Mapping Lesion-Related Epilepsy to a Human Brain Network.
Mapping Lesion-Related Epilepsy to a Human Brain Network.
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DOI：
10.1001/jamaneurol.2023.1988
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发表时间：
2023-09-01
期刊：
影响因子：
29
通讯作者：
中科院分区：
文献类型：
--
作者：
与病变相关的癫痫是否映射到大脑网络？在这项病例对照研究中，无论患者是否患有癫痫，与癫痫相关的病变都发生在多个不同的脑部位。然而，这些相同的病变位置是特定大脑网络的一部分，该网络由与基底节和小脑的功能连接定义，与癫痫控制相关的深部脑刺激位置连接到该网络。这些发现表明，与病变相关的癫痫映射到一个大脑网络，该网络可以帮助识别大脑病变后有癫痫风险的患者，并指导脑刺激治疗。这项病例对照研究评估了癫痫相关病变在特定大脑区域和网络中的位置。目前尚不清楚为什么某些部位的病变会导致癫痫，而另一些部位则不会。通过绘制这些病变的图谱来识别与癫痫相关的大脑区域或网络，可以告知预后并指导干预。以评估与癫痫相关的病变位置是否映射到特定的大脑区域和网络。这项病例对照研究使用病灶定位和病灶网络图，在发现中风后癫痫患者和对照中风患者的数据集中识别与癫痫相关的脑区和大脑网络。有卒中病变伴癫痫患者(n = 76例)和无癫痫患者(n = 6 2 5例)纳入研究对象。使用4个独立的队列作为验证数据集来评估对其他病变类型的概括性。所有数据集(包括发现数据集和验证数据集)中的癫痫患者总数为347人，非癫痫患者为1126人。使用改善癫痫控制的脑深部刺激部位来评估治疗相关性。对2018年9月至2022年12月的数据进行了分析。所有共享的患者数据都被分析并纳入其中；没有患者被排除在外。不管有没有癫痫。卒中后癫痫患者76例(男性39例(51%)，平均年龄61.0[14.6]岁；平均随访6.7[2.0]年)和对照组625例(男性366例(59%)，平均年龄62.0[14.1]岁；随访3~12个月)。与癫痫相关的病变发生在跨越不同叶和血管区域的多个不同部位。然而，这些相同的病变位置是特定大脑网络的一部分，该网络由与基底节和小脑的功能连接定义。结果在4个独立队列中得到验证，其中包括772名脑部病变患者(271例癫痫患者；515例男性患者；中位年龄60[50-70]岁；随访期3-35年)。病变与这一大脑网络的连通性与中风后癫痫风险的增加(优势比[OR]，2.82；95%CI，2.02-4.10；P <； .001)以及不同病变类型之间(OR，2.85；95%CI，2.23-3.69；P <； .001)相关。30例耐药癫痫患者(男性21例，70%；中位年龄39岁[32-46]岁；中位随访24[16-30]个月)中，脑深部刺激部位与同一网络的连接与癫痫控制的改善有关(r，0.63；P <； .001)。这项研究的发现表明，与病变相关的癫痫映射到人类大脑网络，这可以帮助识别大脑病变后有癫痫风险的患者，并指导脑刺激治疗。
Does lesion-related epilepsy map to a brain network? In this case-control study of lesion locations in patients who either developed epilepsy or did not, lesions associated with epilepsy occurred in multiple heterogenous brain locations. However, these same lesion locations were part of a specific brain network defined by functional connectivity to the basal ganglia and cerebellum, and deep brain stimulation sites associated with seizure control were connected to this same network. The findings indicate that lesion-related epilepsy mapped to a brain network that could help identify patients at risk of epilepsy after a brain lesion and guide brain stimulation therapies. This case-control study evaluates the locations of epilepsy-associated lesions with respect to specific brain regions and networks. It remains unclear why lesions in some locations cause epilepsy while others do not. Identifying the brain regions or networks associated with epilepsy by mapping these lesions could inform prognosis and guide interventions. To assess whether lesion locations associated with epilepsy map to specific brain regions and networks. This case-control study used lesion location and lesion network mapping to identify the brain regions and networks associated with epilepsy in a discovery data set of patients with poststroke epilepsy and control patients with stroke. Patients with stroke lesions and epilepsy (n = 76) or no epilepsy (n = 625) were included. Generalizability to other lesion types was assessed using 4 independent cohorts as validation data sets. The total numbers of patients across all datasets (both discovery and validation datasets) were 347 with epilepsy and 1126 without. Therapeutic relevance was assessed using deep brain stimulation sites that improve seizure control. Data were analyzed from September 2018 through December 2022. All shared patient data were analyzed and included; no patients were excluded. Epilepsy or no epilepsy. Lesion locations from 76 patients with poststroke epilepsy (39 [51%] male; mean [SD] age, 61.0 [14.6] years; mean [SD] follow-up, 6.7 [2.0] years) and 625 control patients with stroke (366 [59%] male; mean [SD] age, 62.0 [14.1] years; follow-up range, 3-12 months) were included in the discovery data set. Lesions associated with epilepsy occurred in multiple heterogenous locations spanning different lobes and vascular territories. However, these same lesion locations were part of a specific brain network defined by functional connectivity to the basal ganglia and cerebellum. Findings were validated in 4 independent cohorts including 772 patients with brain lesions (271 [35%] with epilepsy; 515 [67%] male; median [IQR] age, 60 [50-70] years; follow-up range, 3-35 years). Lesion connectivity to this brain network was associated with increased risk of epilepsy after stroke (odds ratio [OR], 2.82; 95% CI, 2.02-4.10; P < .001) and across different lesion types (OR, 2.85; 95% CI, 2.23-3.69; P < .001). Deep brain stimulation site connectivity to this same network was associated with improved seizure control (r, 0.63; P < .001) in 30 patients with drug-resistant epilepsy (21 [70%] male; median [IQR] age, 39 [32-46] years; median [IQR] follow-up, 24 [16-30] months). The findings in this study indicate that lesion-related epilepsy mapped to a human brain network, which could help identify patients at risk of epilepsy after a brain lesion and guide brain stimulation therapies.
影响因子：
3.6
作者：
Forcelli PA
通讯作者：
Forcelli PA
影响因子：
4.8
作者：
Nordberg, Janne;Schaper, Frederic L. W. V. J.;Bucci, Marco;Nummenmaa, Lauri;Joutsa, Juho
通讯作者：
Joutsa, Juho