Neurofunctional divergence between classical and idiopathic trigeminal neuralgia: A large-cohort resting-state fMRI study of 139 patients

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-08-28 DOI:10.1016/j.clineuro.2025.109127

Gaoquan Lv , Zihao Zhang , Qingpei Hao , Qiang Di , Zheng Wang , Zhentao Li , Ruen Liu

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引用次数: 0

Abstract

Background

Resting-state functional MRI (rs-fMRI) has advanced our understanding of trigeminal neuralgia (TN), but the neural distinctions between its classical (CTN) and idiopathic (ITN) subtypes are poorly understood. This study aims to investigate differential brain activity and connectivity patterns between CTN and ITN to elucidate their underlying central mechanisms and identify potential neuroimaging biomarkers.

Methods

This prospective study included rs-fMRI data from 139 TN patients (84 CTN, 55 ITN) and 49 matched healthy controls (HCs). We analyzed the amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and functional connectivity (FC). Group comparisons were performed using two-sample t-tests with cluster-level family-wise error (FWE) correction. Correlations between imaging metrics and clinical variables were assessed.

Results

Compared to HCs, TN patients exhibited decreased ReHo in the right fusiform gyrus and increased ReHo in the right thalamus. Subtype analysis revealed that ITN patients, compared to CTN, showed significantly increased ALFF in the right hippocampus and decreased fALFF in the bilateral postcentral gyrus. Clinically, ReHo in the right fusiform gyrus negatively correlated with pain intensity (VAS; r = -0.255, p = 0.002), while right thalamic ReHo showed a positive correlation (r = 0.208, p = 0.014). In the CTN subgroup, connectivity between the left supramarginal gyrus and right perigenual cingulate gyrus was inversely correlated with disease duration (r = -0.267, p = 0.014).

Conclusion

Our findings reveal divergent rs-fMRI profiles for TN patients versus HCs, and notably, between CTN and ITN subtypes. These distinctions, particularly the hippocampal hyperactivity in ITN, suggest different central pathophysiological mechanisms. These quantifiable neurofunctional alterations may serve as potential biomarkers to differentiate TN subtypes and guide personalized therapeutic strategies.

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经典和特发性三叉神经痛的神经功能差异：139例患者的大队列静息状态fMRI研究

背景：睡眠状态功能MRI （rs-fMRI）提高了我们对三叉神经痛（TN）的认识，但其经典亚型（CTN）和特发性亚型（ITN）之间的神经区别尚不清楚。本研究旨在研究CTN和ITN之间的脑活动差异和连接模式，以阐明其潜在的中枢机制，并确定潜在的神经成像生物标志物。方法本前瞻性研究包括139例TN患者（CTN 84例，ITN 55例）和49例匹配健康对照（hc）的rs-fMRI数据。我们分析了低频波动幅度（ALFF）、分数ALFF （fALFF）、区域同质性（ReHo）和功能连通性（FC）。采用双样本t检验进行组间比较，并校正聚类水平家庭误差（FWE）。评估影像学指标与临床变量之间的相关性。结果与hc相比，TN患者右侧梭状回的ReHo减少，右侧丘脑的ReHo增加。亚型分析显示，与CTN相比，ITN患者右侧海马ALFF显著升高，双侧中央后回ALFF显著降低。临床中，右侧梭状回ReHo与疼痛强度呈负相关（VAS; r = -0.255,p = 0.002），右侧丘脑ReHo与疼痛强度呈正相关（r = 0.208,p = 0.014）。在CTN亚组中，左侧边缘上回和右侧扣带回与病程呈负相关（r = -0.267,p = 0.014）。结论：我们的研究结果揭示了TN患者与hcc患者的rs-fMRI特征存在差异，特别是CTN和ITN亚型之间的差异。这些区别，特别是ITN的海马过度活跃，提示了不同的中枢病理生理机制。这些可量化的神经功能改变可能作为区分TN亚型和指导个性化治疗策略的潜在生物标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.