| Objective Epilepsy is a common disease of the central nervous system.The accurate diagnosis and evaluation is the key to improve the treatment and rehabilitation effect of patients with epilepsy.Focal cortical dysplasia is a common structural cause of epilepsy,mostly occurred in the temporal lobe and frontal lobe,clinically appeared as drug resisted epilepsy.This study collected diffusion tensor imaging data of patients with frontal or temporal lobe epilepsy with focal cortical dysplasia,and aims to analyze the role of epileptic networks in white matter changes in these patients,and analysis the correlation between white matter structural network with cognitive dysfunction.Research Subjects and Methods There were 22 patients with frontal lobe epilepsy,and 24 patients with temporal lobe epilepsy,and 25 healthy volunteers.All subjects underwent DTI and Ti image scanning and MoCA-B scale evaluation.The DTI and Ti sequence data was preprocessed with FSL,including format conversion,eddy current correction,brain extraction,calculation of DTI index.SPM 8 was used for voxel based analysis,including normalization and smoothing,statistical modeling,estimation,displaying results;Graph-theory white matter structure analysis was done by PANDA and GRETNA,including registration,definition of brain network nodes,deterministic fiber tracking,construction of white matter fiber network,calculating the brain network properties etc..Statistics analysis was performed by SPSS 21.One-way ANOVA was performed to analyse the differences in "small world" network properties and nodal properties among frontal lobe epilepsy,temporal lobe epilepsy,and normal control group.Spearman correlation was used to analyse association between white matter network properties and clinical data or cognitive function.Results VBA results showed that:compared with normal control group,patients with frontal lobe epilepsy have decreased FA values in corpus callosum,bilateral anterior cingulate gyrus,midbrain,left pallidum;increased MD values in bilateral anterior cingulate cortex and in the insula,right claustrum,left supplementary motor area and in the central sulcus cover,corpus callosum,and bilateral frontal and temporal lobe areas;increased AD values in the right frontal gyrus and back to the front buckle;increased RD values in bilateral anterior cingulate gyrus,corpus callosum,left putamen and claustrum,left insula,central sulcus cover,supplementary motor area,and bilateral frontal and temporal part of the region.Patients with temporal lobe epilepsy have decreased FA values in corpus callosum,left anterior cingulate,left pallidum and putamen,left hippocampus,parahippocampal gyrus,superior temporal gyrus,midbrain and right amygdala;increased MD values in bilateral central sulcus cover,insula,claustrum,putamen the right side,thalamus,hippocampus,parahippocampal gyrus,right inferior temporal gyrus,middle frontal gyrus;increased AD values in bilateral putamen,claustrum,insula,right anterior cingulate gyrus,inferior frontal gyrus in the triangle;increased RD values in corpus callosum,anterior cingulate,bilateral insula,claustrum,left putamen,and bilateral temporal,frontal part of the region.Graph-theory white matter structural network analysis results show that the white matter network structure of frontal lobe epilepsy,temporal lobe epilepsy and the normal control group were consistent with the "small world" properties.However,compared with the normal control group,the white matter of the brain network properties of frontal and temporal lobe epilepsy patients have varying degree of change,mainly appeared as increasing shortest path length,decreasing local and global network efficiency,and these changes were more significant in patients with frontal lobe epilepsy.Compared with the normal control group,patients with frontal lobe epilepsy have decrease nodal degree in the left frontal gyrus,right medial frontal gyrus,bilateral orbital anterior cingulate,right posterior cingulate,right occipital gyrus,left angular gyrus,left paracentral lobule,left inferior temporal gyrus;decreased nodal local efficiency in left dorsolateral frontal gyrus,right insula and the left fusiform gyrus,inferior parietal gyrus and left temporal pole:superior temporal gyrus.Patients with temporal lobe epilepsy have decreased nodal degree in the left parahippocampal gyrus,right occipital gyrus,middle occipital gyrus;decreaed nodal efficiency in left hippocampus,right fusiform gyrus,right occipital gyrus the left temporal pole:superior temporal gyrus,right inferior temporal gyrus.Correlation analysis between white matter network changes and clinical data or cognitive function shows that clustering coefficient is positively correlated with age of onset in patients with frontal lobe epilepsy;clustering coefficient is negatively correlated to the disease duration in patients with temporal lobe epilepsy;local efficiency is positively correlated to MoCA-B scale scores in patients with temporal lobe epilepsy.In patients with frontal lobe epilepsy,node degree of left angular gyrus is negatively correlated to disease duration and positively correlated to abstraction;node degree of left inferior temporal gyrus is positively correlated to MoCA-B scale scores;nodal local efficiency in left fusiform gyrus is positively correlated to orientation function,nodal local efficiency in left inferior parietal margin angular gyrus is negatively correlated to the disease duration;node local efficiency in left temporal pole:superior temporal gyrus is positively correlated to executive function.In patients with temporal lobe epilepsy,nodal degree in left parahippocampal gyrus is positively correlated to MoCA-B scale score,executive function,abstraction,delayed recall;local nodal efficiency in left hippocampus is positively correlated to MoCA-B scale scores,executive function,naming.abstraction,nodal local efficiency in right fusiform gyrus and left temporal temporal pole is positively correlated to executive function.Conclusions White matter integrity in patients with frontal and temporal lobe epilepsy due to focal cortical dysplasia was more than where the epileptic foci located.Basal ganglia-thalamo-cortical circuit has obvious white matter changes.White matter structural network changes are vary between epilepsy originate from different lobes.Decreased local and global efficiency was more significant in patients with frontal lobe epilepsy,and the extent of changes is associated with cognitive dysfunction. |
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