Purpose

We aimed to analyze the characteristics of brain function and microstructure linked to epilepsy relapse after drug withdrawal in patients with focal epilepsy.

Methods

Resting-state functional magnetic resonance imaging and high-resolution T1-weighted images were acquired within 1 month prior to drug withdrawal from 15 patients who did not have epilepsy relapse (PER − group) and 16 patients who subsequently had epilepsy relapse (PER + group). Additionally, 23 healthy participants undergoing the same scanning protocol were included as controls. Fractional amplitude of low-frequency fluctuation (fALFF) and gray matter density (GMD) were compared among groups. Subgroup and correlation analyses were also performed.

Results

There were no significant differences in fALFF between patient groups, but the PER + group showed lower GMD in the bilateral calcarine, left precuneus, and right superior temporal gyrus than the PER − group (Gaussian random field correction, voxel-level P < 0.001 and cluster-level P < 0.05). Both increased seizure number and polytherapy were associated with lower GMD; also, patients using other antiseizure medications showed lower GMD than those using only levetiracetam (Gaussian random field correction, voxel-level P < 0.001, and cluster-level P < 0.05). The active period and disease duration showed both positive and negative correlations with GMD, while the seizure-free period mainly showed positive correlations with GMD (uncorrected, P < 0.001).

Conclusion

Gray matter microstructure, but not local functional activity, showed distinct characteristics between patients with and without epilepsy relapse and may serve as a potential biomarker for predicting seizure recurrence upon drug withdrawal.

中文翻译：

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停药后癫痫复发患者的脑功能和结构特征

目的

我们旨在分析与局灶性癫痫患者停药后癫痫复发相关的脑功能和微观结构特征。

方法

在停药前 1 个月内，从 15 名未出现癫痫复发的患者（PER - 组）和 16 名随后出现癫痫复发的患者（PER + 组）中获取静息态功能性磁共振成像和高分辨率 T1 加权图像）。此外，还包括 23 名接受相同扫描方案的健康参与者作为对照。比较组间低频波动幅度分数（fALFF）和灰质密度（GMD）。还进行了亚组和相关分析。

结果

患者组之间的 fALFF 没有显着差异，但 PER + 组在双侧距骨、左侧楔前叶和右侧颞上回的 GMD 低于 PER - 组（高斯随机场校正，体素水平P  < 0.001 和聚类水平P  < 0.05）。癫痫发作次数增加和多药治疗均与 GMD 降低有关；此外，使用其他抗癫痫药物的患者的 GMD 低于仅使用左乙拉西坦的患者（高斯随机场校正，体素水平P  < 0.001，集群水平P < 0.05)。活动期和病程与GMD均呈正负相关，无发作期主要与GMD呈正相关（未校正，P  < 0.001）。

结论

灰质微观结构，但不是局部功能活动，在癫痫复发和未复发患者之间显示出明显的特征，可能作为预测停药后癫痫复发的潜在生物标志物。