Li Wei, Qin Yingjie, Li Xiuli, Zhang Heng, Gong Qiyong, Zhou Dong, An Dongmei
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Ann Clin Transl Neurol. 2025 Feb;12(2):383-392. doi: 10.1002/acn3.52285. Epub 2024 Dec 21.
Epilepsy is associated with progressive cortical atrophy exceeding normal aging. We aimed to explore longitudinal cortical alterations in patients with temporal lobe epilepsy (TLE) and distinct surgery outcomes.
We obtained longitudinal T1-weighted MRI data in a well-designed cohort, including 53 operative TLE patients, 23 nonoperative TLE patients, and 23 healthy controls. According to seizure outcomes at 24 months after surgery, operative patients were divided into seizure-free (SF) and nonseizure-free (NSF) group. Operative patients were scanned before and after surgery, while nonoperative patients and healthy controls were rescanned with similar interval times. We measured gray matter volume (GMV) in all participants and compared longitudinal cortical alterations among groups.
In nonoperative group, statistically significant GMV decrease was observed in ipsilateral median cingulate and paracingulate gyri and cerebellum crus I when compared with healthy controls. In operative group, postoperative GMV increase was discovered in many regions involving bilateral hemispheres, especially in the frontal lobe, without differences between SF and NSF group. Postoperative GMV decrease was found in ipsilateral inferior frontal gyrus, putamen, thalamus, and insula. GMV decrease in ipsilateral inferior frontal gyrus, putamen, and insula was more significant in SF group.
Progressive cortical atrophy existed in nonoperative TLE patients. Cortical remodeling indicated by postoperative GMV increase may arise mostly from the surgery itself, rather than postsurgical seizure outcomes. More significant GMV decrease in ipsilateral inferior frontal gyrus, putamen, and insula may imply their closer connections with resected regions in seizure-free patients.
癫痫与超过正常衰老的进行性皮质萎缩有关。我们旨在探讨颞叶癫痫（TLE）患者的纵向皮质改变及不同的手术结果。
我们在一个精心设计的队列中获取了纵向T1加权MRI数据，包括53例接受手术的TLE患者、23例未接受手术的TLE患者和23名健康对照者。根据术后24个月的癫痫发作结果，将接受手术的患者分为无癫痫发作（SF）组和非无癫痫发作（NSF）组。对接受手术的患者在手术前后进行扫描，而未接受手术的患者和健康对照者在相似的间隔时间进行重新扫描。我们测量了所有参与者的灰质体积（GMV），并比较了各组之间的纵向皮质改变。
在未接受手术的组中，与健康对照者相比，同侧中央扣带回和旁扣带回以及小脑脚I的GMV出现统计学显著下降。在接受手术的组中，术后在涉及双侧半球的许多区域发现GMV增加，尤其是在额叶，SF组和NSF组之间无差异。术后同侧额下回、壳核、丘脑和岛叶的GMV下降。SF组同侧额下回、壳核和岛叶的GMV下降更显著。
未接受手术的TLE患者存在进行性皮质萎缩。术后GMV增加所表明的皮质重塑可能主要源于手术本身，而非术后癫痫发作结果。同侧额下回、壳核和岛叶更显著的GMV下降可能意味着它们与无癫痫发作患者切除区域的联系更紧密。
