Corrigendum: Alterations of cerebral perfusion and functional connectivity in children with idiopathic generalized epilepsy.

[This corrects the article DOI: 10.3389/fnins.2022.918513.].

Alterations of Cerebral Perfusion and Functional Connectivity in Children With Idiopathic Generalized Epilepsy.

Background: Studies have demonstrated that adults with idiopathic generalized epilepsy (IGE) have functional abnormalities; however, the neuropathological pathogenesis differs between adults and children. This study aimed to explore alterations in the cerebral blood flow (CBF) and functional connectivity (FC) to comprehensively elucidate the neuropathological mechanisms of IGE in children. Methods: We obtained arterial spin labeling (ASL) and resting state functional magnetic resonance imaging data of 28 children with IGE and 35 matched controls. We used ASL to determine differential CBF regions in children with IGE. A seed-based whole-brain FC analysis was performed for regions with significant CBF changes. The mean CBF and FC of brain areas with significant group differences was extracted, then its correlation with clinical variables in IGE group was analyzed by using Pearson correlation analysis. Results: Compared to controls, children with IGE had CBF abnormalities that were mainly observed in the right middle temporal gyrus, right middle occipital gyrus (MOG), right superior frontal gyrus (SFG), left inferior frontal gyrus (IFG), and triangular part of the left IFG (IFGtriang). We observed that the FC between the left IFGtriang and calcarine fissure (CAL) and that between the right MOG and bilateral CAL were decreased in children with IGE. The CBF in the right SFG was correlated with the age at IGE onset. FC in the left IFGtriang and left CAL was correlated with the IGE duration. Conclusion: This study found that CBF and FC were altered simultaneously in the left IFGtriang and right MOG of children with IGE. The combination of CBF and FC may provide additional information and insight regarding the pathophysiology of IGE from neuronal and vascular integration perspectives.

Altered Neurovascular Coupling in Patients with Chronic Myofascial Pain.

BACKGROUND: Despite previous reports on cerebral structures and functional connectivity in patients with myofascial pain (MFP), it is not clear whether alterations in neurovascular coupling occur in these patients. OBJECTIVES: We analyzed the coupling between resting-state cerebral blood flow (CBF) and functional connectivity strength (FCS) for observation of neurovascular coupling in patients with chronic MFP. STUDY DESIGN: Observational study. SETTING: University hospital. METHODS: Resting-state functional magnetic resonance imaging and arterial spin labeling were performed in 23 patients with chronic MFP and 23 healthy controls (HC) for the calculation of FCS and CBF. The whole-brain gray matter CBF-FCS correlations and CBF/FCS ratios of the various voxels of the 2 groups were subsequently compared. RESULTS: Compared with the HC, the patients with MFP experienced a decrease in whole-brain gray matter CBF-FCS coupling. In patients with MFP, a decrease in CBF/FCS was found in the bilateral superior temporal gyri, right parahippocampal gyrus, right hippocampus, caudate nucleus, right medial prefrontal cortex, and the periaqueductal gray matter (PAG), whereas an increase in CBF/FCS was found in the bilateral lingual gyri, posterior cingulate cortex, and bilateral inferior parietal lobules. In addition, the CBF/FCS of the PAG in patients with MFP was significantly negatively correlated with the pain visual analog scale score and pain duration. LIMITATIONS: Alterations in neurovascular coupling in patients with MFP were observed only before treatment. Therefore, there is a lack of data on the alterations that occurred after treatment. CONCLUSION: This study demonstrated for the first time that impairment of neurovascular coupling in the brain may be a potential neuropathological mechanism of chronic MFP.

Primary left ventricular neuroendocrine tumor in a middle-aged female: a case report.

Primary neuroendocrine tumors (NETs) in the heart are exceptionally rare. Here, we report a case found at our hospital of a 51-year-old woman with a primary left ventricular NET. The patient presented with non-causal recurrent diarrhea for 2 years, abdominal pain, and vomiting. Endoscopy revealed chronic proctitis and duodenal ulcer but found no explanation for the clinical symptoms. Comprehensive cardiovascular tests were conducted, and a mass measuring 26 mm × 41 mm × 30 mm was detected in the left ventricle. The patient underwent complete surgical resection to remove the tumor. Postoperative pathological results indicated a NET. No recurrence or other signs of metastasis were experienced during a 13-month follow-up observation period. Herein, we report this case and describe the imaging manifestations and clinical diagnosis strategy of this rare tumor. A diagnosis of NET of the heart may be considered when there are unexplained abdominal symptoms and without an abdominal or pelvic mass.

Functional and Structural Changes in Postherpetic Neuralgia Brain Before and Six Months After Pain Relieving.

OBJECTIVE: Multimodal magnetic resonance imaging (MRI) was used to detect whether 6 months after pain relieving, the structural and functional abnormalities in the brain of postherpetic neuralgia (PHN) patients are changeable. METHODS: Fifteen successfully treated PHN patients were enrolled; the brain activity and structural abnormalities were detected and compared before and 6 months after treatment. The functional parameters were evaluated with resting-state functional MRI technique, i.e., the regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuation (fALFF). Structural changes were detected with voxel-based morphometry (VBM) and diffusion kurtosis imaging (DKI). RESULTS: Six months after pain relieving, PHN brain showed different ReHo and fALFF values in the frontal lobe, caudate, supramarginal gyrus, anterior cingulate cortex (ACC), cuneus, middle temporal gyrus, and cerebellum. In addition, VBM intensity in the cerebellum increased; DKI values decreased in the thalamus and increased in the temporal lobe after successful treatment. CONCLUSION: Six months after pain relieving, functional and structural changes exist in PHN brain. Changes in some differential areas in PHN brain, such as ACC, frontal lobe, thalamus, and temporal lobe indicate that the central plasticity may be reversible after chronic pain relieving.

[Diffusion tensor imaging and resting-state functional magnetic resonance imaging in patients with delirium in intensive care unit].

OBJECTIVE: To analyze the brain function of patients with delirium in intensive care unit (ICU) using resting-state functional magnetic resonance imaging (fMRI), further analyze the structural changes in the brain using diffusion tensor imaging (DTI), and explore the correlations of brain function with structural changes in patients with delirium in ICU from a new perspective of functional imaging, provide visual evidence for the diagnosis of delirium. METHODS: Patients with delirium admitted to ICU of the Affiliated Hospital of Zunyi Medical University from January 1st to December 31st in 2017 were enrolled as subjects. During the same period, the healthy volunteers who matched the gender, age and education level of the patients with delirium were enrolled as control group. The intensive care delirium screening checklist (ICDSC) scores within 24 hours after ICU admission were recorded. All the subjects were scanned by fMRI and DTI. The abnormal changes in resting-state brain function of the patients with delirium were evaluated by cerebral regional homogeneity (ReHo) data analysis. The DTI data were processed by the FSL software, and the fractional anisotropy (FA) and mean diffusivity (MD) of the brain were extracted, respectively, to evaluate the damage to brain structure. The values of ReHo, FA and MD were compared between the two groups. The ReHo value of brain region with reduced ReHo value of patients with delirium as compared with the healthy volunteers was extracted for Pearson correlation analysis with ICDSC scores. RESULTS: A total of 22 patients with delirium were included. Seven patients who did not cooperate in the examination, used sedatives or had false images in scanning, were excluded. Finally, 15 patients were enrolled in the delirium group, and 15 healthy volunteers in the healthy control group. (1) No statistically significant difference was found in gender, age or education time between the two groups. ICDSC score of the delirium group was significantly higher than that of the healthy control group (6.07±1.28 vs. 1.07±0.88, P < 0.01). (2) fMRI scanning and analysis results: compared with the healthy control group, the ReHo values of the cerebellum, right hippocampus, striatum, midbrain and pons in the delirium group were significantly increased (all P < 0.05, AlphaSim correction), while the ReHo values of bilateral superior frontal gyrus, bilateral median frontal gyrus, left inferior frontal gyrus, temporal lobe and parietal lobe were significantly lowered (all P < 0.05, AlphaSim correction). Correlation analysis showed that the ReHo value of the left superior frontal gyrus was negatively correlated with ICDSC score in the patients with delirium (r = -0.794, P < 0.05), indicating that the changes in the functional area of the medial frontal gyrus was most closely related to delirium. (3) DTI scanning and analysis results: compared with the healthy control group, the FA values of the left cerebellum, bilateral frontal lobes, left temporal lobe, corpus callosum and left hippocampus in the delirium group were decreased significantly (all P < 0.05, AlphaSim correction), while the MD values of the medial frontal gyrus, right superior temporal gyrus, anterior cingulate gyrus, bilateral insular lobes and left caudate nucleus were enhanced significantly (all P < 0.05, AlphaSim correction), suggesting that the structural and functional damage was found in multiple brain regions in patients with delirium. CONCLUSIONS: Multiple brain regions of patients with delirium present abnormal resting-state brain function. The abnormal resting-state brain function of the left superior frontal gyrus is closely related to the occurrence of delirium. Structural damage is found in multiple brain regions of patients with delirium. The structural changes in the frontal lobe, temporal lobe, corpus callosum, hippocampus and cerebellum and their abnormal functions can be used as preliminary imaging indexes for the diagnosis of delirium.

Herpes zoster chronification to postherpetic neuralgia induces brain activity and grey matter volume change.

OBJECTIVE: Herpes zoster (HZ) can develop into postherpetic neuralgia (PHN), which is a chronic neuropathic pain (NP). Whether the chronification from HZ to PHN induced brain functional or structural change is unknown and no study compared the changes of the same brains of patients who transited from HZ to PHN. We minimized individual differences and observed whether the chronification of HZ to PHN induces functional and pain duration dependent grey matter volume (GMV) change in HZ-PHN patients. METHODS: To minimize individual differences induced error, we enrolled 12 patients with a transition from HZ to PHN. The functional and structural changes of their brains between the two states were identified with resting-state functional MRI (rs-fMRI) technique (i.e., the regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF) method) and the voxel based morphometry (VBM) technology respectively. The correlations between MRI parameters (i.e., ΔReHo, ΔfALFF and ΔVBM) and Δpain duration were analyzed too. RESULTS: Compared with HZ brains, PHN brains exhibited abnormal ReHo, fALFF and VBM values in pain matrix (the frontal lobe, parietal lobe, thalamus, limbic lobe and cerebellum) as well as the occipital lobe and temporal lobe. Nevertheless, the activity of vast area of cerebellum and frontal lobe significantly increased while that of occipital lobe and limbic lobe showed apparent decrease when HZ developed to PHN. In addition, PHN brain showed decreased GMV in the frontal lobe, the parietal lobe and the occipital lobe but increased in the cerebellum and the temporal lobe. Correlation analyses showed that some of the ReHo, fALFF and VBM differential areas (such as the cerebellum posterior lobe, the thalamus extra-nuclear and the middle temporal gyrus) correlated well with Δpain duration. CONCLUSIONS: HZ chronification induced functional and structural change in cerebellum, occipital lobe, temporal lobe, parietal lobe and limbic lobe. These changes may be correlated with HZ-PHN chronification. In addition, these changes could be reasons of refractory chronic pain of PHN.

Altered Spontaneous Brain Activity in Patients With Idiopathic Trigeminal Neuralgia: A Resting-state Functional MRI Study.

OBJECTIVES: To identify the changes of local coherence and intrinsic brain activity in resting-state idiopathic trigeminal neuralgia (ITN) patients by using regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF) analysis. METHODS: ReHo and fALFF were analyzed in 23 ITN patients and 23 age-matched and sex-matched pain-free controls to detect the functional abnormality in the brains of ITN patients. Correlations between ReHo and fALFF were analyses. ITN pain intensity were also assessed in the ITN group. RESULTS: Compared with pain-free controls, ITN patients exhibited significantly abnormal ReHo and fALFF in several brain regions, including the cerebellum, cingulate cortex, temporal lobe, putamen, occipital lobe, limbic lobe, precuneus, insula, medial, and superior frontal gyrus compared with healthy controls. Correlation analysis showed that ReHo values of several altered brain areas positively correlated with visual analog scale values. But no correlation was found between fALFF and visual analog scale. DISCUSSION: Our results showed that ITN patients exhibited significantly abnormal spontaneous brain activity in several brain regions that are involved in pain modulation and perception. The present study reflects the maladaptive process of daily pain attacks and may enhance the understanding of how chronic pain affects local intrinsic brain activity.

Corrigendum: Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain.

[This corrects the article on p. 122 in vol. 10, PMID: 28066193.].

Abnormal Local Brain Activity Beyond the Pain Matrix in Postherpetic Neuralgia Patients: A Resting-State Functional MRI Study.

BACKGROUND: Postherpetic neuralgia (PHN) patients suffer debilitating chronic pain, hyperalgesia, and allodynia, as well as emotional disorders such as insomnia, anxiety, and depression. The brain structure and functional basis of PHN are still not fully understood. OBJECTIVES: To identify the changes of regional brain activity in resting-state PHN patients using regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF) methods. Correlations between spontaneous pain intensity and ReHo or fALFF were analyzed. STUDY DESIGN: Observational study. SETTING: University hospital. METHODS: ReHo, fALFF change was analyzed in 19 PHN patients and 19 healthy controls to detect the functional abnormality in the brains of PHN patients. Correlations between ReHo, fALFF, and PHN pain intensity were assessed in the PHN group. RESULTS: PHN patients exhibited significantly abnormal ReHo and fALFF intensity in several brain regions, including the brainstem, thalamus, limbic system, temporal lobe, prefrontal lobe, and cerebellum compared with healthy controls. Correlation analysis showed that most of the ReHo values of the aforementioned brain regions positively correlated with visual analog scale (VAS) values. But much less correlation was found between fALFF and VAS. LIMITATIONS: (a) No specific emotional assessment was given for PHN patients before fMRI scans, therefore we cannot exclude whether the emotional disorders exist in these patients. (b) Relatively short pain duration (mean 5.4 months) and small sample size (n = 19) for the PHN group. CONCLUSIONS: For PHN patients, the local brain activity abnormality was not restricted to the pain matrix. Besides regions related to pain perception, areas in charge of affective processes, emotional activity, and pain modulation also showed abnormal local brain activity in a resting state, which may suggest complicated supraspinal function and plasticity change in PHN patients. ReHo was more closely correlated with pain intensity of PHN patients than fALFF. This work indicates that besides physical and emotional pain perception, mood disorder and pain modulation could be characteristic of PHN patients. This also supports the potential use of therapeutic interventions not only restricted to pain alleviation, but that also attempt to ameliorate the cognitive and emotional comorbidities. Key words: Postherpetic neuralgia, resting-state fMRI (rs-fMRI), mood disorder, limbic system, fractional aptitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo).

Functional cortical changes in relapsing-remitting multiple sclerosis at amplitude configuration: a resting-state fMRI study.

OBJECTIVE: The aim of this study was to explore the amplitude of spontaneous brain activity fluctuations in patients with relapsing-remitting multiple sclerosis (RRMS) using the amplitude of low-frequency fluctuation (ALFF) method. METHODS: ALFF and SPM8 were utilized to assess alterations in regional spontaneous brain activities in patients with RRMS in comparison with healthy controls (HCs). The beta values of altered brain regions between patients with RRMS and HCs were extracted, and a receiver operating characteristic (ROC) curve was generated to calculate the sensitivities and specificities of these different brain areas for distinguishing patients with RRMS from HCs. Pearson correlation analyses were applied to assess the relationships between the beta values of altered brain regions and disease duration and Expanded Disability Status Scale (EDSS) score. PATIENTS AND PARTICIPANTS: A total of 18 patients with RRMS (13 females; five males) and 18 sex-, age-, and education-matched HCs (14 females; four males) were recruited for this study. MEASUREMENTS AND RESULTS: Compared with HCs, patients with RRMS showed higher ALFF responses in the right fusiform gyrus (Brodmann area [BA] 37) and lower ALFF responses in the bilateral anterior cingulate cortices (BA 24 and 32), bilateral heads of the caudate nuclei, and bilateral brainstem. The ROC analysis revealed that the beta values of these abnormal brain areas showed high degrees of sensitivity and specificity for distinguishing patients with RRMS from HCs. The EDSS score showed a significant negative Pearson correlation with the beta value of the caudate head (r=-0.474, P=0.047). CONCLUSION: RRMS is associated with disturbances in spontaneous regional brain activity in specific areas, and these specific abnormalities may provide important information about the neural mechanisms underlying behavioral impairment in RRMS.

Microstructural Abnormalities in Gray Matter of Patients with Postherpetic Neuralgia: A Diffusional Kurtosis Imaging Study.

BACKGROUND: Changes in functional activity and connectivity have been shown in patients experiencing postherpetic neuralgia (PHN) pain. However, PHN-induced structural changes, particularly in the gray matter of which volume and density was widely reported to be altered by other chronic pain, have not been well characterized. OBJECTIVE: In this study, we aimed to detect the difference in the microstructure of gray matter of PHN patients as compared to the healthy controls, and to analyze the correlation between microstructural alterations and clinical features of PHN patients. STUDY DESIGN: Observational study. SETTING: University hospital. METHODS: Diffusional kurtosis imaging (DKI) was performed in 19 patients with PHN and in 19 age- and gender-matched healthy controls. Maps of axial kurtosis (K//), mean kurtosis (MK), radial kurtosis (K) in gray matter were calculated and compared between the 2 groups. Correlations between kurtosis metrics in the regions where between-group difference was detected and pain intensity as well as lesion duration were tested by Pearson's correlation. RESULTS: Compared with healthy controls, PHN patients exhibited significantly decreased DKI parameters in the bilateral insula and superior temporal gyrus, left middle frontal gyrus and occipital lobe, right cerebellum anterior lobe, right thalamus, caudate and parahippocampal gyrus. K// in the bilateral insula and MK in the right insula were negatively correlated with visual analogue scale (VAS) scores of PHN patients, whereas no correlation was found between DKI parameters and lesion duration of PHN pain. LIMITATION: Relatively small sample size. We still cannot determine the causal and effect relationship between the microstructural abnormalities in the gray matter and PHN. CONCLUSIONS: DKI can specifically reflect pathophysiological microstructural alterations in the cerebral gray matters of PHN patients. This feature enables magnetic resonance imaging (MRI) to be a potentially valuable technique for objectively estimating the severity of PHN pain, which would provide an opportunity for elucidating the central mechanisms underlying PHN as well. KEY WORDS: Postherpetic neuralgia, diffusional kurtosis imaging, insula cortex, gray matter, voxel-based analysis.

Microstructural Abnormalities Were Found in Brain Gray Matter from Patients with Chronic Myofascial Pain.

Myofascial pain, presented as myofascial trigger points (MTrPs)-related pain, is a common, chronic disease involving skeletal muscle, but its underlying mechanisms have been poorly understood. Previous studies have revealed that chronic pain can induce microstructural abnormalities in the cerebral gray matter. However, it remains unclear whether the brain gray matters of patients with chronic MTrPs-related pain undergo alteration. In this study, we employed the Diffusion Kurtosis Imaging (DKI) technique, which is particularly sensitive to brain microstructural perturbation, to monitor the MTrPs-related microstructural alterations in brain gray matter of patients with chronic pain. Our results revealed that, in comparison with the healthy controls, patients with chronic myofascial pain exhibited microstructural abnormalities in the cerebral gray matter and these lesions were mainly distributed in the limbic system and the brain areas involved in the pain matrix. In addition, we showed that microstructural abnormalities in the right anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) had a significant negative correlation with the course of disease and pain intensity. The results of this study demonstrated for the first time that there are microstructural abnormalities in the brain gray matter of patients with MTrPs-related chronic pain. Our findings may provide new insights into the future development of appropriate therapeutic strategies to this disease.