1
|
Xie F, Zhou C, Jin H, Xing W, Wang D. Bilateral glymphatic dysfunction and its association with disease duration in unilateral temporal lobe epilepsy patients with hippocampal sclerosis. Epilepsy Behav 2024; 155:109777. [PMID: 38640726 DOI: 10.1016/j.yebeh.2024.109777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/01/2023] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE In this study, the diffusion tensor imaging along perivascular space analysis (DTI-ALPS) technique was utilized to evaluate the functional changes in the glymphatic system of the bilateral hemispheres in patients with unilateral temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS). The aim was to gain insights into the alterations in the glymphatic system function in TLE patients. METHODS A total of 61 unilateral TLE patients with HS and 53 healthy controls (HCs) from the Department of Neurosurgery at Xiangya Hospital were included in the study. All subjects underwent DTI using the same 3 T MR Scanner, and the DTI-ALPS index was calculated. Differences in the DTI-ALPS index between TLE patients and HCs were evaluated, along with the correlation between the DTI-ALPS index of TLE and clinical features of epilepsy. These features included age, age of onset, seizure duration, and neuropsychological scores. RESULTS Compared to the bilateral means of the HCs, both the ipsilateral and contralateral DTI-ALPS index of the TLE patients were significantly decreased (TLE ipsilateral 1.41 ± 0.172 vs. HC bilateral mean: 1.49 ± 0.116, p = 0.006; TLE contralateral: 1.42 ± 0.158 vs. HC bilateral mean: 1.49 ± 0.116, p = 0.015). The ipsilateral DTI-ALPS index in TLE patients showed a significant negative correlation with disease duration (r = -0.352, p = 0.005). CONCLUSIONS The present study suggests the presence of bilateral dysfunctions in the glymphatic system and also highlight a laterality feature in these dysfunctions. Additionally, the study found a significant negative correlation between the ipsilateral DTI-ALPS index and disease duration, underscoring the significance of early effective interventions and indicating potential for the development of innovative treatments targeting the glymphatic system.
Collapse
Affiliation(s)
- Fangfang Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chunyao Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Jin
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
2
|
Villacis G, Schmidt A, Rudolf JC, Schwenke H, Küchler J, Schramm P, Ulloa P. Evaluating the glymphatic system via magnetic resonance diffusion tensor imaging along the perivascular spaces in brain tumor patients. Jpn J Radiol 2024:10.1007/s11604-024-01602-7. [PMID: 38819694 DOI: 10.1007/s11604-024-01602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To investigate glymphatic system function in patients with brain tumors, including both primary and secondary tumors, using diffusion tensor imaging along perivascular spaces (DTI-ALPS). METHODS We retrospectively analyzed the MR DTI of 24 patients with unilateral brain tumors and compared them with age and sex-matched controls. We compared the DTI-ALPS index of the ipsi- and contralateral brain hemispheres. The region of interest was placed in the periventricular vessels adjacent to the lateral ventricles. Differences between sex, age, and kind of tumor (primary or brain metastasis) were evaluated. Correlations between DTI-ALPS index and age and the tumor's apparent diffusion coefficient (ADC) were also investigated. RESULTS The DTI-ALPS index was significantly lower (p < 0.05) in the tumor-affected hemisphere (mean = 1.26 ± 0.24) than contralateral (mean = 1.43 ± 0.28). A comparison with healthy controls revealed no significant difference on the matched ipsilateral side. However, the DTI-ALPS index of the contralateral side of the patients was larger than the HC. Additionally, no statistically significant differences were found when analyzing the DTI-ALPS index vs. age, sex, and tumor entity. Additionally, we did not find a correlation between the DTI-ALPS index and patient age or tumor ADC. CONCLUSION The decreased DTI-ALPS index in the tumor-affected hemisphere may be related to impaired glymphatic system function. However, cancer is often a systemic disease; thus, the DTI-ALPS index from the contralateral brain hemisphere may not generally be considered as a normal control. Nonetheless, the DTI-ALPS index does not only reflect diffusion in the perivascular spaces but it can also be influenced by factors such as axonal degeneration. Therefore, it does not directly reflect brain waste clearance and changes in the index should be interpreted carefully.
Collapse
Affiliation(s)
- Gabriela Villacis
- Department of Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - Aileen Schmidt
- Department of Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - Justus C Rudolf
- Department of Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - Hannes Schwenke
- Department of Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - Jan Küchler
- Department of Neurosurgery, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - Peter Schramm
- Department of Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany
| | - Patricia Ulloa
- Department of Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Luebeck, Germany.
| |
Collapse
|
3
|
Hlauschek G, Nicolo J, Sinclair B, Law M, Yasuda CL, Cendes F, Lossius MI, Kwan P, Vivash L. Role of the glymphatic system and perivascular spaces as a potential biomarker for post-stroke epilepsy. Epilepsia Open 2024; 9:60-76. [PMID: 38041607 PMCID: PMC10839409 DOI: 10.1002/epi4.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023] Open
Abstract
Stroke is one of the most common causes of acquired epilepsy, which can also result in disability and increased mortality rates particularly in elderly patients. No preventive treatment for post-stroke epilepsy is currently available. Development of such treatments has been greatly limited by the lack of biomarkers to reliably identify high-risk patients. The glymphatic system, including perivascular spaces (PVS), is the brain's waste clearance system, and enlargement or asymmetry of PVS (ePVS) is hypothesized to play a significant role in the pathogenesis of several neurological conditions. In this article, we discuss potential mechanisms for the role of perivascular spaces in the development of post-stroke epilepsy. Using advanced MR-imaging techniques, it has been shown that there is asymmetry and impairment of glymphatic function in the setting of ischemic stroke. Furthermore, studies have described a dysfunction of PVS in patients with different focal and generalized epilepsy syndromes. It is thought that inflammatory processes involving PVS and the blood-brain barrier, impairment of waste clearance, and sustained hypertension affecting the glymphatic system during a seizure may play a crucial role in epileptogenesis post-stroke. We hypothesize that impairment of the glymphatic system and asymmetry and dynamics of ePVS in the course of a stroke contribute to the development of PSE. Automated ePVS detection in stroke patients might thus assist in the identification of high-risk patients for post-stroke epilepsy trials. PLAIN LANGUAGE SUMMARY: Stroke often leads to epilepsy and is one of the main causes of epilepsy in elderly patients, with no preventative treatment available. The brain's waste removal system, called the glymphatic system which consists of perivascular spaces, may be involved. Enlargement or asymmetry of perivascular spaces could play a role in this and can be visualised with advanced brain imaging after a stroke. Detecting enlarged perivascular spaces in stroke patients could help identify those at risk for post-stroke epilepsy.
Collapse
Affiliation(s)
- Gernot Hlauschek
- Division of Clinical Neuroscience, National Centre for Epilepsy, member of ERN EpicareOslo University HospitalNorway
- The University of OsloOsloNorway
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - John‐Paul Nicolo
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Benjamin Sinclair
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
| | - Meng Law
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of RadiologyThe AlfredMelbourneVictoriaAustralia
| | | | | | - Morten Ingvar Lossius
- Division of Clinical Neuroscience, National Centre for Epilepsy, member of ERN EpicareOslo University HospitalNorway
- The University of OsloOsloNorway
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Lucy Vivash
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| |
Collapse
|
4
|
Lee DA, Lee HJ, Park KM. Structural connectivity as a predictive factor for responsiveness to levetiracetam treatment in epilepsy. Neuroradiology 2024; 66:93-100. [PMID: 38015213 DOI: 10.1007/s00234-023-03261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To investigate whether structural connectivity or glymphatic system function is a potential predictive factor for levetiracetam (LEV) response in patients with newly diagnosed epilepsy. METHODS We enrolled patients with newly diagnosed epilepsy who were administered LEV as initial monotherapy and underwent diffusion tensor imaging (DTI) at diagnosis. We categorized the patients into drug response. We used graph theory to calculate the network measures for structural connectivity based on the DTI scans in patients with epilepsy. Additionally, we evaluated glymphatic system function by calculating the DTI analysis along the perivascular space (DTI-ALPS) index based on DTI scans. RESULTS We enrolled 84 patients with epilepsy. The clinical factors and DTI-ALPS index did not differ between the groups. However, some of the structural connectivity measures significantly differ between the groups. The poor responders exhibited a higher mean clustering coefficient, global efficiency, and small-worldness index than the good responders (p = 0.003, p = 0.048, and p = 0.038, respectively). In the receiver operating characteristic curve analysis, the mean clustering coefficient exhibited the highest performance in predicting the responsiveness to LEV (area under the curve of 0.677). In the multiple logistic regression analysis, the mean clustering coefficient of the structural connectivity measures was the only significant predictor of LEV response (p = 0.014). Furthermore, in the survival analysis, the mean clustering coefficient was the only significant predictor of LEV response (p = 0.026). CONCLUSION We demonstrated that structural connectivity is a potential predictive factor for responsiveness to LEV treatment in patients with newly diagnosed epilepsy.
Collapse
Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.
| |
Collapse
|
5
|
Kim ST, Kim SE, Lee DA, Lee HJ, Park KM. Anti-seizure medication response and the glymphatic system in patients with focal epilepsy. Eur J Neurol 2024; 31:e16097. [PMID: 37823697 DOI: 10.1111/ene.16097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/14/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE We 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). METHODS We 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. RESULTS Of 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. CONCLUSION Our 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.
Collapse
Affiliation(s)
- Sung-Tae Kim
- Department of Neurosugery, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
6
|
Peng T, Xie Y, Liu F, Lian Y, Xie Y, Ma Y, Wang C, Xie N. The cerebral lymphatic drainage system and its implications in epilepsy. J Neurosci Res 2024; 102:e25267. [PMID: 38284855 DOI: 10.1002/jnr.25267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 01/30/2024]
Abstract
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.
Collapse
Affiliation(s)
- Tingting Peng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, P.R. China
| | - Yinyin Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, P.R. China
| | - Fengxia Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yi Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yunqing Ma
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Cui Wang
- Key Clinical Laboratory of Henan Province, Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Nanchang Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| |
Collapse
|
7
|
Taoka T, Ito R, Nakamichi R, Nakane T, Kawai H, Naganawa S. Interstitial Fluidopathy of the Central Nervous System: An Umbrella Term for Disorders with Impaired Neurofluid Dynamics. Magn Reson Med Sci 2024; 23:1-13. [PMID: 36436975 PMCID: PMC10838724 DOI: 10.2463/mrms.rev.2022-0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/29/2022] [Indexed: 01/05/2024] Open
Abstract
Interest in interstitial fluid dynamics has increased since the proposal of the glymphatic system hypothesis. Abnormal dynamics of the interstitial fluid have been pointed out to be an important factor in various pathological statuses. In this article, we propose the concept of central nervous system interstitial fluidopathy as a disease or condition in which abnormal interstitial fluid dynamics is one of the important factors for the development of a pathological condition. We discuss the aspects of interstitial fluidopathy in various diseases, including Alzheimer's disease, Parkinson's disease, normal pressure hydrocephalus, and cerebral small vessel disease. We also discuss a method called "diffusion tensor image analysis along the perivascular space" using MR diffusion images, which is used to evaluate the degree of interstitial fluidopathy or the activity of the glymphatic system.
Collapse
Affiliation(s)
- Toshiaki Taoka
- Department of Innovative Biomedical Visualization (iBMV), Nagoya University, Nagoya, Aichi, Japan
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Rintaro Ito
- Department of Innovative Biomedical Visualization (iBMV), Nagoya University, Nagoya, Aichi, Japan
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Rei Nakamichi
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Toshiki Nakane
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Hisashi Kawai
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| |
Collapse
|
8
|
Ota M, Sone D, Shigemoto Y, Kimura Y, Matsuda H, Sato N. Glymphatic System Activity and Brain Morphology in Patients With Psychogenic Non-epileptic Seizures. Cureus 2024; 16:e53072. [PMID: 38410305 PMCID: PMC10896675 DOI: 10.7759/cureus.53072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Miho Ota
- Neuropsychiatry, University of Tsukuba, Tsukuba, JPN
| | - Daichi Sone
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Yoko Shigemoto
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Yukio Kimura
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Hiroshi Matsuda
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| | - Noriko Sato
- Radiology, National Center of Neurology and Psychiatry, Kodaira, JPN
| |
Collapse
|
9
|
Hlauschek G, Lossius MI, Schwartz DL, Silbert LC, Hicks AJ, Ponsford JL, Vivash L, Sinclair B, Kwan P, O'Brien TJ, Shultz SR, Law M, Spitz G. Reduced total number of enlarged perivascular spaces in post-traumatic epilepsy patients with unilateral lesions - a feasibility study. Seizure 2023; 113:1-5. [PMID: 37847935 DOI: 10.1016/j.seizure.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/21/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND We investigated the value of automated enlarged perivascular spaces (ePVS) quantification to distinguish chronic traumatic brain injury (TBI) patients with post-traumatic epilepsy (PTE+) from chronic TBI patients without PTE (PTE-) in a feasibility study. METHODS Patients with and without PTE were recruited and underwent an MRI post-TBI. Multimodal auto identification of ePVS algorithm was applied to T1-weighted MRIs to segment ePVS. The total number of ePVS was calculated and corrected for white matter volume, and an asymmetry index (AI) derived. RESULTS PTE was diagnosed in 7 out of the 99 participants (male=69) after a median time of less than one year since injury (range 10-22). Brain lesions were observed in all 7 PTE+ cases (unilateral=4, 57%; bilateral=3, 43%) as compared to 40 PTE- cases (total 44%; unilateral=17, 42%; bilateral=23, 58%). There was a significant difference between PTE+ (M=1.21e-4, IQR [8.89e-5]) and PTE- cases (M=2.79e-4, IQR [6.25e-5]) in total corrected numbers of ePVS in patients with unilateral lesions (p=0.024). No differences in AI, trauma severity and lesion volume were seen between groups. CONCLUSION This study has shown that automated quantification of ePVS is feasible and provided initial evidence that individuals with PTE with unilateral lesions may have fewer ePVS compared to TBI patients without epilepsy. Further studies with larger sample sizes should be conducted to determine the value of ePVS quantification as a PTE-biomarker.
Collapse
Affiliation(s)
- Gernot Hlauschek
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway; The University of Oslo, Oslo, Norway; Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.
| | - Morten I Lossius
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway; The University of Oslo, Oslo, Norway.
| | - Daniel L Schwartz
- Oregon Health & Science University, Oregon Alzheimer's Disease Research Center, Neurology, Advanced Imaging Research Center, USA.
| | - Lisa C Silbert
- Oregon Health & Science University, Oregon Alzheimer's Disease Research Center, Neurology, Advanced Imaging Research Center, USA.
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Lucy Vivash
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred, Melbourne, Australia,; Departments of Medicine and Neurology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Australia.
| | - Benjamin Sinclair
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred, Melbourne, Australia,.
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred, Melbourne, Australia,; Departments of Medicine and Neurology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Australia.
| | - Terrence J O'Brien
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred, Melbourne, Australia,; Departments of Medicine and Neurology, The University of Melbourne, Royal Melbourne Hospital, Parkville, Australia.
| | - Sandy R Shultz
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred, Melbourne, Australia,; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia; Health Sciences, Vancouver Island University, Nanaimo, Canada.
| | - Meng Law
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Department of Radiology, The Alfred, Melbourne, Australia.
| | - Gershon Spitz
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| |
Collapse
|
10
|
Park KM, Kim KT, Lee DA, Motamedi GK, Cho YW. Glymphatic system dysfunction in restless legs syndrome: evidenced by diffusion tensor imaging along the perivascular space. Sleep 2023; 46:zsad239. [PMID: 37702251 DOI: 10.1093/sleep/zsad239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/11/2023] [Indexed: 09/14/2023] Open
Abstract
STUDY OBJECTIVES There is growing evidence pointing at glymphatic system dysfunction in diseases with circadian disruption, such as sleep disorders. Lower diffusivity in the direction of perivascular space has been shown in several neurological and sleep-related disorders; however, its role in restless legs syndrome (RLS) is unclear. We hypothesized that similarly, in RLS the diffusivity in glymphatic system is decreased. Here, we aimed to evaluate glymphatic system functionality in patients with RLS, compare it to healthy controls, and analyze the correlation between its function and clinical characteristics. METHODS Sixty-nine patients with primary RLS and 51 healthy controls were recruited at a tertiary hospital. All participants underwent diffusion tensor imaging (DTI) and magnetic resonance imaging (MRI) using a 3T MRI scanner, and the DTI along the perivascular space (DTI-ALPS) index was calculated using DTI data. We compared the DTI-ALPS index between the patients with RLS and healthy controls. We also conducted the correlation analysis between the DTI-ALPS index and clinical characteristics, including age, age of onset, symptom duration, and RLS severity. RESULTS DTI-ALPS index differed significantly between the patients with RLS and healthy controls; the DTI-ALPS index in the patients with RLS was lower than that in the healthy controls (1.48 vs. 0.60, p = 0.008). There was no significant correlation between the DTI-ALPS index and clinical characteristics. CONCLUSION A significantly lower DTI-ALPS index in patients with RLS suggests that the glymphatic system function is impaired in patients with RLS.
Collapse
Affiliation(s)
- Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Gholam K Motamedi
- Department of Neurology, Georgetown University Hospital, Washington, DC, USA
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| |
Collapse
|
11
|
Zhao X, Zhou Y, Li Y, Huang S, Zhu H, Zhou Z, Zhu S, Zhu W. The asymmetry of glymphatic system dysfunction in patients with temporal lobe epilepsy: A DTI-ALPS study. J Neuroradiol 2023; 50:562-567. [PMID: 37301366 DOI: 10.1016/j.neurad.2023.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE While the occurrence of glymphatic system dysfunction has been observed in temporal lobe epilepsy (TLE), the potential asymmetry of this system has yet to be investigated in the TLE context. We aimed to investigate the glymphatic system function in both hemispheres and to analyze asymmetric features of the glymphatic system in TLE patients using diffusion tensor image analysis along the perivascular space (DTI-ALPS) method. MATERIALS AND METHODS 43 patients (left TLE (LTLE), n = 20; right TLE (RTLE), n = 23) and 39 healthy controls (HC) were enrolled in this study. The DTI-ALPS index was calculated for the left (left ALPS index) and right (right ALPS index) hemispheres respectively. An asymmetry index (AI) was calculated by AI = (Right - Left)/ [(Right + Left)/2] to represent the asymmetric pattern. Independent two sample t-test, two-sample paired t-test or one-way ANOVA with Bonferroni correction were conducted to compare the differences in ALPS indices and AI among the groups. RESULTS Both left ALPS index (p = 0.040) and right ALPS index (p = 0.001) of RTLE patients were significantly decreased, while only left ALPS index of LTLE patients (p = 0.005) was reduced. Compared to contralateral ALPS index, the ipsilateral ALPS index was significantly decreased in TLE (p = 0.008) and RTLE (p = 0.009) patients. Leftward asymmetry of the glymphatic system was found in HC (p = 0.045) and RTLE (p = 0.009) patients. The LTLE patients presented reduced asymmetric traits when compared to RTLE patients (p = 0.029). CONCLUSION The TLE patients exhibited altered ALPS indices, which could be triggered by glymphatic system dysfunction. Altered ALPS indices were more severe in ipsilateral than in the contralateral hemisphere. Moreover, LTLE and RTLE patients exhibited different change patterns of the glymphatic system. In addition, glymphatic system function presented asymmetric patterns in both normal adult brain and RTLE patients.
Collapse
Affiliation(s)
- Xu Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingying Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanhao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongquan Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Zhou
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
12
|
Zhang C, Xu K, Zhang H, Sha J, Yang H, Zhao H, Chen N, Li K. Recovery of glymphatic system function in patients with temporal lobe epilepsy after surgery. Eur Radiol 2023; 33:6116-6123. [PMID: 37010581 DOI: 10.1007/s00330-023-09588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/06/2023] [Accepted: 02/20/2023] [Indexed: 04/04/2023]
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.
Collapse
Affiliation(s)
- Chao Zhang
- 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
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
| | - Kai Xu
- 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.
| | - Haiyan Zhang
- Department of Radiology, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, 221006, People's Republic of China
| | - Jingyun Sha
- 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
| | - Hongyu Yang
- Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, 101100, People's Republic of China
| | - Houliang Zhao
- 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
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
| |
Collapse
|
13
|
Xu J, Su Y, Fu J, Shen Y, Dong Q, Cheng X. Glymphatic pathway in sporadic cerebral small vessel diseases: From bench to bedside. Ageing Res Rev 2023; 86:101885. [PMID: 36801378 DOI: 10.1016/j.arr.2023.101885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Cerebral small vessel diseases (CSVD) consist of a group of diseases with high heterogeneity induced by pathologies of intracranial small blood vessels. Endothelium dysfunction, bloodbrain barrier leakage and the inflammatory response are traditionally considered to participate in the pathogenesis of CSVD. However, these features cannot fully explain the complex syndrome and related neuroimaging characteristics. In recent years, the glymphatic pathway has been discovered to play a pivotal role in clearing perivascular fluid and metabolic solutes, which has provided novel insights into neurological disorders. Researchers have also explored the potential role of perivascular clearance dysfunction in CSVD. In this review, we presented a brief overview of CSVD and the glymphatic pathway. In addition, we elucidated CSVD pathogenesis from the perspective of glymphatic failure, including basic animal models and clinical neuroimaging markers. Finally, we proposed forthcoming clinical applications targeting the glymphatic pathway, hoping to provide novel ideas on promising therapies and preventions of CSVD.
Collapse
Affiliation(s)
- Jiajie Xu
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ya Su
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiayu Fu
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong Shen
- Institute on Aging and Brain Disorders, The First Affiliated Hospital of USTC and Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
14
|
Kim J, Lee DA, Lee HJ, Park KM. Glymphatic system dysfunction in patients with occipital lobe epilepsy. J Neuroimaging 2023; 33:455-461. [PMID: 36627235 DOI: 10.1111/jon.13083] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the glymphatic system function in patients with occipital lobe epilepsy (OLE) and healthy controls using diffusion tensor image analysis along the perivascular space (DTI-ALPS) index. METHODS We retrospectively included 23 patients with OLE and 30 healthy controls. The participants underwent brain MRI, which was normal, and diffusion tensor imaging. We used the DSI Studio for data preprocessing, obtained the fiber orientation and diffusivities, and calculated the DTI-ALPS index from the diffusivity values associated with the projection and association fibers in the left hemisphere. RESULTS There were no differences in mean age (31.6 years [range: 13-58] vs. 31.3 years [range: 20-57], p = .912) and male sex ratio (10/23 [43.5%] vs. 15/30 [50.0%]) between the groups. Compared to healthy controls, the diffusivities in patients with OLE were higher along the Y-axis in the projection fiber and along the Z-axis in the association fiber and lower along the Y-axis in the association fiber. The DTI-ALPS index in patients with OLE was lower than that in the healthy controls (1.421 ± 0.171 vs. 1.667 ± 0.271, p < .001, 95% confidence interval of difference = 0.117-0.376, Test statistic t = 3.823). We found no association between the DTI-ALPS index and clinical characteristics in OLE. CONCLUSION The DTI-ALPS index in patients with OLE was significantly lower than that in healthy controls, suggesting glymphatic system dysfunction in OLE. The DTI-ALPS index could help assess the glymphatic system function in patients with epilepsy.
Collapse
Affiliation(s)
- Jinseung Kim
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| |
Collapse
|
15
|
Diffusion along perivascular spaces as marker for impairment of glymphatic system in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:174. [PMID: 36543809 PMCID: PMC9772196 DOI: 10.1038/s41531-022-00437-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
The brain glymphatic system is involved in the clearance of misfolding α-synuclein, the impaired glymphatic system may contribute to the progression of Parkinson's disease (PD). We aimed to analyze the diffusion tensor image along the perivascular space (DTI-ALPS) and perivascular space (PVS) burden to reveal the relationship between the glymphatic system and PD. A cross-sectional study using a 7 T MRI of 76 PD patients and 48 controls was performed to evaluate the brain's glymphatic system. The DTI-ALPS and PVS burden in basal ganglia were calculated. Correlation analyses were conducted between DTI-ALPS, PVS burden and clinical features. We detected lower DTI-ALPS in the PD subgroup relative to controls, and the differences were more pronounced in patients with Hoehn & Yahr stage greater than two. The decreased DTI-ALPS was only evident in the left hemisphere in patients in the early stage but involved both hemispheres in more advanced PD patients. Decreased DTI-ALPS were also correlated with longer disease duration, higher Unified Parkinson's Disease Rating Scale motor score (UPDRS III) and UPDRS total scores, as well as higher levodopa equivalent daily dose. Moreover, the decreased DTI-ALPS correlated with increased PVS burden, and both indexes correlated with PD disease severity. This study demonstrated decreased DTI-ALPS in PD, which might initiate from the left hemisphere and progressively involve right hemisphere with the disease progression. Decreased DTI-ALPS index correlated with increased PVS burden, indicating that both metrics could provide supporting evidence of an impaired glymphatic system. MRI evaluation of the PVS burden and diffusion along PVS are potential imaging biomarkers for PD for disease progression.
Collapse
|
16
|
Li X, Ruan C, Zibrila AI, Musa M, Wu Y, Zhang Z, Liu H, Salimeen M. Children with autism spectrum disorder present glymphatic system dysfunction evidenced by diffusion tensor imaging along the perivascular space. Medicine (Baltimore) 2022; 101:e32061. [PMID: 36482590 PMCID: PMC9726346 DOI: 10.1097/md.0000000000032061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study used diffusion tensor imaging (DTI) along the perivascular space (DTI-ALPS) to assess glymphatic system function in autism spectrum disorder (ASD) compared to healthy controls. Patients with ASD may have glymphatic system dysfunction, which is related to age. We retrospectively included 30 children with ASD and 25 healthy controls in this study. 3T magnetic resonance imaging scanner was used to perform DTI magnetic resonance imaging on all participants, and the DTI-ALPS index was calculated from the DTI data. Additionally, we evaluated how the DTI-ALPS index differed between the 2 groups. Moreover, we examined the relationships between the bilateral DTI-ALPS index and the age of the participants. The DTI-ALPS index considerably differed between groups. In the left index (1.02 ± 0.12 vs. 1.27 ± 0.25, P < .001) and in the right index (1.03 ± 0.12 vs. 1.32 ± 0.20, P < .001), the DTI-ALPS in ASD patients was significantly lower than that in healthy controls. Furthermore, the DTI-ALPS index was strongly and positively associated with age. In patients with ASD, there is a glymphatic system dysfunction. This is intimately correlated to age. Our findings suggest the importance of the DTI-ALPS approach in assessing the function of the glymphatic system in ASD.
Collapse
Affiliation(s)
- Xin Li
- Department of Anaesthesiology, School of Medicine, Yan’an University, Yanan, China
| | - Cailian Ruan
- Anatomy Department, School of Medicine, Yan’an University, Yanan City, China
| | - Abdoulaye Issotina Zibrila
- Laboratory of Experimental Pharmacology, Department of Animal Physiology, Faculty of Science and Technology, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Mazen Musa
- Department of Orthodontics, Al Tegana Dental Teaching Hospital, Faculty of Dentistry, University of Science and Technology, Omdurman, Sudan
| | - Yifan Wu
- MD Undergraduate Program, School of Medicine, Yan’an University, Yan’an City, China
| | - Zhengxiang Zhang
- Department of Pharmacology, School of Medicine, Yan’an University, Yan’an City, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi City, China
| | - Mustafa Salimeen
- Department of Radiology, Affiliated Hospital, School of Medicine, Yan’an University, Yan’an City, China
- Department of Radiology, Dongola Teaching Hospital Faculty of Medicine and Health Sciences, University of Dongola, Dongola, Republic of Sudan, Dongola, Sudan
- * Correspondence: Mustafa Salimeen, Radiology Department, Affiliated Hospital, School of Medicine, Yana’an University, Yan’an City, China (e-mail: )
| |
Collapse
|
17
|
Wasteosomes ( corpora amylacea) as a hallmark of chronic glymphatic insufficiency. Proc Natl Acad Sci U S A 2022; 119:e2211326119. [PMID: 36409907 PMCID: PMC9860256 DOI: 10.1073/pnas.2211326119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In different organs and tissues, the lymphatic system serves as a drainage system for interstitial fluid and is useful for removing substances that would otherwise accumulate in the interstitium. In the brain, which lacks lymphatic circulation, the drainage and cleaning function is performed by the glymphatic system, called so for its dependence on glial cells and its similar function to that of the lymphatic system. In the present article, we define glymphatic insufficiency as the inability of the glymphatic system to properly perform the brain cleaning function. Furthermore, we propose that corpora amylacea or wasteosomes, which are protective structures that act as waste containers and accumulate waste products, are, in fact, a manifestation of chronic glymphatic insufficiency. Assuming this premise, we provide an explanation that coherently links the formation, distribution, structure, and function of these bodies in the human brain. Moreover, we open up new perspectives in the study of the glymphatic system since wasteosomes can provide information about which variables have the greatest impact on the glymphatic system and which diseases occur with chronic glymphatic insufficiency. For example, based on the presence of wasteosomes, it seems that aging, sleep disorders, and cerebrovascular pathologies have the highest impact on the glymphatic system, whereas neurodegenerative diseases have a more limited impact. Furthermore, as glymphatic insufficiency is a risk factor for neurodegenerative diseases, information provided by wasteosomes could help to define the strategies and actions that can prevent glymphatic disruptions, thus limiting the risk of developing neurodegenerative diseases.
Collapse
|
18
|
Heo CM, Lee DA, Park KM, Lee YJ, Park S, Kim YW, Ko J, Yoo BC, Park BS. Glymphatic system dysfunction in patients with early chronic kidney disease. Front Neurol 2022; 13:976089. [PMID: 36003297 PMCID: PMC9393609 DOI: 10.3389/fneur.2022.976089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction It is a recent finding that glymphatic system dysfunction contributes to various neurological problems. The purpose of this research was to assess the function of the glymphatic system in neurologically asymptomatic early chronic kidney disease (CKD) patients and healthy controls, using diffusion tensor image analysis along perivascular space (DTI-ALPS) index. Methods In a prospective study, we included patients with early CKD who were asymptomatic for neurological issues and obtained clinical and laboratory data. In all participants, brain magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) was conducted. We used DSI program for DTI preprocessing and DTI-ALPS index estimation. The DTI-ALPS index was compared between patients with early CKD and healthy controls, and the association between clinical characteristics and the DTI-ALPS index was investigated. Results Eighteen patients with early CKD and 18 healthy controls were included in this study. Patients with early CKD had lower DTI-ALPS index than healthy controls (1.259 ± 0.199 vs. 1.477 ± 0.232, p = 0.004). In the correlation analysis, the DTI-ALPS index had no significant relationship with other clinical factors. Conclusion We suggest dysfunction of glymphatic system in patients with early chronic kidney disease using the DTI-ALPS index. This may be related to the pathophysiology of neurological problems including impairment of cognition in patients with early CKD.
Collapse
Affiliation(s)
- Chang Min Heo
- Departments of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Dong Ah Lee
- Departments of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kang Min Park
- Departments of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yoo Jin Lee
- Departments of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sihyung Park
- Departments of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yang Wook Kim
- Departments of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Junghae Ko
- Departments of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | | | - Bong Soo Park
- Departments of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
- *Correspondence: Bong Soo Park
| |
Collapse
|
19
|
Lee DA, Lee J, Park KM. Glymphatic system impairment in patients with status epilepticus. Neuroradiology 2022; 64:2335-2342. [PMID: 35835880 DOI: 10.1007/s00234-022-03018-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to compare the function of the glymphatic system in patients with status epilepticus (SE) with that in healthy controls by diffusion tensor image analysis along the perivascular space (DTI-ALPS) method. We also investigated the association between glymphatic system function and the clinical characteristics of SE. METHODS We retrospectively enrolled 28 patients with SE and 31 healthy controls matched for age and sex. All study participants underwent diffusion tensor imaging using the same 3-T MRI scanner, and the DTI-ALPS index was calculated. We compared the DTI-ALPS index between the SE group and the control group. We also evaluated the associations of the DTI-ALPS index with etiology and type of SE, age, putative duration of seizure, time interval until MRI, seizure-related changes on diffusion-weighted imaging, and any previous structural lesions. RESULTS The DTI-ALPS index was significantly lower in the SE group than in the control group (1.462 ± 0.297 vs. 1.632 ± 0.270, p = 0.026) and was negatively correlated with age (r = - 0.280, p = 0.032) in the SE group. However, there were no significant between-group differences in the DTI-ALPS index according to other clinical factors. SIGNIFICANCE The finding of a significantly lower DTI-ALPS index in the SE group suggests that the glymphatic system is impaired in patients with SE. DTI-ALPS is a useful tool for evaluation of the function of the glymphatic system in these patients.
Collapse
Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea
| | - Joonwon Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.
| |
Collapse
|