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Eussen MJ, Jansen JF, Voncken TP, Debeij-Van Hall MH, Hendriksen JG, Vermeulen RJ, Klinkenberg S, Backes WH, Drenthen GS. Exploring the core network of the structural covariance network in childhood absence epilepsy. Heliyon 2023; 9:e22657. [PMID: 38107302 PMCID: PMC10724663 DOI: 10.1016/j.heliyon.2023.e22657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Childhood absence epilepsy (CAE) is a generalized pediatric epilepsy, which is generally considered to be a benign condition since most children become seizure-free before reaching adulthood. However, cognitive deficits and changes of brain morphological have been previously reported in CAE. These morphological changes, even if they might be very subtle, are not independent due to the underlying network structure and can be captured by the structural covariance network (SCN). In this study, SCNs were used to quantify the structural brain network for children with CAE as well as controls. Seventeen children with CAE (6-12y) and fifteen controls (6-12y) were included. To estimate the SCN, T1-weighted images were acquired and parcellated into 68 cortical regions. Graph measures characterizing the core network architecture, i.e. the assortativity and rich-club coefficient, were calculated for all individuals. Multivariable linear regression models, including age and sex as covariates, were used to assess differences between children with CAE and controls. Additionally, potential relations between the core network and cognitive performance was investigated. A lower assortativity (i.e. less efficiently organized core network organization) was found for children with CAE compared to controls. Moreover, better cognitive performance was found to relate to stronger assortative mixing pattern (i.e. more efficient core network structure). Rich-club coefficients did not differ between groups, nor relate to cognitions. The core network organization of the SCN in children with CAE tend to be less efficient organized compared to controls, and relates to cognitive performance, and therefore this study provides novel insights into the SCN organization in relation to CAE and cognition.
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Affiliation(s)
- Merel J.A. Eussen
- Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jacobus F.A. Jansen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Twan P.C. Voncken
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
| | | | - Jos G.M. Hendriksen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
- Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
| | - R. Jeroen Vermeulen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Walter H. Backes
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gerhard S. Drenthen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
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Zhang T, Zhang Y, Ren J, Zhou H, Yang M, Li L, Lei D, Gong Q, Zhou D, Yang T. Dynamic alterations of striatal-related functional networks in juvenile absence epilepsy. Epilepsy Behav 2023; 149:109506. [PMID: 37925871 DOI: 10.1016/j.yebeh.2023.109506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To explore the features of dynamic functional connectivity (dFC) variability of striatal-cortical/subcortical networks in juvenile absence epilepsy (JAE). METHODS We collected resting-state functional magnetic imaging data from 18 JAE patients and 28 healthy controls. The striatum was divided into six pairs of regions: the inferior-ventral striatum (VSi), superior-ventral striatum (VSs), dorsal-caudal putamen, dorsal-rostral putamen, dorsal-caudate (DC) and ventral-rostral putamen. We assessed the dFC variability of each subdivision in the whole brain using the sliding-window method, and correlated altered circuit with clinical variables in JAE patients. RESULTS We found altered dFC variability of striatal-cortical/subcortical networks in patients with JAE. The VSs exhibited decreased dFC variability with subcortical regions, and dFC variability between VSs and thalamus was negatively correlated with epilepsy duration. For the striatal-cortical networks, the dFC variability was decreased in VSi-affective network but increased in DC-executive network. The altered dynamics of striatal-cortical networks involved crucial nodes of the default mode network (DMN). CONCLUSION JAE patients exhibit excessive stability in the striatal-subcortical networks. For striatal-cortical networks in JAE, the striatal-affective circuit was more stable, while the striatal-executive circuit was more variable. Furthermore, crucial nodes of DMN were changed in striatal-cortical networks in JAE.
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Affiliation(s)
- Tianyu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huanyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Menghan Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Du Lei
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianhua Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Yu Y, Qiu M, Zou W, Zhao Y, Tang Y, Tian J, Chen X, Qiu W. Impaired rich-club connectivity in childhood absence epilepsy. Front Neurol 2023; 14:1135305. [PMID: 37251238 PMCID: PMC10213928 DOI: 10.3389/fneur.2023.1135305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Childhood absence epilepsy (CAE) is a well-known pediatric epilepsy syndrome. Recent evidence has shown the presence of a disrupted structural brain network in CAE. However, little is known about the rich-club topology. This study aimed to explore the rich-club alterations in CAE and their association with clinical characteristics. Methods Diffusion tensor imaging (DTI) datasets were acquired in a sample of 30 CAE patients and 31 healthy controls. A structural network was derived from DTI data for each participant using probabilistic tractography. Then, the rich-club organization was examined, and the network connections were divided into rich-club connections, feeder connections, and local connections. Results Our results confirmed a less dense whole-brain structural network in CAE with lower network strength and global efficiency. In addition, the optimal organization of small-worldness was also damaged. A small number of highly connected and central brain regions were identified to form the rich-club organization in both patients and controls. However, patients exhibited a significantly reduced rich-club connectivity, while the other class of feeder and local connections was relatively spared. Moreover, the lower levels of rich-club connectivity strength were statistically correlated with disease duration. Discussion Our reports suggest that CAE is characterized by abnormal connectivity concentrated to rich-club organizations and might contribute to understanding the pathophysiological mechanism of CAE.
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Affiliation(s)
- Yadong Yu
- Department of Neurology, Lianshui County People's Hospital, Huai'an, China
| | - Mengdi Qiu
- Department of Neurology, The Fifth People's Hospital of Huai'an, Huai'an, China
| | - Wenwei Zou
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Ying Zhao
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Yan Tang
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Jisha Tian
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Xiaoyu Chen
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Wenchao Qiu
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
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Zhong L, Wan J, Wu J, He S, Zhong X, Huang Z, Li Z. Temporal and spatial dynamic propagation of electroencephalogram by combining power spectral and synchronization in childhood absence epilepsy. Front Neuroinform 2022; 16:962466. [PMID: 36059863 PMCID: PMC9433125 DOI: 10.3389/fninf.2022.962466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objective During the transition from normal to seizure and then to termination, electroencephalography (EEG) signals have complex changes in time-frequency-spatial characteristics. The quantitative analysis of EEG characteristics and the exploration of their dynamic propagation in this paper would help to provide new biomarkers for distinguishing between pre-ictal and inter-ictal states and to better understand the seizure mechanisms. Methods Thirty-three children with absence epilepsy were investigated with EEG signals. Power spectral and synchronization were combined to provide the time-frequency-spatial characteristics of EEG and analyze the spatial distribution and propagation of EEG in the brain with topographic maps. To understand the mechanism of spatial-temporal evolution, we compared inter-ictal, pre-ictal, and ictal states in EEG power spectral and synchronization network and its rhythms in each frequency band. Results Power, frequency, and spatial synchronization are all enhanced during the absence seizures to jointly dominate the epilepsy process. We confirmed that a rapid diffusion at the onset accompanied by the frontal region predominance exists. The EEG power rapidly bursts in 2–4 Hz through the whole brain within a few seconds after the onset. This spatiotemporal evolution is associated with spatial diffusion and brain regions interaction, with a similar pattern, increasing first and then decreasing, in both the diffusion of the EEG power and the connectivity of the brain network during the childhood absence epilepsy (CAE) seizures. Compared with the inter-ictal group, we observed increases in power of delta and theta rhythms in the pre-ictal group (P < 0.05). Meanwhile, the synchronization of delta rhythm decreased while that of alpha rhythm enhanced. Conclusion The initiation and propagation of CAE seizures are related to the abnormal discharge diffusion and the synchronization network. During the seizures, brain activity is completely changed with the main component delta rhythm. Furthermore, this article demonstrated for the first time that alpha inhibition, which is consistent with the brain’s feedback regulation mechanism, is caused by the enhancement of the network connection. Temporal and spatial evolution of EEG is of great significance for the transmission mechanism, clinical diagnosis and automatic detection of absence epilepsy seizures.
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Affiliation(s)
- Lisha Zhong
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
- School of Medical Information and Engineering, Southwest Medical University, Luzhou, China
| | - Jiangzhong Wan
- School of Medical Information and Engineering, Southwest Medical University, Luzhou, China
| | - Jia Wu
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
- School of Medical Information and Engineering, Southwest Medical University, Luzhou, China
| | - Suling He
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Xuefei Zhong
- Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiwei Huang
- School of Medical Information and Engineering, Southwest Medical University, Luzhou, China
- Central Nervous System Drug Key Laboratory of Sichuan Province, Luzhou, China
| | - Zhangyong Li
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
- Research Center of Biomedical Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
- *Correspondence: Zhangyong Li,
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McKavanagh A, Kreilkamp BAK, Chen Y, Denby C, Bracewell M, Das K, De Bezenac C, Marson AG, Taylor PN, Keller SS. Altered Structural Brain Networks in Refractory and Nonrefractory Idiopathic Generalized Epilepsy. Brain Connect 2022; 12:549-560. [PMID: 34348477 DOI: 10.1089/brain.2021.0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Idiopathic generalized epilepsy (IGE) is a collection of generalized nonlesional epileptic network disorders. Around 20-40% of patients with IGE are refractory to antiseizure medication, and mechanisms underlying refractoriness are poorly understood. Here, we characterize structural brain network alterations and determine whether network alterations differ between patients with refractory and nonrefractory IGE. Methods: Thirty-three patients with IGE (10 nonrefractory and 23 refractory) and 39 age- and sex-matched healthy controls were studied. Network nodes were segmented from T1-weighted images, while connections between these nodes (edges) were reconstructed from diffusion magnetic resonance imaging (MRI). Diffusion networks of fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and streamline count (Count) were studied. Differences between all patients, refractory, nonrefractory, and control groups were computed using network-based statistics. Nodal volume differences between groups were computed using Cohen's d effect size calculation. Results: Patients had significantly decreased bihemispheric FA and Count networks and increased MD and RD networks compared with controls. Alterations in network architecture, with respect to controls, differed depending on treatment outcome, including predominant FA network alterations in refractory IGE and increased nodal volume in nonrefractory IGE. Diffusion MRI networks were not influenced by nodal volume. Discussion: Although a nonlesional disorder, patients with IGE have bihemispheric structural network alterations that may differ between patients with refractory and nonrefractory IGE. Given that distinct nodal volume and FA network alterations were observed between treatment outcome groups, a multifaceted network analysis may be useful for identifying imaging biomarkers of refractory IGE.
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Affiliation(s)
- Andrea McKavanagh
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Christine Denby
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Martyn Bracewell
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
- School of Psychology, Bangor University, Bangor, United Kingdom
| | - Kumar Das
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Christophe De Bezenac
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Peter N Taylor
- CNNP Lab, Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle, United Kingdom
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Pretreatment Topological Disruptions of Whole-brain Networks Exist in Childhood Absence Epilepsy: A Resting-state EEG-fMRI Study. Epilepsy Res 2022; 182:106909. [DOI: 10.1016/j.eplepsyres.2022.106909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/24/2022] [Accepted: 03/13/2022] [Indexed: 11/19/2022]
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Sun J, Li Y, Zhang K, Sun Y, Wang Y, Miao A, Xiang J, Wang X. Frequency-Dependent Dynamics of Functional Connectivity Networks During Seizure Termination in Childhood Absence Epilepsy: A Magnetoencephalography Study. Front Neurol 2021; 12:744749. [PMID: 34759883 PMCID: PMC8573389 DOI: 10.3389/fneur.2021.744749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/21/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: Our aim was to investigate the dynamics of functional connectivity (FC) networks during seizure termination in patients with childhood absence epilepsy (CAE) using magnetoencephalography (MEG) and graph theory (GT) analysis. Methods: MEG data were recorded from 22 drug-naïve patients diagnosed with CAE. FC analysis was performed to evaluate the FC networks in seven frequency bands of the MEG data. GT analysis was used to assess the topological properties of FC networks in different frequency bands. Results: The patterns of FC networks involving the frontal cortex were altered significantly during seizure termination compared with those during the ictal period. Changes in the topological parameters of FC networks were observed in specific frequency bands during seizure termination compared with those in the ictal period. In addition, the connectivity strength at 250–500 Hz during the ictal period was negatively correlated with seizure frequency. Conclusions: FC networks associated with the frontal cortex were involved in the termination of absence seizures. The topological properties of FC networks in different frequency bands could be used as new biomarkers to characterize the dynamics of FC networks related to seizure termination.
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Affiliation(s)
- Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Ke Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Ailiang Miao
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Jing Xiang
- Division of Neurology, MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
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Pegg EJ, McKavanagh A, Bracewell RM, Chen Y, Das K, Denby C, Kreilkamp BAK, Laiou P, Marson A, Mohanraj R, Taylor JR, Keller SS. Functional network topology in drug resistant and well-controlled idiopathic generalized epilepsy: a resting state functional MRI study. Brain Commun 2021; 3:fcab196. [PMID: 34514400 PMCID: PMC8417840 DOI: 10.1093/braincomms/fcab196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
Despite an increasing number of drug treatment options for people with idiopathic generalized epilepsy (IGE), drug resistance remains a significant issue and the mechanisms underlying it remain poorly understood. Previous studies have largely focused on potential cellular or genetic explanations for drug resistance. However, epilepsy is understood to be a network disorder and there is a growing body of literature suggesting altered topology of large-scale resting networks in people with epilepsy compared with controls. We hypothesize that network alterations may also play a role in seizure control. The aim of this study was to compare resting state functional network structure between well-controlled IGE (WC-IGE), drug resistant IGE (DR-IGE) and healthy controls. Thirty-three participants with IGE (10 with WC-IGE and 23 with DR-IGE) and 34 controls were included. Resting state functional MRI networks were constructed using the Functional Connectivity Toolbox (CONN). Global graph theoretic network measures of average node strength (an equivalent measure to mean degree in a network that is fully connected), node strength distribution variance, characteristic path length, average clustering coefficient, small-world index and average betweenness centrality were computed. Graphs were constructed separately for positively weighted connections and for absolute values. Individual nodal values of strength and betweenness centrality were also measured and ‘hub nodes’ were compared between groups. Outcome measures were assessed across the three groups and between both groups with IGE and controls. The IGE group as a whole had a higher average node strength, characteristic path length and average betweenness centrality. There were no clear differences between groups according to seizure control. Outcome metrics were sensitive to whether negatively correlated connections were included in network construction. There were no clear differences in the location of ‘hub nodes’ between groups. The results suggest that, irrespective of seizure control, IGE interictal network topology is more regular and has a higher global connectivity compared to controls, with no alteration in hub node locations. These alterations may produce a resting state network that is more vulnerable to transitioning to the seizure state. It is possible that the lack of apparent influence of seizure control on network topology is limited by challenges in classifying drug response. It is also demonstrated that network topological features are influenced by the sign of connectivity weights and therefore future methodological work is warranted to account for anticorrelations in graph theoretic studies.
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Affiliation(s)
- Emily J Pegg
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrea McKavanagh
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | | | - Yachin Chen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Kumar Das
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Barbara A K Kreilkamp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Petroula Laiou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Rajiv Mohanraj
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jason R Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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Sun Y, Li Y, Sun J, Zhang K, Tang L, Wu C, Gao Y, Liu H, Huang S, Hu Z, Xiang J, Wang X. Functional reorganization of brain regions into a network in childhood absence epilepsy: A magnetoencephalography study. Epilepsy Behav 2021; 122:108117. [PMID: 34246893 DOI: 10.1016/j.yebeh.2021.108117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Epilepsy is considered as a network disorder. However, it is unknown how normal brain activity develops into the highly synchronized discharging activity seen in disordered networks. This study aimed to explore the epilepsy brain network and the significant re-combined brain areas in childhood absence epilepsy (CAE). METHODS Twenty-two children with CAE were recruited to study the neural source activity during ictal-onset and interictal periods at frequency bands of 1-30 Hz and 30-80 Hz with magnetoencephalography (MEG) scanning. Accumulated source imaging (ASI) was used to analyze the locations of neural source activity and peak source strength. RESULTS Most of the participants had more active source activity locations in the ictal-onset period rather than in the interictal period, both at 1-30 Hz and 30-80 Hz. The frontal lobe (FL), the temporo-parietal junction (T-P), and the parietal lobe (PL) became the main active areas of source activity during the ictal period, while the precuneus (PC), cuneus, and thalamus were relatively inactive. CONCLUSIONS Some brain areas become more excited and have increased source activity during seizures. These significant brain regions might be re-combined to form an epilepsy network that regulates the process of absence seizures. SIGNIFICANCE The study confirmed that important brain regions are reorganized in an epilepsy network, which provides a basis for exploring the network mechanism of CAE development. Imaging findings may provide a reference for clinical characteristics.
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Affiliation(s)
- Yulei Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ke Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lu Tang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Caiyun Wu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yuan Gao
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongxing Liu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Shuyang Huang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zheng Hu
- Department of Neurology, Nanjing Children's Hospital, Nanjing, Jiangsu 210029, China
| | - Jing Xiang
- Division of Neurology, MEG Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Li Y, Chen Q, Huang W. Disrupted topological properties of functional networks in epileptic children with generalized tonic-clonic seizures. Brain Behav 2020; 10:e01890. [PMID: 33098362 PMCID: PMC7749549 DOI: 10.1002/brb3.1890] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Generalized tonic-clonic seizure (GTCS) is a condition that is characterized by generalized spike-wave discharge in bilateral cerebral hemispheres during the seizure. Although previous neuroimaging studies revealed functional abnormalities in the brain activities of children with GTCS, the topological alterations in whole-brain networks remain poorly understood. METHODS The present study used graph theory to investigate the topological organization of functional networks in 13 GTCS children and 30 age-matched healthy controls. RESULTS We found that both groups exhibited a small-world topology of the functional network. However, children with GTCS showed a significant decrease in nodal local efficiency and clustering coefficient in some key nodes compared with the controls. The connections within the default mode network (DMN) were decreased significantly, and the internetwork connections were increased significantly. The altered topological properties may be an effect of chronic epilepsy. As a result, the optimal topological organization of the functional network was disrupted in the patient group. Notably, clustering coefficient and nodal local efficiency in the bilateral temporal pole of the middle temporal gyrus negatively correlated with the epilepsy duration. CONCLUSION These results suggest that the bilateral temporal pole plays an important role in reflecting the effect of chronic epilepsy on the topological properties in GTCS children. The present study demonstrated a disrupted topological organization in children with GTCS. These findings provide new insight into our understanding of this disorder.
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Affiliation(s)
- Yongxin Li
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Qian Chen
- Department of Pediatric Neurosurgery, Shenzhen Children Hospital, Shenzhen, China
| | - Wenhua Huang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
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Pegg EJ, Taylor JR, Keller SS, Mohanraj R. Interictal structural and functional connectivity in idiopathic generalized epilepsy: A systematic review of graph theoretical studies. Epilepsy Behav 2020; 106:107013. [PMID: 32193094 DOI: 10.1016/j.yebeh.2020.107013] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/22/2020] [Accepted: 02/28/2020] [Indexed: 12/18/2022]
Abstract
The evaluation of the role of anomalous neuronal networks in epilepsy using a graph theoretical approach is of growing research interest. There is currently no consensus on optimal methods for performing network analysis, and it is possible that variations in study methodology account for diverging findings. This review focuses on global functional and structural interictal network characteristics in people with idiopathic generalized epilepsy (IGE) with the aim of appraising the methodological approaches used and assessing for meaningful consensus. Thirteen studies were included in the review. Data were heterogenous and not suitable for meta-analysis. Overall, there is a suggestion that the cerebral neuronal networks of people with IGE have different global structural and functional characteristics to people without epilepsy. However, the nature of the aberrations is inconsistent with some studies demonstrating a more regular network configuration in IGE, and some, a more random topology. There is greater consistency when different data modalities and connectivity subtypes are compared separately, with a tendency towards increased small-worldness of networks in functional electroencephalography/magnetoencephalography (EEG/MEG) studies and decreased small-worldness of networks in structural studies. Prominent variation in study design at all stages is likely to have contributed to differences in study outcomes. Despite increasing literature surrounding neuronal network analysis, systematic methodological studies are lacking. Absence of consensus in this area significantly limits comparison of results from different studies, and the ability to draw firm conclusions about network characteristics in IGE.
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Affiliation(s)
- Emily J Pegg
- Department of Neurology, Manchester Centre for Clinical Neurosciences, United Kingdom; Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom.
| | - Jason R Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom; Manchester Academic Health Sciences Centre, United Kingdom
| | - Simon S Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Rajiv Mohanraj
- Department of Neurology, Manchester Centre for Clinical Neurosciences, United Kingdom; Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
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Drenthen GS, Fasen F, Fonseca Wald ELA, Backes WH, Aldenkamp AP, Vermeulen RJ, Debeij-van Hall M, Hendriksen J, Klinkenberg S, Jansen JFA. Functional brain network characteristics are associated with epilepsy severity in childhood absence epilepsy. NEUROIMAGE-CLINICAL 2020; 27:102264. [PMID: 32387851 PMCID: PMC7210592 DOI: 10.1016/j.nicl.2020.102264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/16/2020] [Accepted: 04/03/2020] [Indexed: 12/15/2022]
Abstract
The functional network of children with childhood absence epilepsy is less efficiently organized in terms of clustering and small-worldness. Longer path lengths (i.e. less efficient organization) of the functional network relate to a longer duration of childhood absence epilepsy. Longer path lengths of the functional network relate to a higher seizure frequency in childhood absence epilepsy.
While cognitive impairments are not generally considered to be part of the childhood absence epilepsy (CAE) syndrome, some recent studies report cognitive, mainly attentional, deficits. Here we set out to investigate the whole brain functional network of children with CAE and controls. Furthermore, the possible relation of the functional network abnormalities with epilepsy and neurocognitive characteristics is studied. Seventeen children with childhood CAE (aged 9.2 ± 2.1 years) and 15 controls (aged 9.8 ± 1.8 years) were included. Resting state functional MRI was acquired to study the functional network. Using graph theoretical analysis, three global metrics of the functional network were investigated: the characteristic path length, the clustering coefficient, and the small-worldness. A multivariable linear regression model including age, sex, and subject motion as covariates was used to investigate group differences in the graph metrics. Subsequently, relations of the graph metrics with epilepsy and neurocognitive characteristics were assessed. Longer path lengths, weaker clustering and a lower small-world network topology were observed in children with CAE compared to controls. Moreover, longer path lengths were related to a longer duration of CAE and a higher number of absence seizure per hour. Clustering and small-worldness were not significantly related to epilepsy or neurocognitive characteristics. The organization of the functional network of children with CAE is less efficient compared to controls, and is related to disease duration. These preliminary findings suggest that CAE is associated with alterations in the functional network.
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Affiliation(s)
- Gerhard S Drenthen
- Department of Electrical Engineering, Eindhoven University of Technology, De Rondom 70, Eindhoven, Netherlands,; School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands
| | - Floor Fasen
- Department of Electrical Engineering, Eindhoven University of Technology, De Rondom 70, Eindhoven, Netherlands,; School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands
| | - Eric L A Fonseca Wald
- School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Neurology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, Sterkselseweg 65, Heeze, Netherlands
| | - Walter H Backes
- School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands
| | - Albert P Aldenkamp
- Department of Electrical Engineering, Eindhoven University of Technology, De Rondom 70, Eindhoven, Netherlands,; Department of Neurology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, Sterkselseweg 65, Heeze, Netherlands
| | - R Jeroen Vermeulen
- School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Neurology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands
| | - Mariette Debeij-van Hall
- Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, Sterkselseweg 65, Heeze, Netherlands
| | - Jos Hendriksen
- Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, Sterkselseweg 65, Heeze, Netherlands
| | - Sylvia Klinkenberg
- School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Neurology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands
| | - Jacobus F A Jansen
- Department of Electrical Engineering, Eindhoven University of Technology, De Rondom 70, Eindhoven, Netherlands,; School for Mental Health and Neuroscience, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, Netherlands.
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13
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Kim EH, Shim WH, Lee JS, Yoon HM, Ko TS, Yum MS. Altered Structural Network in Newly Onset Childhood Absence Epilepsy. J Clin Neurol 2020; 16:573-580. [PMID: 33029962 PMCID: PMC7541981 DOI: 10.3988/jcn.2020.16.4.573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Recent quantitative neuroimaging studies of childhood absence epilepsy (CAE) have identified various structural abnormalities that might be involved in the onset of absence seizure and associated cognitive and behavioral functions. However, the neuroanatomical alterations specific to CAE remain unclear, and so this study investigated the regional alterations of brain structures associated with newly diagnosed CAE. METHODS Surface and volumetric magnetic resonance imaging data of patients with newly diagnosed CAE (n=18) and age-matched healthy controls (n=18) were analyzed using Free-Surfer software. A group comparison using analysis of covariance was performed with significance criteria of p<0.05 and p<0.01 in global and regional analyses, respectively. RESULTS Compared with control subjects, the patients with CAE had smaller total and regional volumes of cortical gray-matter (GM) in the right rostral middle frontal, right lateral orbitofrontal, and left rostral middle frontal regions, as well as in the right precentral, right superior, middle, left middle, and inferior temporal gyri. The cortex in the right posterior cingulate gyrus and left medial occipital region was significantly thicker in patients with CAE than in controls. CONCLUSIONS Patients with CAE showed a reduced bilateral frontotemporal cortical GM volume and an increased posterior medial cortical thickness, which are associated with the default mode network. These structural changes can be suggested as the neural basis of the absence seizures and neuropsychiatric comorbidities in CAE.
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Affiliation(s)
- Eun Hee Kim
- Department of Pediatrics, Sejong Chungnam National University Hospital, Chungnam National University College of Medicine, Sejong, Korea.,Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Woo Hyun Shim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Mang Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sung Ko
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
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An S, Bartolomei F, Guye M, Jirsa V. Optimization of surgical intervention outside the epileptogenic zone in the Virtual Epileptic Patient (VEP). PLoS Comput Biol 2019; 15:e1007051. [PMID: 31242177 PMCID: PMC6594587 DOI: 10.1371/journal.pcbi.1007051] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/17/2019] [Indexed: 01/18/2023] Open
Abstract
Studies to improve the efficacy of epilepsy surgery have focused on better refining the localization of the epileptogenic zone (EZ) with the aim of effectively resecting it. However, in a considerable number of patients, EZs are distributed across multiple brain regions and may involve eloquent areas that cannot be removed due to the risk of neurological complications. There is a clear need for developing alternative approaches to induce seizure relief, but minimal impact on normal brain functions. Here, we develop a personalized in-silico network approach, that suggests effective and safe surgical interventions for each patient. Based on the clinically identified EZ, we employ modularity analysis to identify target brain regions and fiber tracts involved in seizure propagation. We then construct and simulate a patient-specific brain network model comprising phenomenological neural mass models at the nodes, and patient-specific structural brain connectivity using the neuroinformatics platform The Virtual Brain (TVB), in order to evaluate effectiveness and safety of the target zones (TZs). In particular, we assess safety via electrical stimulation for pre- and post-surgical condition to quantify the impact on the signal transmission properties of the network. We demonstrate the existence of a large repertoire of efficient surgical interventions resulting in reduction of degree of seizure spread, but only a small subset of them proves safe. The identification of novel surgical interventions through modularity analysis and brain network simulations may provide exciting solutions to the treatment of inoperable epilepsies. We propose a personalized in-silico surgical approach able to suggest effective and safe surgical options for each epilepsy patient. In particular, we focus on deriving effective alternative methods for those cases where EZs are inoperable because of issues related with neurological complications. Based on modularity analysis using structural brain connectivity from each patient, TZs that would be considered as surgical sites are obtained. The acquired TZs are evaluated by personalized brain network simulations in terms of effectiveness and safety. Through the feedback approach combining modularity analysis and brain network simulations, the optimized TZ options that minimize seizure propagation while not affecting normal brain functions are obtained. Our study has a great importance in that it demonstrates the possibility of computational neuroscience field being able to construct a paradigm for personalized medicine by deriving innovative surgical options suitable for each patient and predicting the surgical outcomes.
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Affiliation(s)
- Sora An
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | | | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM UMR 7339, Marseille, France
| | - Viktor Jirsa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
- * E-mail:
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15
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Altered brain functional network in children with type 1 Gaucher disease: a longitudinal graph theory-based study. Neuroradiology 2018; 61:63-70. [DOI: 10.1007/s00234-018-2104-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023]
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16
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Wu Q, Zhao CW, Long Z, Xiao B, Feng L. Anatomy Based Networks and Topology Alteration in Seizure-Related Cognitive Outcomes. Front Neuroanat 2018; 12:25. [PMID: 29681801 PMCID: PMC5898178 DOI: 10.3389/fnana.2018.00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/20/2018] [Indexed: 01/19/2023] Open
Abstract
Epilepsy is a paroxysmal neurological disorder characterized by recurrent and unprovoked seizures affecting approximately 50 million people worldwide. Cognitive dysfunction induced by seizures is a severe comorbidity of epilepsy and epilepsy syndromes and reduces patients’ quality of life. Seizures, along with accompanying histopathological and pathophysiological changes, are associated with cognitive comorbidities. Advances in imaging technology and computing allow anatomical and topological changes in neural networks to be visualized. Anatomical components including the hippocampus, amygdala, cortex, corpus callosum (CC), cerebellum and white matter (WM) are the fundamental components of seizure- and cognition-related topological networks. Damage to these structures and their substructures results in worsening of epilepsy symptoms and cognitive dysfunction. In this review article, we survey structural, network changes and topological alteration in different regions of the brain and in different epilepsy and epileptic syndromes, and discuss what these changes may mean for cognitive outcomes related to these disease states.
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Affiliation(s)
- Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Charlie W Zhao
- Department of Neuroscience, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Zhe Long
- Sydney Medical School and the Brain & Mind Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
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