Changes in topological properties of brain structural covariance networks and alertness in temporal lobe epilepsy with and without focal to bilateral tonic-clonic seizures.

This study investigated brain structural covariance network (SCN) topological changes and alertness in temporal lobe epilepsy (TLE) with and without focal to bilateral tonic-clonic seizures (FBTCS). Seventy-eight subjects, including 32 TLE patients with FBTCS (TLE-FBTCS), 46 TLE patients without FBTCS (TLE-FS), and 42 healthy controls (HCs), underwent the Attention Network Test to assess alertness and volumetric MRI scans. SCNs were constructed and analyzed using graph theory. Results showed that TLE-FS patients had lower total cerebral volume than HCs, and the lowest volume was observed in the TLE-FBTCS group. Compared to HCs and TLE-FBTCS patients, TLE-FS patients exhibited increased small-worldness, normalized clustering coefficient, global efficiency, and modularity, but decreased normalized characteristic shortest path length and assortativity. Specific brain regions, such as the hippocampus, thalamus, and superior temporal sulcus, showed changes in nodal clustering coefficients and efficiency in TLE-FS patients. Further analysis revealed decreased intrinsic/phasic alertness in TLE-FBTCS patients. Correlation analysis indicated that SCN topological properties were associated with alertness in TLE-FS patients but not in TLE-FBTCS patients. These findings suggest that TLE-FS and TLE-FBTCS patients show different changes in SCN integration and segregation, with TLE-FS alertness linked to SCN topological properties, providing insights into TLE's neuropathological mechanisms.