Epilepsy & behavior : E&B · 2026
Clinical study on glymphatic system dysfunction in patients with temporal lobe epilepsy.
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Qiu Yueer, Lin Yamei, Chen Nuozhen, Chen Yaling, Lin Kanlin, Wang Xiaoyang, Xu Shangwen
Аннотация
OBJECTIVE: To investigate glymphatic system (GS) dysfunction in patients with unilateral temporal lobe epilepsy (TLE) based on the coupling of global blood-oxygen-level-dependent (gBOLD) signals and cerebrospinal fluid (CSF) inflow, as well as choroid plexus (CP) volume.
METHODS: This retrospective study included 64 unilateral TLE patients and 40 age- and sex-matched healthy controls (HC). gBOLD-CSF coupling strength and CP volume were measured in all participants. Patients were grouped by epileptogenic zone into left temporal lobe epilepsy (LTLE) and right temporal lobe epilepsy (RTLE) groups; and by postsurgical outcome into good outcome (GO) and poor outcome (PO) groups. Group differences in gBOLD-CSF coupling and CP volume were compared, and their correlations with clinical characteristics and structural metrics (including total intracranial volume [TIV], cortical gray matter volume [CGMV], and lateral ventricular volume [LVV]) were analyzed. Additionally, univariate and multivariate logistic regression analyses were conducted to construct predictive models for postsurgical seizure outcomes.
RESULTS: TLE patients showed significantly weaker gBOLD-CSF coupling and larger CP volume than the HC group. gBOLD-CSF coupling was reduced in both GO and PO groups compared with the HC group. LTLE patients exhibited significantly weaker gBOLD-CSF coupling than the HC group. CP volume was significantly larger in the PO group than in both the HC and GO groups, with no significant differences among the LTLE, RTLE, and HC groups. gBOLD-CSF coupling correlated negatively with CGMV/TIV, while CP volume correlated negatively with CGMV/TIV and positively with ventricular indices. Notably, CP volume was an independent predictor of postsurgical outcome. The combined model (CGMV/TIV + history of febrile seizures + CPV/TIV) yielded an area under the curve (AUC) of 0.799 for predicting postsurgical outcome.
CONCLUSION: Patients with TLE exhibit significant GS dysfunction associated with cerebral atrophy. CP volume represents an independent predictor of postsurgical outcome. Furthermore, the combined model (CGMV/TIV + history of febrile seizures + CPV/TIV) demonstrates strong predictive value for postsurgical outcome.
METHODS: This retrospective study included 64 unilateral TLE patients and 40 age- and sex-matched healthy controls (HC). gBOLD-CSF coupling strength and CP volume were measured in all participants. Patients were grouped by epileptogenic zone into left temporal lobe epilepsy (LTLE) and right temporal lobe epilepsy (RTLE) groups; and by postsurgical outcome into good outcome (GO) and poor outcome (PO) groups. Group differences in gBOLD-CSF coupling and CP volume were compared, and their correlations with clinical characteristics and structural metrics (including total intracranial volume [TIV], cortical gray matter volume [CGMV], and lateral ventricular volume [LVV]) were analyzed. Additionally, univariate and multivariate logistic regression analyses were conducted to construct predictive models for postsurgical seizure outcomes.
RESULTS: TLE patients showed significantly weaker gBOLD-CSF coupling and larger CP volume than the HC group. gBOLD-CSF coupling was reduced in both GO and PO groups compared with the HC group. LTLE patients exhibited significantly weaker gBOLD-CSF coupling than the HC group. CP volume was significantly larger in the PO group than in both the HC and GO groups, with no significant differences among the LTLE, RTLE, and HC groups. gBOLD-CSF coupling correlated negatively with CGMV/TIV, while CP volume correlated negatively with CGMV/TIV and positively with ventricular indices. Notably, CP volume was an independent predictor of postsurgical outcome. The combined model (CGMV/TIV + history of febrile seizures + CPV/TIV) yielded an area under the curve (AUC) of 0.799 for predicting postsurgical outcome.
CONCLUSION: Patients with TLE exhibit significant GS dysfunction associated with cerebral atrophy. CP volume represents an independent predictor of postsurgical outcome. Furthermore, the combined model (CGMV/TIV + history of febrile seizures + CPV/TIV) demonstrates strong predictive value for postsurgical outcome.