Schlump Andrea, Feige Bernd, Matthies Swantje, von Zedtwitz Katharina, Matteit Isabelle, Lange Thomas, Nickel Kathrin, Domschke Katharina, Reisert Marco, Rau Alexander, Heinrichs Markus, Endres Dominique, Tebartz van Elst Ludger, Maier Simon
Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany.
Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, Department of Psychology, University of Freiburg, 79085 Freiburg, Germany.
Brain Sci. 2025 May 31;15(6):592. doi: 10.3390/brainsci15060592.
: Previous neuroimaging studies have reported structural brain alterations and local network hyperexcitability in terms of increased slow-wave electroencephalography (EEG) activity in patients with borderline personality disorder (BPD). In particular, intermittent rhythmic delta and theta activity (IRDA/IRTA) has drawn attention in mental health contexts due to its links with metabolic imbalances, neuronal stress, and emotional dysregulation-processes that are highly pertinent to BPD. These functional disturbances may be reflected in corresponding structural brain changes. The current study investigated cortical thickness and subcortical volumes in BPD and examined their associations with IRDA/IRTA events per minute, symptom severity, and neuropsychological measures. : Seventy female BPD patients and 36 age-matched female healthy controls (HC) were included (for clinical EEG comparisons even 72 patients were available). IRDA/IRTA rates were assessed using an automatic independent component analyses (ICA) approach. T1-weighted MRI data were obtained using a MAGNETOM Prisma 3T system and analyzed with FreeSurfer (version 7.2) for subcortical structures and CAT12 for cortical thickness and global volume measurements. Psychometric assessments included questionnaires such as Borderline Symptom List (BSL-23) and Inventory of Personality Organization (IPO). Neuropsychological performance was evaluated with the Test for Attentional Performance (TAP), Culture Fair Intelligence Test (CFT-20-R), and Verbal Learning and Memory Test (VLMT). : Between-group comparisons exhibited no significant increase in IRDA/IRTA rates or structural abnormalities between the BPD and HC group. However, within the BPD group, cortical thickness of the right isthmus of the cingulate gyrus negatively correlated with the IRDA/IRTA difference (after minus before hyperventilation, HV; < 0.001). Furthermore, BPD symptom severity (BSL-23) and IPO scores positively correlated with the thickness of the right rostral anterior cingulate cortex ( < 0.001), and IPO scores were associated with the thickness of the right temporal pole ( < 0.001). Intrinsic alertness (TAP) significantly correlated with relative cerebellar volume ( 0.01). : While no group-level structural abnormalities were observed, correlations between EEG slowing, BPD symptom severity, and alertness with cortical thickness and/or subcortical volumes suggest a potential role of the anterior cingulate cortex, temporal pole, and cerebellum in emotion regulation and cognitive functioning in BPD. Future research employing multimodal EEG-MRI approaches may provide deeper insights into the neural mechanisms underlying BPD and guide personalized therapeutic strategies.
以往的神经影像学研究报告称，边缘型人格障碍（BPD）患者存在大脑结构改变以及局部网络过度兴奋，表现为慢波脑电图（EEG）活动增加。特别是，间歇性节律性δ波和θ波活动（IRDA/IRTA）因其与代谢失衡、神经元应激和情绪调节失调（这些过程与BPD高度相关）的联系，在心理健康领域引起了关注。这些功能障碍可能反映在相应的大脑结构变化中。本研究调查了BPD患者的皮质厚度和皮质下体积，并检查了它们与每分钟IRDA/IRTA事件、症状严重程度和神经心理学测量指标之间的关联。
纳入了70名女性BPD患者和36名年龄匹配的女性健康对照者（HC）（为进行临床EEG比较，甚至有72名患者可用）。使用自动独立成分分析（ICA）方法评估IRDA/IRTA发生率。使用MAGNETOM Prisma 3T系统获取T1加权MRI数据，并使用FreeSurfer（7.2版）分析皮质下结构，使用CAT12分析皮质厚度和总体积测量。心理测量评估包括诸如边缘型症状清单（BSL - 23）和人格组织问卷（IPO）等问卷。使用注意力表现测试（TAP）、文化公平智力测试（CFT - 20 - R）和言语学习与记忆测试（VLMT）评估神经心理学表现。
组间比较显示，BPD组和HC组之间的IRDA/IRTA发生率或结构异常没有显著增加。然而，在BPD组内，扣带回右峡部的皮质厚度与IRDA/IRTA差异（过度换气后减去过度换气前，HV；<0.001）呈负相关。此外，BPD症状严重程度（BSL - 23）和IPO得分与右喙状前扣带回皮质厚度呈正相关（<0.001），IPO得分与右颞极厚度相关（<0.001）。内在警觉性（TAP）与相对小脑体积显著相关（0.01）。
虽然未观察到组水平的结构异常，但EEG减慢、BPD症状严重程度以及警觉性与皮质厚度和/或皮质下体积之间的相关性表明，前扣带回皮质、颞极和小脑在BPD的情绪调节和认知功能中可能发挥潜在作用。未来采用多模态EEG - MRI方法的研究可能会更深入地了解BPD潜在的神经机制，并指导个性化治疗策略。
