Interictal blood–brain barrier dysfunction in piriform cortex of people with epilepsy

IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY
Freya Schulte, Johannes T. Reiter, Tobias Bauer, Julia Taube, Felix Bitzer, Juri-Alexander Witt, Rory Piper, Anoja Thanabalasingam, Randi von Wrede, Attila Racz, Tobias Baumgartner, Valeri Borger, Louisa Specht-Riemenschneider, Hartmut Vatter, Elke Hattingen, Ralf Deichmann, Christoph Helmstaedter, Alexander Radbruch, Alon Friedman, Rainer Surges, Theodor Rüber
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Abstract

Objective

The piriform cortex is considered to be highly epileptogenic. Its resection during epilepsy surgery is a predictor for postoperative seizure freedom in temporal lobe epilepsy. Epilepsy is associated with a dysfunction of the blood–brain barrier. We investigated blood–brain barrier dysfunction in the piriform cortex of people with temporal lobe epilepsy using quantitative T1-relaxometry.

Methods

Gadolinium-based contrast agent was administered ictally and interictally in 37 individuals before undergoing quantitative T1-relaxometry. Postictal and interictal images were co-registered, and subtraction maps were created as biomarkers for peri-ictal (∆qT1interictal-postictal) and interictal (∆qT1noncontrast-interictal) blood–brain barrier dysfunction. Values were extracted for the piriform cortex, hippocampus, amygdala, and the whole cortex.

Results

In temporal lobe epilepsy (n = 14), ∆qT1noncontrast-interictal was significantly higher in the piriform cortex than in the whole cortex (p = 0.02). In extratemporal lobe epilepsy (n = 23), ∆qT1noncontrast-interictal was higher in the hippocampus than in the whole cortex (p = 0.05). Across all individuals (n = 37), duration of epilepsy was correlated with ∆qT1noncontrast-interictal (ß = 0.001, p < 0.001) in all regions, while the association was strongest in the piriform cortex. Impaired verbal memory was associated with ∆qT1noncontrast-interictal only in the piriform cortex (p = 0.04). ∆qT1interictal-postictal did not show differences in any region.

Interpretation

Interictal blood–brain barrier dysfunction occurs in the piriform cortex in temporal lobe epilepsy. This dysfunction is linked to longer disease duration and worse cognitive deficits, emphasizing the central role of the piriform cortex in the epileptogenic network of temporal lobe epilepsy.

Abstract Image

癫痫患者梨状皮层发作间期血脑屏障功能障碍。
目的:梨状皮层被认为是高度致痫区。在癫痫手术中切除梨状皮层可预测颞叶癫痫患者术后是否不再发作。癫痫与血脑屏障功能障碍有关。我们使用定量 T1 弛豫测定法研究了颞叶癫痫患者梨状皮层的血脑屏障功能障碍:方法:在进行定量T1-松弛测量之前,对37名患者在发作期和发作间期注射钆基造影剂。对发作后和发作间期的图像进行共同注册,并绘制减影图,作为发作周(ΔqT1发作-发作后)和发作间期(ΔqT1无对比度-发作间期)血脑屏障功能障碍的生物标记。提取了梨状皮层、海马、杏仁核和整个皮层的数值:在颞叶癫痫患者(n = 14)中,梨状皮层的ΔqT1非对比间期显著高于整个皮层(p = 0.02)。在颞叶外癫痫(n = 23)中,海马区的∆qT1非对比间期高于整个皮层(p = 0.05)。在所有个体(n = 37)中,癫痫持续时间与∆qT1非对比间期相关(ß = 0.001,p 非对比间期仅在梨状皮层相关(p = 0.04)。∆ΔqT1发作间期-发作后在任何区域均未显示差异:解释:颞叶癫痫患者的梨状皮层会出现发作间期血脑屏障功能障碍。这种功能障碍与病程延长和认知障碍恶化有关,强调了梨状皮层在颞叶癫痫致痫网络中的核心作用。
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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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