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

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Abstract

Objectives

To investigate the recovery of human glymphatic system (GS) function in patients with temporal lobe epilepsy (TLE) after successful anterior temporal lobectomy (ATL) using diffusion tensor image analysis along the perivascular space (DTI-ALPS).

Methods

We retrospectively analysed DTI-ALPS index in 13 patients with unilateral TLE before and after ATL, and compared the index with 20 healthy controls (HCs). Two-sample t tests and paired t tests were performed to analyse differences in the DTI-ALPS index between patients and HCs. The Pearson correlation analysis was used to observe the relationship between the disease duration and GS function.

Results

The DTI-ALPS index before ATL was significantly lower in the hemisphere ipsilateral to the epileptogenic foci than in the contralateral hemisphere of the patients (p < 0.001, t =  − 4.81) and in the ipsilateral hemisphere of the HCs (p = 0.007, t =  − 2.90). A significant increase in the DTI-ALPS index was found in the hemisphere ipsilateral to the epileptogenic foci after successful ATL (p = 0.01, t =  − 3.01). In addition, the DTI-ALPS index of the lesion side before ATL was significantly correlated with disease duration (p = 0.04, r =  − 0.59).

Conclusions

DTI-ALPS may be used as a quantitative biomarker evaluating surgical outcomes and TLE disease duration. DTI-ALPS index may also help localise epileptogenic foci in unilateral TLE. Overall, our study suggests that GS may potentially serve as a new method for the management of TLE and a new direction for investigating the mechanism of epilepsy.

Key Points

• DTI-ALPS index may contribute to epileptogenic foci lateralisation in TLE.

• DTI-ALPS index is a potential quantitative feature evaluating surgical outcomes and TLE disease duration.

• The GS provides a new perspective for the study of TLE.

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Abbreviations

AD:

Alzheimer’s disease

AQP4:

Aquaporin 4

ATL:

Anterior temporal lobectomy

Aβ:

Amyloid beta

CSF:

Cerebrospinal fluid

DTI:

Diffusion tensor imaging

DTI-ALPS:

Diffusion tensor image analysis along the perivascular space

FOV:

Field of view

GS:

Glymphatic system

HCs:

Healthy controls

HS:

Hippocampal sclerosis

ISF:

Interstitial fluid

JME:

Juvenile myoclonic epilepsy

MRI:

Magnetic resonance imaging

PD:

Parkinson’s disease

PVS:

Perivascular space

ROI:

Region of interest

SD:

Standard deviation

SEEG:

Stereotactic electroencephalography

TE:

Echo time

TLE:

Temporal lobe epilepsy

TR:

Repetition time

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Acknowledgements

The authors thank the patients who participated in this study and the staff of the Department of Radiology and Department of Functional Neurosurgery.

Funding

This work was supported by Doctor of Entrepreneurship and Innovation in Jiangsu Province (No. 2019204006), Research Project of Elderly Health in Jiangsu Province (No. LKM2023014) and Hospital-level Project of Affiliated Hospital of Xuzhou Medical University (No. 2020KA013).

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Authors and Affiliations

  1. Department of Radiology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu Province, 221006, People’s Republic of China

    Chao Zhang, Kai Xu, Jingyun Sha & Houliang Zhao

  2. Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China

    Chao Zhang, Nan Chen & Kuncheng Li

  3. Department of Radiology, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, 221006, People’s Republic of China

    Haiyan Zhang

  4. Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, 101100, People’s Republic of China

    Hongyu Yang

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  1. Chao Zhang
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Correspondence to Kai Xu, Nan Chen or Kuncheng Li.

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The scientific guarantor of this publication is Kuncheng Li.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

The authors Chao Zhang and Kai Xu did statistical analyses.

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Written informed consent was waived by the Institutional Review Board.

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• Retrospective

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Zhang, C., Xu, K., Zhang, H. et al. Recovery of glymphatic system function in patients with temporal lobe epilepsy after surgery. Eur Radiol 33, 6116–6123 (2023). https://doi.org/10.1007/s00330-023-09588-y

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  • DOI: https://doi.org/10.1007/s00330-023-09588-y

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