Abstract
PurposeThis study aimed to use graph theoretical analysis of anatomical covariance derived from structural MRI to reveal how the gray matter connectivity pattern is altered after corpus callosotomy (CC).Materials and methodsWe recruited 21 patients with epilepsy who had undergone CC. Enrollment criteria were applied: (1) no lesion identified on brain MRI; (2) no history of other brain surgery; and (3) age not younger than 3 years and not older than 18 years at preoperative MRI evaluation. The most common epilepsy syndrome was Lennox-Gastaut syndrome (11 patients). For voxel-based morphometry, the normalized gray matter images of pre-CC and post-CC patients were analyzed with SPM12 (voxel-level threshold of p<0.05 [familywise error-corrected]). Secondly, the images of both groups were subjected to graph theoretical analysis using the Graph Analysis Toolbox with SPM8. Each group was also compared with 32 age- and sex-matched control patients without brain diseases.ResultsComparisons between the pre- and post-CC groups revealed a significant reduction in seizure frequency with no change in mean intelligence quotient/developmental quotient levels. There was no relationship among the three groups in global network metrics or in targeted attack. A regional comparison of betweenness centrality revealed decreased connectivity to and from the right middle cingulate gyri and medial side of the right superior frontal gyrus and a partial shift in the distribution of betweenness centrality hubs to the normal location. Significantly lower resilience to random failure was found after versus before CC and versus controls (p = 0.0450 and p = 0.0200, respectively).ConclusionGraph theoretical analysis of anatomical covariance derived from structural imaging revealed two neural network effects of resection associated with seizure reduction: the reappearance of a structural network comparable to that in healthy children and reduced connectivity along the median line, including the middle cingulate gyrus.
Highlights
Corpus callosotomy (CC) is an established palliative treatment for patients with intractable epilepsy who are not candidates for resective surgery
Comparisons between the pre- and post-CC groups revealed a significant reduction in seizure frequency with no change in mean intelligence quotient/developmental quotient levels
Graph theoretical analysis of anatomical covariance derived from structural imaging revealed two neural network effects of resection associated with seizure reduction: the reappearance of a structural network comparable to that in healthy children and reduced connectivity along the median line, including the middle cingulate gyrus
Summary
Corpus callosotomy (CC) is an established palliative treatment for patients with intractable epilepsy who are not candidates for resective surgery. In a prospective population-based observational study, a greater than 50% seizure reduction was seen in 64% of the patients in the long-term follow-up, including 10% with seizure freedom [1]. Three factors related to seizure freedom after CC are “lack of abnormal magnetic resonance imaging findings”, “lack of proven etiology of seizures”, and underwent “surgery at age 6 years or younger” [3]. The sequential mean developmental quotient (DQ) score during a 3-year follow-up after CC was not significantly changed in children who underwent CC or vagal nerve stimulation [4]. Patients even show attention enhancement, which is related to drop seizure frequency and postoperative EEG improvements [5, 6]
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