Patterns of seizure spread in temporal lobe epilepsy are associated with distinct white matter tracts.
Patterns of seizure spread in temporal lobe epilepsy are associated with distinct white matter tracts.
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DOI：
10.1016/j.eplepsyres.2021.106571
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发表时间：
2021-03
影响因子：
2.2
通讯作者：
Bonilha L
中科院分区：
文献类型：
--
作者：
Gleichgerrcht E;Greenblatt AS;Kellermann TS;Rowland N;Vandergrift WA;Edwards J;Davis KA;Bonilha L
通常假设局灶性癫痫患者的癫痫发作扩散模式与结构性脑通路相关。然而，这种关系是知之甚少，并没有得到充分证明，在颞叶癫痫患者。在这里，我们试图确定癫痫发作扩散的方向性（DSS）是否与颞叶癫痫患者特定的大脑白色物质束相关。研究纳入了33例接受立体脑电图（sEEG）和磁共振扩散张量成像（MRDTI）作为标准治疗临床评价的成年颞叶癫痫患者。DSS被定义为基于两位独立专家的sEEG评估的前后（AP）或内外（ML）扩散，两位专家表现出良好的评分者间一致性（Cohen's kappa = .92）。DTI连接测定法用于评估癫痫发作传播模式组之间的差异沿着主要纤维途径有关分数各向异性（FA）。24名参与者显示癫痫发作伴AP扩散，9名参与者显示癫痫发作伴ML扩散。两组的人口统计学和临床特征无显著差异。ML发作的患者沿胼胝体有较高的FA沿着，在较小程度上，双侧扣带束的某些部分。与此相反，AP发作的患者有较高的FA沿着几个前后白色物质投射束，包括扣带束和下纵束，与ML发作相比，胼胝体的参与显着减少。这项研究证实了这一假设，即电生理发作传播的解剖模式与颞叶癫痫支持通路的结构强化有关。这一观察结果有助于阐明发作传播的机制，并可能指导未来的翻译方法，以减少癫痫发作的蔓延。
It is commonly hypothesized that seizure spread patterns in patients with focal epilepsy are associated with structural brain pathways. However, this relationship is poorly understood and has not been fully demonstrated in patients with temporal lobe epilepsy. Here, we sought to determine whether directionality of seizure spread (DSS) is associated with specific cerebral white matter tracts in patients with temporal lobe epilepsy. Thirty-three adult patients with temporal lobe epilepsy who underwent stereoelectroencephalography (sEEG) and magnetic resonance diffusion tensor imaging (MRDTI) as part of their standard-of-care clinical evaluation were included in the study. DSS was defined as anterior-posterior (AP) or medial-lateral (ML) spread based upon sEEG evaluation by two independent specialists who demonstrated excellent inter-rater agreement (Cohen’s kappa = .92). DTI connectometry was used to assess differences between seizure spread pattern groups along major fiber pathways regarding fractional anisotropy (FA). Twenty-four participants showed seizures with AP spread and nine participants showed seizures with ML spread. There were no significant differences between the groups on their demographic and clinical profile. Patients with ML seizures had higher FA along the corpus callosum and, to a lesser degree, some portions of the bilateral cingulate tracts. In contrast, patients with AP seizures had higher FA along several anterior-posterior white matter projections bundles, including the cingulate fasciculus and the inferior longitudinal, with significantly less involvement of the corpus callosum compared with ML seizures. This study confirms the hypothesis that the anatomical pattern of electrophysiological ictal propagation is associated with the structural reinforcement of supporting pathways in temporal lobe epilepsy. This observation can help elucidate mechanisms of ictal propagation and may guide future translational approaches to curtail seizure spread.
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