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Javidi SS, He X, Ankeeta A, Zhang Q, Citro S, Sperling MR, Tracy JI. Edge-wise analysis reveals white matter connectivity associated with focal to bilateral tonic-clonic seizures. Epilepsia 2024; 65:1756-1767. [PMID: 38517477 PMCID: PMC11166520 DOI: 10.1111/epi.17960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Focal to bilateral tonic-clonic seizures (FBTCS) represent a challenging subtype of focal temporal lobe epilepsy (TLE) in terms of both severity and treatment response. Most studies have focused on regional brain analysis that is agnostic to the distribution of white matter (WM) pathways associated with a node. We implemented a more selective, edge-wise approach that allowed for identification of the individual connections unique to FBTCS. METHODS T1-weighted and diffusion-weighted images were obtained from 22 patients with solely focal seizures (FS), 43 FBTCS patients, and 65 age/sex-matched healthy participants (HPs), yielding streamline (STR) connectome matrices. We used diffusion tensor-derived STRs in an edge-wise approach to determine specific structural connectivity changes associated with seizure generalization in FBTCS compared to matched FS and HPs. Graph theory metrics were computed on both node- and edge-based connectivity matrices. RESULTS Edge-wise analyses demonstrated that all significantly abnormal cross-hemispheric connections belonged to the FBTCS group. Abnormal connections associated with FBTCS were mostly housed in the contralateral hemisphere, with graph metric values generally decreased compared to HPs. In FBTCS, the contralateral amygdala showed selective decreases in the structural connection pathways to the contralateral frontal lobe. Abnormal connections in TLE involved the amygdala, with the ipsilateral side showing increases and the contralateral decreases. All the FS findings indicated higher graph metrics for connections involving the ipsilateral amygdala. Data also showed that some FBTCS connectivity effects are moderated by aging, recent seizure frequency, and longer illness duration. SIGNIFICANCE Data showed that not all STR pathways are equally affected by the seizure propagation of FBTCS. We demonstrated two key biases, one indicating a large role for the amygdala in the propagation of seizures, the other pointing to the prominent role of cross-hemispheric and contralateral hemisphere connections in FBTCS. We demonstrated topographic reorganization in FBTCS, pointing to the specific WM tracts involved.
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Affiliation(s)
- Sam S Javidi
- Farber Institute for Neuroscience, Department of Neurology, Thomas Jefferson University, Philadelphia, PA
| | - Xiaosong He
- University of Science and Technology of China, Department of Psychology, Hefei, Anhui, P.R. China
| | - A Ankeeta
- Farber Institute for Neuroscience, Department of Neurology, Thomas Jefferson University, Philadelphia, PA
| | - Qirui Zhang
- Farber Institute for Neuroscience, Department of Neurology, Thomas Jefferson University, Philadelphia, PA
| | - Salvatore Citro
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michael R Sperling
- Farber Institute for Neuroscience, Department of Neurology, Thomas Jefferson University, Philadelphia, PA
| | - Joseph I Tracy
- Farber Institute for Neuroscience, Department of Neurology, Thomas Jefferson University, Philadelphia, PA
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Sun K, Li Y, Zhai Z, Yin H, Liang S, Zhai F, Cui Y, Zhang G. Effects of transcutaneous auricular vagus nerve stimulation and exploration of brain network mechanisms in children with high-functioning autism spectrum disorder: study protocol for a randomized controlled trial. Front Psychiatry 2024; 15:1337101. [PMID: 38374975 PMCID: PMC10875019 DOI: 10.3389/fpsyt.2024.1337101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Background Autism Spectrum Disorders (ASD) are a collection of neurodevelopmental diseases characterized by poor social interaction and communication, a limited range of interests, and stereotyped behavior. High-functioning autism (HFA) indicates a subgroup of individuals with autism who possess cognitive and/or language skills that are within the average to above-normal range for their age. Transcutaneous auricular vagus nerve stimulation (taVNS) holds promise in children with HFA. However, few studies have used randomized controlled trials to validate the effectiveness of taVNS. Therefore, in this study, we intend to provide a study protocol to examine the therapeutic effects of taVNS in individuals diagnosed with HFA and to investigate the process of brain network remodeling in individuals with ASD using functional imaging techniques to observe alterations in large-scale neural networks. Methods and design We planned to employ a randomized, double-blind experimental design, including 40 children receiving sham stimulation and 40 children receiving real stimulation. We will assess clinical scales and perform functional imaging examinations before and after the stimulation. Additionally, we will include age- and gender-matched healthy children as controls and conduct functional imaging examinations. We plan first to observe the therapeutic effects of taVNS. Furthermore, we will observe the impact of taVNS stimulation on the brain network. Discussion taVNS was a low-risk, easy-to-administer, low-cost, and portable option to modulate the vagus system. taVNS may improve the social performance of HFA. Changes in the network properties of the large-scale brain network may be related to the efficacy of taVNS. Clinical trial registration http://www.chictr.org.cn, identifier ChiCTR2300074035.
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Affiliation(s)
- Ke Sun
- Functional Neurosurgery Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children’s Hospital, Beijing, China
| | - Zhenhang Zhai
- Functional Neurosurgery Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Heqing Yin
- Functional Neurosurgery Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Shuli Liang
- Functional Neurosurgery Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Functional Neurosurgery Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children’s Hospital, Beijing, China
| | - Guojun Zhang
- Functional Neurosurgery Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
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Wang M, Cheng X, Shi Q, Xu B, Hou X, Zhao H, Gui Q, Wu G, Dong X, Xu Q, Shen M, Cheng Q, Xue S, Feng H, Ding Z. Brain diffusion tensor imaging reveals altered connections and networks in epilepsy patients. Front Hum Neurosci 2023; 17:1142408. [PMID: 37033907 PMCID: PMC10073437 DOI: 10.3389/fnhum.2023.1142408] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Accumulating evidence shows that epilepsy is a disease caused by brain network dysfunction. This study explored changes in brain network structure in epilepsy patients based on graph analysis of diffusion tensor imaging data. Methods The brain structure networks of 42 healthy control individuals and 26 epilepsy patients were constructed. Using graph theory analysis, global and local network topology parameters of the brain structure network were calculated, and changes in global and local characteristics of the brain network in epilepsy patients were quantitatively analyzed. Results Compared with the healthy control group, the epilepsy patient group showed lower global efficiency, local efficiency, clustering coefficient, and a longer shortest path length. Both healthy control individuals and epilepsy patients showed small-world attributes, with no significant difference between groups. The epilepsy patient group showed lower nodal local efficiency and nodal clustering coefficient in the right olfactory cortex and right rectus and lower nodal degree centrality in the right olfactory cortex and the left paracentral lobular compared with the healthy control group. In addition, the epilepsy patient group showed a smaller fiber number of edges in specific regions of the frontal lobe, temporal lobe, and default mode network, indicating reduced connection strength. Discussion Epilepsy patients exhibited lower global and local brain network properties as well as reduced white matter fiber connectivity in key brain regions. These findings further support the idea that epilepsy is a brain network disorder.
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Affiliation(s)
- Meixia Wang
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaoyu Cheng
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qianru Shi
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Bo Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaoxia Hou
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Huimin Zhao
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qian Gui
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Guanhui Wu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaofeng Dong
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qinrong Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Mingqiang Shen
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qingzhang Cheng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Shouru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongxuan Feng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- *Correspondence: Hongxuan Feng,
| | - Zhiliang Ding
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- Zhiliang Ding,
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Ferreira Soares D, Pires de Aguiar PH. Callosotomy vs Vagus Nerve Stimulation in the Treatment of Lennox-Gastaut Syndrome: A Systematic Review With Meta-Analysis. Neuromodulation 2022; 26:518-528. [PMID: 35989160 DOI: 10.1016/j.neurom.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lennox-Gastaut syndrome (LGS) is a severe drug-resistant epileptic syndrome. Palliative treatments such as corpus callosotomy (CC) and vagus nerve stimulation (VNS) have emerged as treatments to reduce the number of seizures in patients. The aim of this study is to compare the effectiveness of CC and VNS in patients with LGS studied in the last 30 years. MATERIALS AND METHODS We conducted a systematic review with meta-analysis and collected papers from PubMed (MEDLINE), Ovidsp, Web of Science, and Cochrane Library data bases. The articles analyzed were published between January 1990 and December 2020. Keywords were chosen based on internal and external validation in the PubMed data base (the analysis is available in the Supplementary Data Supplementary Appendix). Prospective or retrospective case reports (n ≥ 2), case series, cohort studies, or case-control studies involving patients with LGS were included in the analysis. We selected studies that had no age or sex restriction and that provided data on seizures before and after treatments. Studies not written in English, published without peer review, or not indexed in the data bases were excluded. Other exclusion criteria were the absence of seizure data and the impossibility of extracting this information from the studies. To analyze the results, we used the random-effects model based on the assessment of heterogeneity (I2 statistics) in two scenarios. In scenario 1, we assessed the incidence of patients with a seizure reduction ≥ 50%; in scenario 2, we assessed the incidence of patients with a seizure reduction > 0%. RESULTS Of the 7418 articles found using the keywords, 32 were considered eligible. Of these, 18 articles were on VNS (175 patients) and 14 on CC (107 patients). For scenario 1 (seizure reduction ≥ 50%), CC had an incidence of 65% (95% CI, 37%-94%), with an I2 value of 82.7%; VNS had an incidence of 34% (95% CI, 11%-57%), with an I2 value of 80.7%. For scenario 2 (seizure reduction > 0%), CC had an incidence of 80% (95% CI, 58%-100%), with an I2 value of 84.7%; VNS had an incidence of 64% (95% CI, 38%-89%), with an I2 value of 90.8%. There was an overlap of confidence intervals, with no statistical difference between the treatments in both scenarios. DISCUSSION Our analysis of LGS showed that the CC and VNS treatments are significantly beneficial to reducing seizures, without superiority between them.
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Affiliation(s)
- Davi Ferreira Soares
- Department of Neurosurgery IAMSPE-State Government Employee Medical Assistance Institute, São Paulo, Brazil; Department of Neurosurgery, FMABC - ABC Medical School, Santo André, Brazil.
| | - Paulo Henrique Pires de Aguiar
- Department of Neurosurgery IAMSPE-State Government Employee Medical Assistance Institute, São Paulo, Brazil; Department of Neurosurgery, FMABC - ABC Medical School, Santo André, Brazil
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Abnormal degree centrality as a potential imaging biomarker for right temporal lobe epilepsy: A resting-state fMRI study and support vector machine analysis. Neuroscience 2022; 487:198-206. [PMID: 35158018 DOI: 10.1016/j.neuroscience.2022.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022]
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Zhou Y, Liu Z, Sun Y, Zhang H, Ruan J. Altered EEG Brain Networks in Patients with Acute Peripheral Herpes Zoster. J Pain Res 2021; 14:3429-3436. [PMID: 34754236 PMCID: PMC8570286 DOI: 10.2147/jpr.s329068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate whether the brain networks changed in patients with acute peripheral herpes zoster (HZ). METHODS We reviewed the EEG database in Jianyang People's Hospital. Patients with acute HZ (n=71) were enrolled from January 2016 to December 2020. Each included subject underwent a ten-minute and 16-channel EEG examination. Five epochs of 10-second EEG data in resting-state were collected from each HZ patient. Five 10-second resting-state EEG epochs from sex- and age-matched healthy controls (HC, n=71) who reported no history of neurological or psychiatric disorders and visited the hospital for routine physical examinations were collected. Brain network and graph theory analysis based on phase locking value parameter and functional ICA were performed using a self-writing Matlab code and the LORETA KEY tool. RESULTS Compared with the HC group, the HZ patients showed significant altered brain networks. The graph theory analysis revealed that the clustering coefficient and local efficiency of full band in HZ patients were lower than those in HC group (P<0.05). In beta band, the global efficiency and local efficiency of HZ patients group decreased, compared with healthy group (P<0.05). The functional ICA showed that three components showed significant differences between the two groups. In component 2, HZ patients showed excess superior frontal gyrus (BA10) neuro oscillation in delta band and less medial frontal gyrus (BA 11) neuro oscillation in beta and gamma bands than that in HCs. And for component 3, the alpha band of the HZ patients presented increased neuro activities in superior frontal gyrus (BA 11) and decreased neuro activities in occipital lobe (BA 18). In component 4, the inferior frontal gyrus (BA 47) showed excess activity in the left hemisphere and reduced activity in the right hemisphere in delta band, compared with HC group. CONCLUSION Altered brain networks exist in resting-state EEG data of patients with acute HZ. The changes of EEG brain networks in HZ patients are characterized by decreased global efficiency and local efficiency in beta band. Moreover, the spontaneous oscillation of some brain regions involving pain management and the connectivity of default mode network changed in HZ patients. Our study provided novel understanding of HZ from an electrophysiological view, and led to converging evidence for treatment of HZ with neural regulation in future.
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Affiliation(s)
- Yan Zhou
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Department of Neurology, Jianyang People’s Hospital, Jianyang, 641400, People’s Republic of China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, People’s Republic of China
| | - Zhenqin Liu
- Department of Dermatology, Jianyang People’s Hospital, Jianyang, 641400, People’s Republic of China
| | - Yuanmei Sun
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400010, People’s Republic of China
| | - Hao Zhang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, People’s Republic of China
| | - Jianghai Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, People’s Republic of China
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Su TY, Hung PL, Chen C, Lin YJ, Peng SJ. Graph Theory-Based Electroencephalographic Connectivity and Its Association with Ketogenic Diet Effectiveness in Epileptic Children. Nutrients 2021; 13:nu13072186. [PMID: 34202047 PMCID: PMC8308392 DOI: 10.3390/nu13072186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Ketogenic diet therapies (KDTs) are widely used treatments for epilepsy, but the factors influencing their responsiveness remain unknown. This study aimed to explore the predictors or associated factors for KDTs effectiveness by evaluating the subtle changes in brain functional connectivity (FC) before and after KDTs. Segments of interictal sleep electroencephalography (EEG) were acquired before and after six months of KDTs. Analyses of FC were based on network-based statistics and graph theory, with a focus on different frequency bands. Seventeen responders and 14 non-responders were enrolled. After six months of KDTs, the responders exhibited a significant functional connectivity strength decrease compared with the non-responders; reductions in global efficiency, clustering coefficient, and nodal strength in the beta frequency band for a consecutive range of weighted proportional thresholds were observed in the responders. The alteration of betweenness centrality was significantly and positively correlated with seizure reduction rate in alpha, beta, and theta frequency bands in weighted adjacency matrices with densities of 90%. We conclude that KDTs tended to modify minor-to-moderate-intensity brain connections; the reduction of global connectivity and the increment of betweenness centrality after six months of KDTs were associated with better KD effectiveness.
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Affiliation(s)
- Ting-Yu Su
- Division of Pediatric Neurology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (T.-Y.S.); (P.-L.H.)
| | - Pi-Lien Hung
- Division of Pediatric Neurology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (T.-Y.S.); (P.-L.H.)
| | - Chien Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital and School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei 11217, Taiwan;
| | - Ying-Jui Lin
- Division of Pediatric Cardiology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, 19F, No.172-1, Sec. 2, Keelung Rd., Da’an Dist., Taipei City 10675, Taiwan
- Correspondence: ; Tel.: +886-2-66382736; Fax: +886-2-27321956
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