Despite an expanding literature on brain alterations in patients with longstanding epilepsy, few neuroimaging studies investigate patients with newly diagnosed focal epilepsy (NDfE). Understanding brain network impairments at diagnosis is necessary to elucidate whether or not brain abnormalities are principally due to the chronicity of the disorder and to develop prognostic markers of treatment outcome. Most adults with NDfE do not have MRI-identifiable lesions and the reasons for seizure onset and refractoriness are unknown. We applied structural connectomics to T1-weighted and multi-shell diffusion MRI data with generalized q-sampling image reconstruction using Network Based Statistics (NBS). We scanned 27 patients within an average of 3.7 (SD = 2.9) months of diagnosis and anti-epileptic drug treatment outcomes were collected 24 months after diagnosis. Seven patients were excluded due to lesional NDfE and outcome data was available in 17 patients. Compared to 29 healthy controls, patients with non-lesional NDfE had connectomes with significantly decreased quantitative anisotropy in edges connecting right temporal, frontal and thalamic nodes and increased diffusivity in edges between bilateral temporal, frontal, occipital and parietal nodes. Compared to controls, patients with persistent seizures showed the largest effect size (|d|>=1) for decreased anisotropy in right parietal edges and increased diffusivity in edges between left thalamus and left parietal nodes. Compared to controls, patients who were rendered seizure-free showed the largest effect size for decreased anisotropy in the edge connecting the left thalamus and right temporal nodes and increased diffusivity in edges connecting right frontal nodes. As demonstrated by large effect sizes, connectomes with decreased anisotropy (edge between right frontal and left insular nodes) and increased diffusivity (edge between right thalamus and left parietal nodes) were found in patients with persistent seizures compared to patients who became seizure-free. Patients who had persistent seizures showed larger effect sizes in all network metrics than patients who became seizure-free when compared to each other and compared to controls. Furthermore, patients with focal-to-bilateral tonic-clonic seizures (FBTCS, N = 11) had decreased quantitative anisotropy in a bilateral network involving edges between temporal, parietal and frontal nodes with greater effect sizes than those of patients without FBTCS (N = 9). NBS findings between patients and controls indicated that structural network changes are not necessarily a consequence of longstanding refractory epilepsy and instead are present at the time of diagnosis. Computed effect sizes suggest that there may be structural network MRI-markers of future pharmacoresistance and seizure severity in patients with a new diagnosis of focal epilepsy.

尽管关于长期癫痫患者大脑改变的文献越来越多，但很少有神经影像学研究调查新诊断的局灶性癫痫 (NDfE) 患者。在诊断时了解大脑网络损伤对于阐明大脑异常是否主要是由于该疾病的慢性性以及开发治疗结果的预后标志物是必要的。大多数患有 NDfE 的成年人没有 MRI 可识别的病变，癫痫发作和难治性的原因尚不清楚。我们将结构连接组学应用于 T1 加权和多壳扩散 MRI 数据，并使用基于网络的统计 (NBS) 进行广义 q 采样图像重建。我们在诊断后平均 3.7 (SD = 2.9) 个月内扫描了 27 名患者，并在诊断后 24 个月收集了抗癫痫药物治疗结果。7 名患者因病变 NDfE 被排除，17 名患者的结果数据可用。与 29 名健康对照者相比，非病变 NDfE 患者的连接体在连接右侧颞叶、额叶和丘脑节点的边缘中的数量各向异性显着降低，而在双侧颞叶、额叶、枕叶和顶叶节点之间的边缘的扩散性增加。与对照组相比，持续性癫痫患者表现出最大的效应大小（|d|>=1），即右顶叶边缘各向异性减少，左丘脑和左顶叶节点之间边缘扩散性增加。与对照组相比，无癫痫发作的患者表现出最大的效应大小，即连接左侧丘脑和右侧颞叶节点的边缘各向异性降低，以及连接右侧额叶节点的边缘扩散性增加。正如大效应大小所证明的那样，与无癫痫发作的患者相比，在持续性癫痫发作的患者中发现各向异性（右额叶和左岛节点之间的边缘）减少和扩散性（右丘脑和左顶叶节点之间的边缘）增加的连接体。与对照组相比，持续性癫痫发作的患者在所有网络指标中都表现出比无癫痫发作的患者更大的效应量。此外，局灶性至双侧强直阵挛性癫痫发作的患者（FBTCS，N = 11）在涉及颞叶、顶叶和额叶节点之间边缘的双侧网络中的定量各向异性降低，其效应大小比没有 FBTCS 的患者更大（N = 9). NBS 在患者和对照之间的研究结果表明，结构网络变化不一定是长期难治性癫痫的结果，而是在诊断时就存在。计算出的效应大小表明，新诊断的局灶性癫痫患者中可能存在未来耐药性和癫痫严重程度的结构网络 MRI 标记。