Recovery of glymphatic system function in patients with temporal lobe epilepsy after surgery

Zhang, Chao; Xu, Kai; Zhang, Haiyan; Sha, Jingyun; Yang, Hongyu; Zhao, Houliang; Chen, Nan

doi:10.1007/s00330-023-09588-y

Cited by 12 publications

(7 citation statements)

References 34 publications

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“…We found no difference in the DTI-ALPS index between our patients with PNES and healthy subjects. Some studies have reported glymphatic system dysfunction in epileptic patients [11][12][13][14]17], and others have suggested that the proinflammatory mediators in patients with epilepsy disrupt the blood-brain barrier and thereby damage the glymphatic system [12][13][14]. Psychogenic non-epileptic seizures are epilepsy-like seizures without epileptic discharges in the brain [1], and unlike in epilepsy, the neurological basis of PNES might not disturb the blood-brain barrier.…”

Section: Discussionmentioning

confidence: 99%

“…Lately, diffusion tensor imaging (DTI)-analysis along the perivascular space (ALPS) conducted using diffusional imaging data has gained notice because this indicator can approximate the activity of the glymphatic system with a high degree of reproducibility [15][16]. Some studies focused on the relation between the DTI-ALPS index and epilepsy symptoms and showed a decrease in the DTI-ALPS index in patients with such symptoms [12][13][14], and one study found that glymphatic system function was recovered in patients with temporal lobe epilepsy after successful anterior temporal lobectomy [17]. However, there has been no DTI-ALPS study focusing on PNES until recently.…”

Section: Introductionmentioning

confidence: 99%

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Glymphatic System Activity and Brain Morphology in Patients With Psychogenic Non-epileptic Seizures

Ota,

Sone,

Shigemoto

et al. 2024

Cureus

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Background: To clarify the neural correlates underlying psychogenic non-epileptic seizures (PNES), we compared glymphatic system activity between patients with PNES and healthy participants using diffusion tensor imaging (DTI)-analysis along the perivascular space (ALPS) method. Methods: The DTI scans were acquired from 16 patients with PNES and 25 healthy participants. We computed the DTI-ALPS index as an index of glymphatic system function and estimated the disease-related changes in the DTI-ALPS index and brain structures in PNES patients. Results: There were no significant differences in the DTI-ALPS index between patients with PNES and healthy participants. On the other hand, patients with PNES had decreased fractional anisotropy values in the bilateral posterior cingula, a higher mean diffusivity value around the left insula, and a lower gray matter volume in the bilateral amygdalae compared with healthy participants. Conclusions: Patients with PNES exhibited an impairment of white matter integrity and a reduction of gray matter volume, but no glymphatic-system changes. These findings will play a significant role in our comprehension of this complex illness.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Glymphatic System Activity and Brain Morphology in Patients With Psychogenic Non-epileptic Seizures

Ota,

Sone,

Shigemoto

et al. 2024

Cureus

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show abstract

“…A recent study also investigated the association between seizure frequency and glymphatic system function using the DTI-ALPS method, the results of which were in line with those of our study. The authors found a reduced DTI-ALPS index in patients with temporal lobe epilepsy compared to healthy controls, but the index could be increased when they became seizure-free after successfully undergoing anterior temporal lobectomy [40]. Albeit in an animal experiment, chronic implantation of EEG electrodes was associated with significant changes in the brain's fluid transport system [41].…”

Section: F I G U R E 3 Correlation Analysis Between the Diffusion Ten...mentioning

confidence: 95%

Anti‐seizure medication response and the glymphatic system in patients with focal epilepsy

Kim,

Lee

et al. 2023

Euro J of Neurology

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Background and purposeWe aimed to evaluate (i) glymphatic system function in patients with focal epilepsy in comparison with healthy controls, and (ii) the association between anti‐seizure medication (ASM) response and glymphatic system function by using diffusion tensor image analysis along the perivascular space (DTI‐ALPS).MethodsWe retrospectively enrolled 100 patients with focal epilepsy who had normal brain magnetic resonance imaging (MRI) findings, and classified them as “poor” or “good” ASM responders according to their seizure control at the time of brain MRI. We also included 79 age‐ and sex‐matched healthy controls. All patients and healthy controls underwent conventional brain MRI and diffusion tensor imaging. The DTI‐ALPS index was calculated using the DSI studio program.ResultsOf the 100 patients with focal epilepsy, 38 and 62 were poor and good ASM responders, respectively. The DTI‐ALPS index differed significantly between patients with focal epilepsy and healthy controls and was significantly lower in patients with focal epilepsy (1.55 vs. 1.70; p < 0.001). The DTI‐ALPS index also differed significantly according to ASM response and was lower in poor ASM responders (1.48 vs. 1.59; p = 0.047). Furthermore, the DTI‐ALPS index was negatively correlated with age (r = −0.234, p = 0.019) and duration of epilepsy (r = −0.240, p = 0.016) in patients with focal epilepsy.ConclusionOur study is the first to identify, in focal epilepsy patients, a greater reduction in glymphatic system function among poor ASM responders compared to good responders. To confirm our results, further prospective multicenter studies with large sample sizes are needed.

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“…Retrospective analyses of patients with epilepsy (Table 2) show that GS function is lower than in control subjects (Kim et al., 2023; Lee, Lee, Shin, & Park, 2022; Lee, Park, Ko, Park, Lee, et al., 2022; Li, Ruan, et al., 2022; Liu et al., 2020; Salimeen et al., 2021; Zhao et al., 2023), and that GS function is completely restored in patients with temporal lobe epilepsy after anterior temporal lobectomy (Zhang, Xu, et al., 2023), suggesting an important role for the GS in epilepsy. Interestingly, in patients with focal epilepsy, no changes in GS were found by Lee, Park, Ko, Park, Park, et al.…”

Section: The Cerebral Lymphatic Drainage System and Epilepsymentioning

confidence: 99%

The cerebral lymphatic drainage system and its implications in epilepsy

Peng,

Xie,

Liu

et al. 2023

J of Neuroscience Research

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The central nervous system has long been thought to lack a clearance system similar to the peripheral lymphatic system. Therefore, the clearance of metabolic waste in the central nervous system has been a subject of great interest in neuroscience. Recently, the cerebral lymphatic drainage system, including the parenchymal clearance system and the meningeal lymphatic network, has attracted considerable attention. It has been extensively studied in various neurological disorders. Solute accumulation and neuroinflammation after epilepsy impair the blood–brain barrier, affecting the exchange and clearance between cerebrospinal fluid and interstitial fluid. Restoring their normal function may improve the prognosis of epilepsy. However, few studies have focused on providing a comprehensive overview of the brain clearance system and its significance in epilepsy. Therefore, this review addressed the structural composition, functions, and methods used to assess the cerebral lymphatic system, as well as the neglected association with epilepsy, and provided a theoretical basis for therapeutic approaches in epilepsy.

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Recovery of glymphatic system function in patients with temporal lobe epilepsy after surgery

Cited by 12 publications

References 34 publications

Glymphatic System Activity and Brain Morphology in Patients With Psychogenic Non-epileptic Seizures

Glymphatic System Activity and Brain Morphology in Patients With Psychogenic Non-epileptic Seizures

Anti‐seizure medication response and the glymphatic system in patients with focal epilepsy

The cerebral lymphatic drainage system and its implications in epilepsy

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