Functional connectome contractions in temporal lobe epilepsy: Microstructural underpinnings and predictors of surgical outcome
Functional connectome contractions in temporal lobe epilepsy: Microstructural underpinnings and predictors of surgical outcome
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颞叶癫痫的功能性连接体收缩：手术结果的微观结构基础和预测因素
DOI：
10.1111/epi.16540
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发表时间：
2020-05-26
期刊：
影响因子：
5.6
通讯作者：
Bernhardt, Boris C.
中科院分区：
文献类型：
--
作者：
Lariviere, Sara;Weng, Yifei;Bernhardt, Boris C.
目的颞叶癫痫（TLE）是成人最常见的耐药性癫痫。虽然它通常与海马病理学有关，但越来越多的证据表明结构变化超出了近中颞叶。功能异常及其与潜在结构改变的联系，然而，仍然不完全understood.Methods我们研究了30耐药TLE患者和57名健康对照使用多模态磁共振成像（MRI）分析。所有患者均经组织学证实海马硬化，并接受术后影像学检查以确定手术切除范围。我们的分析利用了一种新的静息态功能MRI框架，该框架参数化功能连接距离，巩固了宏观大脑网络的拓扑和物理特性。功能的研究结果与形态和微观结构的指标相结合，并使用机器学习technology.Results手术结果预测的效用进行了评估相比，对照组，TLE患者显示颞叶和前额叶网络的连接距离减少，表明功能网络的拓扑隔离。测试形态和显微结构的关联，我们观察到，功能连接收缩发生独立于TLE相关的皮质萎缩，但介导的显微结构变化在底层的白色的问题。在我们的影像学研究后，所有患者均接受了前颞叶切除术作为癫痫发作的治疗，术后癫痫发作结局在术后至少1年随访时确定。使用正则化的监督机器学习范式与五重交叉验证，我们证明了患者特定的功能异常预测术后癫痫发作的结果与76 +/- 4%的准确性，优于分类操作的临床和结构成像features.Significance我们的研究结果表明，连接距离收缩作为TLE的宏观基板。功能性拓扑隔离可能代表了一种微结构介导的网络机制，该机制使受影响网络中的癫痫发生平衡倾斜，并可能有助于患者特异性手术治疗。
Objective Temporal lobe epilepsy (TLE) is the most common drug-resistant epilepsy in adults. Although it is commonly related to hippocampal pathology, increasing evidence suggests structural changes beyond the mesiotemporal lobe. Functional anomalies and their link to underlying structural alterations, however, remain incompletely understood.Methods We studied 30 drug-resistant TLE patients and 57 healthy controls using multimodal magnetic resonance imaging (MRI) analyses. All patients had histologically verified hippocampal sclerosis and underwent postoperative imaging to outline the extent of their surgical resection. Our analysis leveraged a novel resting-state functional MRI framework that parameterizes functional connectivity distance, consolidating topological and physical properties of macroscale brain networks. Functional findings were integrated with morphological and microstructural metrics, and utility for surgical outcome prediction was assessed using machine learning techniques.Results Compared to controls, TLE patients showed connectivity distance reductions in temporoinsular and prefrontal networks, indicating topological segregation of functional networks. Testing for morphological and microstructural associations, we observed that functional connectivity contractions occurred independently from TLE-related cortical atrophy but were mediated by microstructural changes in the underlying white matter. Following our imaging study, all patients underwent an anterior temporal lobectomy as a treatment of their seizures, and postsurgical seizure outcome was determined at a follow-up at least 1 year after surgery. Using a regularized supervised machine learning paradigm with fivefold cross-validation, we demonstrated that patient-specific functional anomalies predicted postsurgical seizure outcome with 76 +/- 4% accuracy, outperforming classifiers operating on clinical and structural imaging features.Significance Our findings suggest connectivity distance contractions as a macroscale substrate of TLE. Functional topological isolation may represent a microstructurally mediated network mechanism that tilts the balance toward epileptogenesis in affected networks and that may assist in patient-specific surgical prognostication.