| Part Ⅰ: Exploring the correlation between gray matter structural changes and neurodevelopmental level in the contralateral hemisphere before hemispherotomy in children with drug-resistant epilepsyObjective: To explore the pattern of cortical structural changes in the preoperative contralateral hemisphere in children with drug-resistant epilepsy and to investigate the correlation between cortical structural alterations and neurodevelopmental level.Methods: Forty-six patients with drug-resistant epilepsy,all with hemispherotomy(HS),who underwent treatment in our hospital from September 2018 to December 2022.They were divided into two groups according to their surgical side: 29 patients with the left hemispherotomy(LHS)and 17 patients with the right hemispherotomy(RHS).The neurodevelopmental level was assessed using the Griffiths Development Scales-Chinese Edition(GDS-C).There were 32 children in the normal control group(HC).Highresolution brain MRI data were acquired,and brain gray matter volume and cortical structure were analyzed using voxel-based morphometry(VBM)and surface-based morphometry(SBM).T-test was used to compare gray matter volume(P < 0.05,FWE)and cortical structure differences(P < 0.05,FWE)between the two groups.The correlation between the volume of gray matter and cortical structure and the neurodevelopmental level was analyzed using Spearman’s rank correlation.Results:(1)SBM analysis of the LHS group: compared with the HC group,the fractal dimension(FD)of the right superior frontal gyrus increased in the LHS group,and the FD of the right paracentral lobule,part of the cingulate cortex and frontal cortex decreased in the LHS group;the gyrification index(GI)of the right parabasal gyrus,lingual gyrus,middle frontal gyrus,postcentral gyrus and part of the temporal cortex increased in the LHS group,and the GI of the right posterior cingulate gyrus,caudal anterior cingulate gyrus and isthmus of the cingulate gyrus decreased.The right superior frontal gyrus and medial orbitofrontal sulcal depth(SD)increased in the LHS group,and SD decreased in the right insular gyrus and part of the parietal-occipital-temporal cortex;the cortical thickness(CT)of the parietal-temporal-occipital multi-brain areas of the right cerebral hemisphere decreased in the LHS group.(2)SBM analysis in the RHS group:the GI of the caudal part of the left middle frontal gyrus was increased in the RHS group;the SD of the left frontal pole,superior frontal gyrus and orbitofrontal cortex were increased in the RHS group.(3)Correlation analysis: age at seizure onset was significantly positively correlated with GDS-C scores in all domains in the HS group(P< 0.01),right superior frontal gyrus,posterior cingulate gyrus and medial orbitofrontal FD were significantly positively correlated with GDS-C scores in all domains in the LHS group(P < 0.01),and right postcentral gyrus and superior temporal gyrus GI were significantly negatively correlated with GDS-C scores in all domains(P < 0.01).The right posterior cingulate gyrus,caudal anterior cingulate gyrus and isthmus of the cingulate gyrus GI were significantly and positively correlated with GDS-C scores in all domains(P < 0.01): the right insular gyrus,transverse temporal gyrus,lingual gyrus,superior temporal gyrus,precentral gyrus and supramarginal gyrus SD were significantly and positively correlated with GDS-C scores in all domains(P < 0.01).The left lateral orbital frontal SD in the RHS group was significantly and positively correlated with GDS-C scores in all domains(P <0.01).Conclusion: Patients with drug-resistant epilepsy have significant preoperative changes in the cortical structure of the prefrontal-limbic system in the contralateral hemisphere.Structural changes in the superior frontal gyrus and lateral orbitofrontal cortex are positively correlated with the level of neurodevelopment,suggesting structural remodeling and functional compensation of the gray matter.Gray matter in the regions responsible for the limbic system,vision,hearing,and movement was being damaged before surgery.Part Ⅱ: Longitudinal study of gray matter structural remodeling and motor prognosis in the contralateral hemisphere after hemispherotomy in children with drugresistant epilepsyObjective:To explore the pattern of longitudinal changes in brain gray matter volume and cortical structure after hemispherotomy in children with drug-resistant epilepsy and to investigate their correlation with the prognosis of postoperative motor function.Methods : Thirty-six children with drug-resistant epilepsy who underwent hemispherotomy at our hospital from September 2018 to December 2022 were recruited and follow-up for at least one year.They underwent clinical assessment and highresolution brain MRI data acquisition preoperatively(time point 1,T1)and postoperatively(time point 2,T2).Longitudinal analyses of brain gray matter volume and cortical structure were performed by using voxel-based morphometry(VBM)and surface-based morphometry(SBM).Differences in gray matter volume(P < 0.05,FWE)and cortical structure(P < 0.001,FWE)between the two groups were compared using analyses of analytic factors.Correlations between the longitudinal rates of change in volume and cortical structure and clinical indicators were analyzed using spearman correlations.Logistic regression was used to analyze each factor of postoperative motor function prognosis,and ROC curves were used to evaluate the predictive value of each parameter.Results :(1)Longitudinal changes in gray matter volume: compared with the preoperative period,the LHS group showed an increase in gray matter volume in the right inferior temporal gyrus and temporal pole-middle temporal gyrus and a decrease in gray matter volume in the right cerebellum,part of the cingulate gyrus,orbital inferior frontal gyrus and hippocampus(FWE corrected,P < 0.05,clusters ≥ 30 voxels).(2)Longitudinal changes in cortical structure: compared with the preoperative period,the LHS group showed increased FD in the caudal right anterior cingulate gyrus,inferior frontal gyrus,postcentral gyrus,inferior parietal gyrus,and middle frontal gyrus after surgery.Postoperatively,the right posterior cingulate gyrus,postcentral gyrus and lateral occipital SD decreased,and the right lateral orbitofrontal,superior marginal,superior temporal and precentral gyrus SD increased;the right cingulate gyrus isthmus,caudal anterior cingulate gyrus and CT of the frontotemporal parieto-occipital part of the cerebral gyrus decreased in the LHS group.The RHS group had increased FD in the left middle frontal gyrus and decreased CT in the left posterior cingulate gyrus,precentral gyrus,precuneus and supramarginal gyrus.(3)Multivariate logistics regression analysis showed that the GMV of temporal pole-middle temporal gyrus was an independent risk factor for improvement in motor function after surgery [OR=0.07,95% CI(0.01-0.85),P=0.037],and the CT of anterior cingulate gyrus was an independent protective factor for improvement in motor function after surgery [OR=18.19,95% CI(1.56-212.43),P=0.021].The AUC of the anterior cingulate gyrus and regression equation predicting improvement in motor function after surgery were 0.765 and 0.955.The AUC of age at seizure onset and the left precentral gyrus in the RHS group predicting improvement in motor function after surgery were 0.838 and 0.850.Conclusion:Postoperative remodeling of gray matter structures in the contralateral hemisphere could compensate for the reorganization of motor function.The CT of the anterior cingulate gyrus was an independent protective factor for postoperative motor function improvement and could be used as a predictor of postoperative motor function improvement.The gray matter volume of the temporal pole-middle temporal gyrus was an independent risk factor for postoperative motor function improvement.Persistent damage to some temporal gray matter structures in the postoperative period affects the neurodevelopmental process in children. |
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