Li Wei, Chen Junxia, Qin Yingjie, Jiang Sisi, Li Xiuli, Zhang Heng, Luo Cheng, Gong Qiyong, Zhou Dong, An Dongmei
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Epilepsia Open. 2024 Dec;9(6):2251-2262. doi: 10.1002/epi4.13056. Epub 2024 Sep 26.
Dystonic posturing (DP) is a common semiology in temporal lobe epilepsy (TLE). We aimed to explore cerebellar gradient alterations in functional connectivity in TLE patients with and without DP.
Resting-state functional MRI data were obtained in 60 TLE patients and 32 matched healthy controls. Patients were further divided into two groups: TLE with DP (TLE + DP, 31 patients) and TLE without DP (TLP-DP, 29 patients). We explored functional gradient alterations in the cerebellum based on cerebellar-cerebral functional connectivity and combined with independent component analysis to evaluate cerebellar-cerebral functional integration and reveal the contribution of the motor components to the gradient.
There were no obvious differences in clinical features and postoperative seizure outcomes between TLE + DP and TLE-DP patients. Patients and controls all showed a clear unimodal-to-transmodal gradient transition in the cerebellum, while TLE patients demonstrated an extended principal gradient in functional connectivity compared to healthy controls, which was more limited in TLE + DP patients. Gradient alterations were more widespread in TLE-DP patients, involving bilateral cerebellum, while gradient alterations in TLE + DP patients were limited in the cerebellum ipsilateral to the seizure focus. In addition, more cerebellar motor components contributed to the gradient alterations in TLE + DP patients, mainly in ipsilateral cerebellum.
Extended cerebellar principal gradients in functional connectivity revealed excessive functional segregation between unimodal and transmodal systems in TLE. The functional connectivity gradients were more limited in TLE + DP patients. Functional connectivity in TLE patients with dystonic posturing involved more contribution of cerebellar motor function to ipsilateral cerebellar gradient.
Dystonic posturing contralateral to epileptic focus is a common symptom in temporal lobe epilepsy, and the cerebellum may be involved in its generation. In this study, we found cerebellar gradients alterations in functional connectivity in temporal lobe epilepsy patients with and without contralateral dystonic posturing. In particular, we found that TLE patients with dystonic posturing may have more limited cerebellar gradient in functional connectivity, involving more contribution of cerebellar motor function to ipsilateral cerebellar gradient. Our study suggests a close relationship between ipsilateral cerebellum and contralateral dystonic posturing.
肌张力障碍姿势（DP）是颞叶癫痫（TLE）常见的症状学表现。我们旨在探究伴或不伴DP的TLE患者小脑功能连接的梯度改变。
对60例TLE患者和32例匹配的健康对照者进行静息态功能磁共振成像（fMRI）数据采集。患者进一步分为两组：伴DP的TLE（TLE+DP，31例患者）和不伴DP的TLE（TLP-DP，29例患者）。我们基于小脑-大脑功能连接探究小脑的功能梯度改变，并结合独立成分分析评估小脑-大脑功能整合，揭示运动成分对梯度的贡献。
TLE+DP患者和TLE-DP患者在临床特征和术后癫痫发作结果方面无明显差异。患者和对照者在小脑中均表现出明显的从单峰到跨峰梯度转变，而与健康对照者相比，TLE患者在功能连接方面表现出延长的主梯度，在TLE+DP患者中更为受限。TLE-DP患者的梯度改变更广泛，累及双侧小脑，而TLE+DP患者的梯度改变局限于癫痫灶同侧的小脑。此外，更多的小脑运动成分对TLE+DP患者的梯度改变有贡献，主要在同侧小脑。
功能连接中延长的小脑主梯度揭示了TLE中单峰和跨峰系统之间过度的功能分离。TLE+DP患者的功能连接梯度更受限。伴有肌张力障碍姿势的TLE患者的功能连接涉及小脑运动功能对同侧小脑梯度的更多贡献。
癫痫灶对侧的肌张力障碍姿势是颞叶癫痫的常见症状，小脑可能参与其产生。在本研究中，我们发现伴或不伴对侧肌张力障碍姿势的颞叶癫痫患者小脑功能连接的梯度改变。特别是，我们发现伴有肌张力障碍姿势的TLE患者在功能连接方面可能具有更受限的小脑梯度，涉及小脑运动功能对同侧小脑梯度的更多贡献。我们的研究表明同侧小脑与对侧肌张力障碍姿势之间存在密切关系。
