Characterization of postsurgical functional connectivity changes in temporal lobe epilepsy
Characterization of postsurgical functional connectivity changes in temporal lobe epilepsy
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DOI：
10.3171/2019.3.jns19350
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发表时间：
2020-08-01
影响因子：
4.1
通讯作者：
Englot, Dario J.
中科院分区：
文献类型：
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作者：
Morgan, Victoria L.;Rogers, Baxter P.;Englot, Dario J.
目的 内侧颞叶癫痫 (mTLE) 手术后的癫痫结果复杂且多样，即使对于术前临床特征相同的患者也是如此。作者推测，这部分是由于手术前后大脑网络连接的变化所致。尽管先前已对这些患者的术前网络连接进行了表征，但本研究的目的是表征 mTLE 手术后整个大脑的术前至术后功能网络连接变化。 方法 20 名药物难治性单侧 mTLE 患者（5 名左侧，10 名女性，年龄 39.3 +/- 13.5 岁）接受选择性杏仁核海马切除术 (n = 13) 或颞叶切除术 (n = 7) 纳入研究。使用 3-T MRI 测量术前和术后（术后 36.6 +/- 14.3 个月）功能连接 (FC)，并与年龄匹配的健康对照（n = 44，21 名女性，年龄 39.3 +/- 14.3 岁）的结果进行比较。术后连接性变化与癫痫发作结果、手术类型和术前疾病参数相关。 结果结果表明，手术后整个大脑的 FC 值较对照组值显着降低，而手术前不存在这种情况，包括手术部位远端的许多对侧海马连接。对侧楔前叶与同侧枕骨连接的术后损伤与癫痫复发相关。与接受颞叶切除术的患者相比，接受选择性杏仁核海马切除术的患者术前对侧楔前叶与对侧颞叶连接的损伤与此相关。最后，手术后丘脑连接的变化与手术前癫痫持续时间和意识障碍癫痫发作的频率线性相关。结论手术后广泛的对侧海马 FC 变化可能反映了手术改变的持续癫痫进展，而不是手术本身的直接结果。这种网络的演变可能有助于长期癫痫发作的结果。因此，将术前网络映射与对手术对网络的动态影响的理解相结合，最终可用于创建 mTLE 手术后个体患者长期癫痫复发可能性的预测因子。
OBJECTIVE Seizure outcome after mesial temporal lobe epilepsy (mTLE) surgery is complex and diverse, even across patients with homogeneous presurgical clinical profiles. The authors hypothesized that this is due in part to variations in network connectivity across the brain before and after surgery. Although presurgical network connectivity has been previously characterized in these patients, the objective of this study was to characterize presurgical to postsurgical functional network connectivity changes across the brain after mTLE surgery.METHODS Twenty patients with drug-refractory unilateral mTLE (5 left side, 10 female, age 39.3 +/- 13.5 years) who underwent either selective amygdalohippocampectomy (n = 13) or temporal lobectomy (n = 7) were included in the study. Presurgical and postsurgical (36.6 +/- 14.3 months after surgery) functional connectivity (FC) was measured with 3-T MRI and compared with findings in age-matched healthy controls (n = 44, 21 female, age 39.3 +/- 14.3 years). Postsurgical connectivity changes were then related to seizure outcome, type of surgery, and presurgical disease parameters.RESULTS The results demonstrated significant decreases of FC from control group values across the brain after surgery that were not present before surgery, including many contralateral hippocampal connections distal to the surgical site. Postsurgical impairment of contralateral precuneus to ipsilateral occipital connectivity was associated with seizure recurrence. Presurgical impairment of the contralateral precuneus to contralateral temporal lobe connectivity was associated with those who underwent selective amygdalohippocampectomy compared to those who had temporal lobectomy. Finally, changes in thalamic connectivity after surgery were linearly related to duration of epilepsy and frequency of consciousness-impairing seizures prior to surgery.CONCLUSIONS The widespread contralateral hippocampal FC changes after surgery may be a reflection of an ongoing epileptogenic progression that has been altered by the surgery, rather than a direct result of the surgery itself. This network evolution may contribute to long-term seizure outcome. Therefore, the combination of presurgical network mapping with the understanding of the dynamic effects of surgery on the networks may ultimately be used to create predictors of the likelihood of long-term seizure recurrence in individual patients after mTLE surgery.