Structural and Functional Abnormalities in Women With Catamenial Epilepsy

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica Pub Date : 2026-04-09 DOI:10.1155/ane/6589710

Yujie Chen, Maojia Ran, Enhui Zhang, Nanya Hao, Chenyang Zhao, Hesheng Zhang, Zhujing Ou, Zhijun Le, Raowei Yan, Weizhi Tian, Muke Zhou, Qiang Yue, Dong Zhou, Xintong Wu

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Abstract

Objective

Catamenial epilepsy (CE) is a neuroendocrine disorder characterized by seizure exacerbation during specific phases of the menstrual cycle. The pathophysiology of CE remains elusive. This study investigates structural and functional brain alterations in women with Type-I CE, focusing on the interaction between hormonal fluctuations and epileptic networks.

Methods

Thirty-three CE women with Type-I CE and 27 healthy controls (HCs) underwent longitudinal multimodal MRI scans during the perimenstrual and midluteal phases. Voxel-based morphometry was used to detect abnormal gray matter volume (GMV), while amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) evaluated local signal changes. Functional connectivity was explored with brain regions showing abnormal GMV, fALFF, or ALFF as seed regions. Mediation analysis evaluated structural–functional relationships between hormonal changes and seizure frequency.

Results

Reduced GMV was found in the CE group within the superior frontal gyrus, mediodorsal thalamus, insula, and limbic regions. Resting-state functional MRI demonstrated cycle-related fluctuations in the anterior cingulate cortex and the inferior temporal gyrus that were specific to women with CE relative to the HC group. In the seed-based FC analysis, the CE group exhibited hypoconnectivity within the temporo–limbic regions compared to HCs. In contrast to the temporal stability observed in HCs, women with CE displayed extensive hyperconnectivity involving the thalamo–striatal and fronto–parietal regions during the perimenstrual phase relative to the midluteal phase. Correlation analysis indicated that perimenstrual estradiol levels were negatively associated with ALFF value in the inferior temporal gyrus. Mediation analysis suggested mediodorsal thalamus GMV atrophy as a critical substrate linking estradiol fluctuations to perimenstrual seizure exacerbation.

Conclusions

These findings may implicate a hormone-sensitive network with widespread cortical alterations anchored in the thalamo–temporolimbic hub as central to CE pathophysiology. The structural vulnerability of the mediodorsal thalamus acts as a modulator where estradiol withdrawal might trigger functional network instability, suggesting a potential precision target for neuromodulation.

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女性羊膜癫痫的结构和功能异常

目的：羊膜癫痫是一种神经内分泌紊乱，其特征是在月经周期的特定阶段发作加剧。CE的病理生理机制尚不明确。本研究调查了i型CE女性大脑结构和功能的改变，重点关注激素波动和癫痫网络之间的相互作用。方法33例ⅰ型CE女性和27例健康对照（hc）在月经围期和黄体中期进行纵向多模态MRI扫描。基于体素的形态测量用于检测异常灰质体积（GMV），低频波动幅度（ALFF）和分数ALFF （fALFF）评估局部信号变化。将显示异常GMV、fALFF或ALFF的脑区作为种子区，探索功能连通性。中介分析评估了激素变化与癫痫发作频率之间的结构-功能关系。结果CE组在额上回、丘脑中背侧、脑岛和边缘区GMV降低。静息状态功能MRI显示，相对于HC组，CE女性患者的前扣带皮层和颞下回出现周期相关波动。在基于种子的FC分析中，与hc相比，CE组在颞边缘区域表现出低连通性。与在HCs中观察到的时间稳定性相反，与黄体中期相比，女性CE患者在月经四周期表现出涉及丘脑纹状体和额顶叶区域的广泛的超连通性。相关分析表明，月经前后雌二醇水平与颞下回ALFF值呈负相关。中介分析表明，丘脑中背侧GMV萎缩是雌二醇波动与月经期癫痫发作加剧相关的关键底物。结论：这些发现可能暗示了一个激素敏感网络，其广泛的皮质改变锚定在丘脑-颞叶中枢，是CE病理生理的核心。丘脑中背侧的结构脆弱性作为一种调节剂，雌二醇戒断可能引发功能网络不稳定，提示神经调节的潜在精确目标。

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来源期刊

Acta Neurologica Scandinavica 医学-临床神经学

CiteScore

6.70

自引率

2.90%

发文量

161

审稿时长

4-8 weeks

期刊介绍： Acta Neurologica Scandinavica aims to publish manuscripts of a high scientific quality representing original clinical, diagnostic or experimental work in neuroscience. The journal''s scope is to act as an international forum for the dissemination of information advancing the science or practice of this subject area. Papers in English will be welcomed, especially those which bring new knowledge and observations from the application of therapies or techniques in the combating of a broad spectrum of neurological disease and neurodegenerative disorders. Relevant articles on the basic neurosciences will be published where they extend present understanding of such disorders. Priority will be given to review of topical subjects. Papers requiring rapid publication because of their significance and timeliness will be included as ''Clinical commentaries'' not exceeding two printed pages, as will ''Clinical commentaries'' of sufficient general interest. Debate within the speciality is encouraged in the form of ''Letters to the editor''. All submitted manuscripts falling within the overall scope of the journal will be assessed by suitably qualified referees.