目的:本研究的目的是评估单纯局灶性癫痫发作(FS)的颞叶癫痫(TLE)患者与局灶性至双侧强直阵挛性癫痫发作(FBTCS)患者在拓扑特征和丰富俱乐部组织方面的差异。
方法:我们招募了130名单侧TLE患者,其中57例仅为FS,73例同时为FS和FBTCS,和68名年龄和性别匹配的健康对照(HC)。基于弥散加权成像数据构建全脑网络。应用图论量化了拓扑网络度量和丰富的俱乐部组织。进行基于网络的统计(NBS)分析以研究边缘连接强度的差异。非参数置换检验用于评估组间差异。进行5%α的Benjamini-HochbergFDR进行多次比较。
结果:与HC相比,FS组和FBTCS组均显示全脑连接强度和整体效率显著降低.与HC相比,FBTCS组在丰富的球杆和支线连接中均显示出较低的连接强度。与HC相比,FS组在馈线和本地连接中的连接强度较低。NBS分析显示,FBTCS组的连接强度下降幅度更大,涉及90%的富裕俱乐部地区,主要影响颞叶皮质下,额叶-顶叶,额叶颞叶,大多数减少的连接在颞叶和地层之间。虽然FS组的连接强度下降是相对局部的,涉及50%的富裕俱乐部地区,主要集中在颞叶皮质下。
结论:TLE的网络集成度降低。带有FBTCS的TLE选择性地破坏了丰富的俱乐部区域,而只有FS的TLE更有可能影响非富俱乐部地区,强调富人俱乐部组织对癫痫发作概括的贡献。
OBJECTIVE: The purpose of this study was to assess the differences of topological characteristic and rich club organization between temporal lobe epilepsy (TLE) patients with focal seizure (FS) only and those with focal to bilateral tonic-clonic seizures (FBTCS).
METHODS: We recruited 130 unilateral TLE patients, of which 57 patients with FS only and 73 patients with both FS and FBTCS, and 68 age- and gender-matched healthy controls (HC). Whole-brain networks were constructed based on diffusion weighted imaging data. Graph theory was applied to quantify the topological network metrics and rich club organization. Network-based statistic (NBS) analysis was administered to investigate the difference in edge-wise connectivity strength. The non-parametric permutation test was applied to evaluate the differences between groups. Benjamini-Hochberg FDR at the alpha of 5% was carried out for multiple comparations.
RESULTS: In comparison with HC, both the FS and FBTCS group displayed a significant reduction in whole-brain connectivity strength and global efficiency. The FBTCS group showed lower connectivity strength both in the rich club and feeder connections compared to HC. The FS group had lower connectivity strength in the feeder and local connections compared to HC. NBS analysis revealed a wider range of decreased connectivity strength in the FBTCS group, involving 90% of the rich club regions, mainly affecting temporal-subcortical, frontal-parietal, and frontal-temporal lobe, the majority decreasing connections were between temporal lobe and stratum. While the decreased connectivity strength in the FS group were relatively local, involving 50% of rich club regions, mainly concentrated on the temporal-subcortical lobe.
CONCLUSIONS: Network integration was reduced in TLE. TLE with FBTCS selectively disrupted the rich club regions, while TLE with FS only were more likely to affect the non-rich club regions, emphasizing the contribution of rich club organization to seizure generalization.