Abstract
Accumulating diffusion tensor imaging (DTI) evidence suggests that white matter abnormalities evaluated by local diffusion homogeneity (LDH) or fractional anisotropy (FA) occur in patients with blepharospasm (BSP), both of which are significantly correlated with disease severity. However, whether the individual severity of BSP can be identified using these DTI metrics remains unknown. We aimed to investigate whether a combination of machine learning techniques and LDH or FA can accurately identify the individual severity of BSP. Forty-one patients with BSP were assessed using the Jankovic Rating Scale and DTI. The patients were assigned to non-functionally and functionally limited groups according to their Jankovic Rating Scale scores. A machine learning scheme consisting of beam search and support vector machines was designed to identify non-functionally versus functionally limited outcomes, with the input features being LDH or FA in 68 white matter regions. The proposed machine learning scheme with LDH or FA yielded an overall accuracy of 88.67 versus 85.19% in identifying non-functionally limited versus functionally limited outcomes. The scheme also identified a sensitivity of 91.40 versus 85.87% in correctly identifying functionally limited outcomes, a specificity of 83.33 versus 83.67% in accurately identifying non-functionally limited outcomes, and an area under the curve of 93.7 versus 91.3%. These findings suggest that a combination of LDH or FA measurements and a sophisticated machine learning scheme can accurately and reliably identify the individual disease severity in patients with BSP.
Highlights
Primary blepharospasm (BSP) is the second most common primary adult-onset dystonia (Hallett et al, 2008)
We show that a combination of local diffusion homogeneity (LDH) or fractional anisotropy (FA) measurements with a sophisticated machine learning scheme can accurately and reliably identify the individual disease severity in patients with BSP, suggesting that diffusion tensor imaging (DTI) parameters may be of clinical value in assessing and following the individual severity of BSP
ConclusionWe show that a combination of local diffusion homogeneity (LDH) or fractional anisotropy (FA) measurements with a sophisticated machine learning scheme can accurately and reliably identify the individual disease severity in patients with BSP (non-functionally limited versus functionally limited), suggesting that diffusion tensor imaging (DTI) parameters may be of clinical value in assessing and following the individual severity of BSP
Summary
Primary blepharospasm (BSP) is the second most common primary adult-onset dystonia (Hallett et al, 2008). Our previous study found widespread white matter abnormalities evaluated by local diffusion homogeneity (LDH) in 29 patients with BSP, which was significantly correlated with disease severity (Guo et al, 2020). A higher FA or LDH value represents the microstructural reorganization of brain white matter, and reduced FA or LDH indicates the microstructural disruption of neural fibers (Tang et al, 2012; Liu et al, 2017; Guo et al, 2020) These studies suggest that DTI has the potential to evaluate the individual severity of BSP, but the specific DTI markers for identifying the individual severity of BSP remain unknown
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