Weiler Marina, Lutkenhoff Evan S, de Campos Brunno M, Casseb Raphael F, Vespa Paul M, Monti Martin M
Department of Psychology, University of California Los Angeles, 1285 Franz HallBox 951563, Los Angeles, CA, 90095, USA.
Neuroimaging Laboratory, University of Campinas, Rua Vital Brasil, 888 Hospital de Clínicas, Cidade Universitária, Campinas, SP, 13083-888, Brazil.
Neuroimage Rep. 2024 Sep;4(3). doi: 10.1016/j.ynirp.2024.100217. Epub 2024 Sep 12.
The Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx, project 3) is a prospective multicenter clinical observational study to identify early biomarkers of epileptogenesis after moderate-to-severe traumatic brain injury (TBI). We used a seed-based approach applied to acute (i.e., ≤14 days) fMRI imaging data, directly testing the hypothesis that the presence of seizures up to two years following brain trauma is associated with functional changes within hippocampi and thalami-cortical networks. Additionally, we hypothesized that the network connectivity involving thalami and hippocampi circuits underlying early and late-onset seizures would differ. Approximately 30% of the initial dataset was deemed unusable due to MRI issues. Approximately 50% of the enrolled sample was lost to a 2-year follow-up. After preprocessing the fMRI data, approximately 40% of the follow-up sample had to be excluded from the analysis due to excessive in-scanner movements, as assessed by state-of-the-art quality control protocols. Only 37 patients provided data that was suitable for the seed-based analysis. Despite these challenges, the remaining, high-quality data returned noteworthy findings. We identified specific hippocampi and thalami biomarkers associated with both early and late seizures following TBI (p < .05, FWE-corrected at the cluster level). The predictive capability for the development of late seizures after TBI, when adding fMRI data to demographic and clinical data, provided 88% accuracy - an additional 8% improvement compared to using demographic and clinical data alone. Our findings highlight the potential of fMRI for uncovering, in hippocampal and thalamic cortical networks, biomarkers of early and late seizures following TBI. However, they also highlight the important challenges that need to be overcome in order for fMRI to become an effective biomarker and prognostic tool in the intensive care context.
抗癫痫发生治疗的癫痫生物信息学研究（EpiBioS4Rx，项目3）是一项前瞻性多中心临床观察性研究，旨在确定中重度创伤性脑损伤（TBI）后癫痫发生的早期生物标志物。我们采用基于种子的方法应用于急性（即≤14天）功能磁共振成像（fMRI）数据，直接检验以下假设：脑外伤后长达两年内癫痫发作的出现与海马体和丘脑-皮质网络内的功能变化相关。此外，我们假设早期和迟发性癫痫发作所涉及的丘脑和海马体回路的网络连通性会有所不同。由于MRI问题，约30%的初始数据集被认为无法使用。约50%的入组样本在2年随访中失访。在对fMRI数据进行预处理后，根据最先进的质量控制方案评估，约40%的随访样本因扫描过程中过度移动而不得不被排除在分析之外。只有37名患者提供了适合基于种子分析的数据。尽管存在这些挑战，但剩余的高质量数据仍得出了值得关注的结果。我们确定了与TBI后早期和晚期癫痫发作相关的特定海马体和丘脑生物标志物（p < 0.05，在簇水平进行FWE校正）。在将fMRI数据添加到人口统计学和临床数据时，对TBI后迟发性癫痫发作发展的预测能力提供了88%的准确率，与仅使用人口统计学和临床数据相比提高了8%。我们的研究结果突出了fMRI在揭示海马体和丘脑皮质网络中TBI后早期和晚期癫痫发作生物标志物方面的潜力。然而，它们也突出了为使fMRI在重症监护环境中成为有效的生物标志物和预后工具而需要克服的重要挑战。
