White matter and glymphatic system alterations in patients with focal epilepsy: insights from PSMD and DTI-ALPS index.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-09-30 DOI:10.1007/s00234-025-03782-z

Ho-Joon Lee, Dong Ah Lee, Kang Min Park

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引用次数: 0

Abstract

Objectives: Peak width of skeletonized mean diffusivity (PSMD) is a neuroimaging biomarker of white matter integrity in cerebral small-vessel disease. However, the significance of PSMD in focal epilepsy remains unclear. This study aimed to investigate alterations in white matter microstructure and glymphatic system function in patients with focal epilepsy by comparing PSMD and the diffusion tensor imaging (DTI) along perivascular spaces (DTI-ALPS) index with healthy controls and by exploring their associations with seizure lateralization and treatment response.

Methods: We retrospectively analyzed DTI data from 102 patients with focal epilepsy and 88 healthy controls. PSMD values and the DTI-ALPS index were obtained using a standard processing pipeline, and between-group comparisons were performed. Associations between PSMD and clinical characteristics were also evaluated.

Results: PSMD was significantly higher in patients with focal epilepsy than in healthy controls (2.218 ± 0.355 × 10^-4 vs. 2.051 ± 0.176 × 10^-4 mm²/s, p < 0.001). In addition, PSMD was significantly higher in the ipsilateral hemisphere than in the contralateral hemisphere (2.239 ± 0.356 × 10^-4 vs. 2.109 ± 0.325 × 10^-4 mm²/s, p = 0.005). The DTI-ALPS index was significantly lower in patients with focal epilepsy than in healthy controls (1.628 ± 0.256 vs. 1.718 ± 0.305, p = 0.028). PSMD was positively correlated with age in patients (r = 0.417, p < 0.001) and controls (r = 0.343, p = 0.001) and negatively correlated with the DTI-ALPS index in patients (r=-0.376, p < 0.001) and controls (r=-0.409, p < 0.001).

Conclusion: Our findings suggest that PSMD is increased in patients with focal epilepsy, potentially reflecting microstructural white matter alterations. Increased PSMD in the ipsilateral hemisphere supports its potential role in lateralizing seizure onset. The significant positive correlation between PSMD and age and the inverse relationship between PSMD and the DTI-ALPS index suggest that PSMD is associated with changes in the glymphatic system and white matter microstructure.

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局灶性癫痫患者的白质和淋巴系统改变：来自PSMD和DTI-ALPS指数的见解。

目的：骨胳化平均扩散率峰宽（PSMD）是脑小血管疾病白质完整性的神经影像学生物标志物。然而，PSMD在局灶性癫痫中的意义尚不清楚。本研究旨在通过与健康对照比较PSMD和沿血管周围间隙弥散张量成像（DTI- alps）指数，探讨局灶性癫痫患者白质微结构和淋巴系统功能的改变，并探讨它们与癫痫发作侧化和治疗反应的关系。方法：回顾性分析102例局灶性癫痫患者和88例健康对照者的DTI资料。使用标准处理管道获得PSMD值和DTI-ALPS指数，并进行组间比较。还评估了PSMD与临床特征之间的关系。结果：局灶性癫痫患者PSMD显著高于健康对照组（2.218±0.355 × 10-4比2.051±0.176 × 10-4 mm2/s， p -4比2.109±0.325 × 10-4 mm2/s, p = 0.005）。局灶性癫痫患者DTI-ALPS指数明显低于健康对照组（1.628±0.256∶1.718±0.305,p = 0.028）。PSMD与患者年龄呈正相关（r = 0.417, p）。结论：局灶性癫痫患者PSMD增加，可能反映了白质微结构改变。同侧半球PSMD的增加支持其在侧化癫痫发作中的潜在作用。PSMD与年龄呈显著正相关，与DTI-ALPS指数呈负相关，提示PSMD与淋巴系统和白质微观结构的改变有关。

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

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.