abnormalities in the profiles of both normative (impaired vs intact MD -0.537 [-0.998, -0.076], = 0.017, intact vs HC MD -0.221 [-0.536, 0.924], = 0.220, and impaired vs HC MD -0.759 [-1.200, -0.319], < 0.001) and non-normative networks (impaired vs intact MD 0.484 [0.030, 0.937], = 0.033, intact vs HC MD 0.369 [0.059, 0.678], = 0.014, and impaired vs HC MD 0.853 [0.419, 1.286], < 0.001) while the intact patients showed abnormalities only in non-normative networks. At the same time, we found that normative networks held a strong, positive association with the neuropsychological measures, with this association negative in non-normative networks.
Our data demonstrated that significant cognitive deficits are associated with the status of both canonical and highly individual ICNs, making clear that the transition from intact to impaired cognitive status is not simply the result of disruption to normative brain networks.
尽管颞叶癫痫（TLE）患者存在颞叶病理学，但仍有相当一部分患者能够保持正常的认知功能。本研究旨在确定 TLE 患者中存在正常与受损神经认知特征的亚组，并探讨是否存在正常和高度个体化的内在连接网络（ICNs），以了解从受损到正常神经认知状态的转变。
这是一项回顾性的横断面研究，纳入了来自托马斯杰斐逊综合癫痫中心的 TLE 患者和匹配的健康对照组（HCs）。使用独立成分分析对功能磁共振成像数据进行分解，以获得个体化的 ICNs。在本文中，我们计算了个体化 ICNs 与经典 ICNs（如，Yeo 等人的 17 个静息态网络）之间的匹配程度，并根据匹配程度将每个参与者的 ICNs 分为正常或非正常状态。
本研究纳入了 100 例 TLE 患者（平均年龄 42.0 [标准差：13.7] 岁，47 例女性）和 92 例 HCs。我们发现，与认知正常（n = 63）的 TLE 患者相比，认知受损（n = 24）患者的个体化网络与经典网络的匹配程度较差，采用 2 因素混合方差分析（认知受损与认知正常的平均差异 [MD] -0.165 [-0.317，-0.013]， = 0.028）。认知受损患者的正常和非正常 ICNs 特征均存在显著异常（正常与认知正常 MD -0.537 [-0.998，-0.076]， = 0.017，正常与 HC MD -0.221 [-0.536，0.924]， = 0.220，以及受损与 HC MD -0.759 [-1.200，-0.319]， < 0.001）和非正常网络（正常与认知正常 MD 0.484 [0.030，0.937]， = 0.033，正常与 HC MD 0.369 [0.059，0.678]， = 0.014，以及受损与 HC MD 0.853 [0.419，1.286]， < 0.001），而认知正常患者仅在非正常网络中存在异常。同时，我们发现正常网络与神经心理学测量有很强的正相关，而非正常网络则呈负相关。
我们的数据表明，显著的认知缺陷与经典和高度个体化 ICNs 的状态有关，这明确表明从认知正常到认知受损状态的转变不仅仅是正常脑网络受到破坏的结果。
