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
{"title":"Interictal blood–brain barrier dysfunction in piriform cortex of people with epilepsy","authors":"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","doi":"10.1002/acn3.52176","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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 (∆qT1<sub>interictal-postictal</sub>) and interictal (∆qT1<sub>noncontrast-interictal</sub>) blood–brain barrier dysfunction. Values were extracted for the piriform cortex, hippocampus, amygdala, and the whole cortex.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In temporal lobe epilepsy (<i>n</i> = 14), ∆qT1<sub>noncontrast-interictal</sub> was significantly higher in the piriform cortex than in the whole cortex (<i>p</i> = 0.02). In extratemporal lobe epilepsy (<i>n</i> = 23), ∆qT1<sub>noncontrast-interictal</sub> was higher in the hippocampus than in the whole cortex (<i>p</i> = 0.05). Across all individuals (<i>n</i> = 37), duration of epilepsy was correlated with ∆qT1<sub>noncontrast-interictal</sub> (<i>ß</i> = 0.001, <i>p</i> < 0.001) in all regions, while the association was strongest in the piriform cortex. Impaired verbal memory was associated with ∆qT1<sub>noncontrast-interictal</sub> only in the piriform cortex (<i>p</i> = 0.04). ∆qT1<sub>interictal-postictal</sub> did not show differences in any region.</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"11 10","pages":"2623-2632"},"PeriodicalIF":4.4000,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52176","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Clinical and Translational Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/acn3.52176","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
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.
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.