Thalamus and focal to bilateral seizures: A multiscale cognitive imaging study.
Thalamus and focal to bilateral seizures: A multiscale cognitive imaging study.
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DOI：
10.1212/wnl.0000000000010645
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发表时间：
2020-10-27
期刊：
影响因子：
9.9
通讯作者：
Sperling MR
中科院分区：
文献类型：
--
作者：
Caciagli L;Allen LA;He X;Trimmel K;Vos SB;Centeno M;Galovic M;Sidhu MK;Thompson PJ;Bassett DS;Winston GP;Duncan JS;Koepp MJ;Sperling MR
目的：探讨颞叶癫痫(TLE)继发性全身性癫痫发作复发的功能相关性，以任务型fMRI为框架检测癫痫特异性网络重排。由于丘脑调节颞叶发作发作的传播，并促进认知过程中皮质的同步化，我们假设继发性全身性癫痫的发生，即局灶性至双侧强直-阵挛发作(FBTCS)，可能与丘脑功能障碍、连接性改变和全脑网络中枢有关。三分之一的TLE患者会发生FBTCS，是疾病严重程度的主要决定因素。在这项横断面研究中，我们分析了113名耐药TLE患者(左55例，右58例)，他们进行了语言流畅的fMRI任务，激发了强大的丘脑激活。33名患者(29%)在调查前一年至少经历过一次FBTC。我们通过多尺度方法比较了有TLE-FBTCS的患者和没有FBTCS的患者，分析了统计参数图(SPM)12派生的激活测量、任务调节的丘脑功能连接(心理生理相互作用)和中心性的图论度量。与无TLE-FBTCS的个体相比，TLE-FBTCS患者双侧丘脑、左侧偏重和左侧海马区的任务相关激活较少。在TLE-FBTCS中，我们还发现与任务相关的丘脑-颞部和丘脑运动连接性更强，丘脑度和中间性中心性更高。接受者的工作特征曲线，基于一个联合的丘脑功能标记物，准确地区分了患有和不患有FBTCS的个体。在TLE-FBTCS中，与任务相关的丘脑招募受损与增强的丘脑-临时连接和全脑丘脑网络嵌入并存。改变的丘脑功能谱被认为是主动二次泛化的成像生物标志物。
To investigate the functional correlates of recurrent secondarily generalized seizures in temporal lobe epilepsy (TLE) using task-based fMRI as a framework to test for epilepsy-specific network rearrangements. Because the thalamus modulates propagation of temporal lobe onset seizures and promotes cortical synchronization during cognition, we hypothesized that occurrence of secondarily generalized seizures, i.e., focal to bilateral tonic-clonic seizures (FBTCS), would relate to thalamic dysfunction, altered connectivity, and whole-brain network centrality. FBTCS occur in a third of patients with TLE and are a major determinant of disease severity. In this cross-sectional study, we analyzed 113 patients with drug-resistant TLE (55 left/58 right), who performed a verbal fluency fMRI task that elicited robust thalamic activation. Thirty-three patients (29%) had experienced at least one FBTCS in the year preceding the investigation. We compared patients with TLE-FBTCS to those without FBTCS via a multiscale approach, entailing analysis of statistical parametric mapping (SPM) 12–derived measures of activation, task-modulated thalamic functional connectivity (psychophysiologic interaction), and graph-theoretical metrics of centrality. Individuals with TLE-FBTCS had less task-related activation of bilateral thalamus, with left-sided emphasis, and left hippocampus than those without FBTCS. In TLE-FBTCS, we also found greater task-related thalamotemporal and thalamomotor connectivity, and higher thalamic degree and betweenness centrality. Receiver operating characteristic curves, based on a combined thalamic functional marker, accurately discriminated individuals with and without FBTCS. In TLE-FBTCS, impaired task-related thalamic recruitment coexists with enhanced thalamotemporal connectivity and whole-brain thalamic network embedding. Altered thalamic functional profiles are proposed as imaging biomarkers of active secondary generalization.