Preoperative functional connectivity by magnetic resonance imaging for refractory neocortical epilepsy.
Preoperative functional connectivity by magnetic resonance imaging for refractory neocortical epilepsy.
复制标题
通过磁共振成像对难治性新皮质癫痫进行术前功能连接。
DOI：
10.1101/2023.01.10.23284374
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Leuthardt,EricC
中科院分区：
文献类型：
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作者：
Johnson,EmilyA;Lee,JohnJ;Hacker,CarlD;Park,KiYun;Rustamov,Nabi;Daniel,AndyGS;Shimony,JoshuaS;Leuthardt,EricC
目的对难治性癫痫患者进行广泛的侵入性临床检测，以确定可通过手术切除治疗的癫痫发作区域。然而，手术切除可能无法提供治疗效果，并且新皮质癫痫患者的治疗效果最差。该病例系列研究了转诊接受手术治疗的新皮质癫痫患者。手术前，除了临床标准护理成像之外，患者还自愿接受静息态功能磁共振成像 (rs-fMRI)。这项工作检查了通过 rs-fMRI 估计的患者功能连接的变异性与手术结果的关联。方法这项工作检查了 7 名癫痫患者的术前结构成像、术前 rs-fMRI 和术后结构成像。临床记录的审查提供了手术结果的恩格尔分类。一种新方法使用来自一大群健康对照受试者的比较 rs-fMRI 评估患者的术前 rs-fMRI，并与健康对照相比估计患者功能连接的吉布斯分布。结果 3 名患者的 Engel 分类为 Ia，1 名患者的 Engel 分类为 IIa，3 名患者的 Engel 分类为 IV。功能连接变异性的指标，包括每个患者的功能连接与健康对照平均值的绝对差异以及绝对差异的概率评分，对于被分类为 Engel IV 的患者较高，对于这些患者来说，癫痫手术没有提供有意义的改善。意义这项工作继续努力使用 rs-fMRI 来表征大脑中的异常功能连接。初步证据表明，癫痫患者的变异功能连接的拓扑结构可能具有临床相关性，可用于识别癫痫手术后不太可能获得良好结果的患者。功能连接的广泛地形变化也支持癫痫是大脑静息态网络疾病的假设。
ObjectivePatients with refractory epilepsy experience extensive and invasive clinical testing for seizure onset zones treatable by surgical resection. However, surgical resection can fail to provide therapeutic benefit, and patients with neocortical epilepsy have the poorest therapeutic outcomes. This case series studied patients with neocortical epilepsy who were referred for surgical treatment. Prior to surgery, patients volunteered for resting-state functional magnetic resonance imaging (rs-fMRI) in addition to imaging for the clinical standard of care. This work examined the variability of functional connectivity in patients, estimated from rs-fMRI, for associations with surgical outcomes.MethodsThis work examined pre-operative structural imaging, pre-operative rs-fMRI, and post-operative structural imaging from seven epilepsy patients. Review of the clinical record provided Engel classifications for surgical outcomes. A novel method assessed pre-operative rs-fMRI from patients using comparative rs-fMRI from a large cohort of healthy control subjects and estimated Gibbs distributions for functional connectivity in patients compared to healthy controls.ResultsThree patients had Engel classification Ia, one patient had Engel classification IIa, and three patients had Engel classification IV. Metrics for variability of functional connectivity, including absolute differences of the functional connectivity of each patient from healthy control averages and probabilistic scores for absolute differences, were higher for patients classified as Engel IV, for whom epilepsy surgery provided no meaningful improvement.SignificanceThis work continues on-going efforts to use rs-fMRI to characterize abnormal functional connectivity in the brain. Preliminary evidence indicates that the topography of variant functional connectivity in epilepsy patients may be clinically relevant for identifying patients unlikely to have favorable outcomes after epilepsy surgery. Widespread topographic variations of functional connectivity also support the hypothesis that epilepsy is a disease of brain resting-state networks.