Borne Anna, Perrone-Bertolotti Marcela, Bulteau Christine, Cousin Emilie, Roger Elise, Baciu Monica
Univ. Grenoble Alpes, CNRS, LPNC, Grenoble, 38000, France.
Service de Neurochirurgie Pédiatrique, EpiCARE member, Hôpital Fondation Adolphe de Rothschild, Paris, 75019, France.
Brain Struct Funct. 2025 May 9;230(5):63. doi: 10.1007/s00429-025-02923-7.
Rasmussen's encephalitis (RE) is a rare neurological disorder affecting a single cerebral hemisphere, often requiring hemispherotomy as a curative treatment. While significant brain plasticity occurs due to the pathology and surgical intervention, the mechanisms underlying cognitive functioning in the remaining hemisphere remain poorly understood. This multiple-case study longitudinally investigates neurocognitive reorganization in childhood after left hemispherotomy for RE and identifies structural patterns in the right hemisphere associated with language recovery. Indeed, the mechanisms that allow the right hemisphere to support language, after left hemispherotomy remain unclear. Cognitive trajectories were analyzed in three RE patients, and their cortical thickness (CT) changes were compared with data from a publicly available cohort of 393 healthy subjects. Language neuropsychological scores and T1-weighted MRI data were assessed in the healthy right hemisphere before hemispherotomy, one year, and five years post-surgery. Specifically, principal component analysis, structural covariance, and graph theory approaches were employed to investigate language network organization in patients and controls. Results reveal diverse language recovery trajectories among the three patients. Regarding CT, three potential signatures associated with favorable language outcomes were identified: (1) normal or below-normal CT values in cortical regions; (2) a more associative and integrative organization of the language network; and (3) increased global efficiency. These preliminary longitudinal findings provide novel insights into the mechanisms of neurocognitive reorganization following left hemispherotomy in childhood. By emphasizing structural patterns linked to favorable postoperative language recovery, this study highlights their value for guiding future research and clinical interventions.
拉斯穆森脑炎（RE）是一种罕见的神经系统疾病，影响单个大脑半球，通常需要进行大脑半球切除术作为根治性治疗。虽然由于病理和手术干预会发生显著的大脑可塑性，但剩余半球认知功能的潜在机制仍知之甚少。这项多病例研究纵向调查了儿童期因RE行左侧大脑半球切除术后的神经认知重组，并确定了与语言恢复相关的右侧半球结构模式。事实上，左侧大脑半球切除术后右侧半球支持语言的机制仍不清楚。对三名RE患者的认知轨迹进行了分析，并将他们的皮质厚度（CT）变化与来自393名健康受试者的公开队列数据进行了比较。在大脑半球切除术之前、术后一年和五年，对健康右侧半球的语言神经心理学评分和T1加权MRI数据进行了评估。具体而言，采用主成分分析、结构协方差和图论方法来研究患者和对照组的语言网络组织。结果显示三名患者的语言恢复轨迹各不相同。关于CT，确定了与良好语言结果相关的三个潜在特征：（1）皮质区域CT值正常或低于正常；（2）语言网络的组织更具关联性和整合性；（3）全局效率提高。这些初步的纵向研究结果为儿童期左侧大脑半球切除术后神经认知重组的机制提供了新的见解。通过强调与术后良好语言恢复相关的结构模式，本研究突出了它们对指导未来研究和临床干预的价值。
