Imaging blood-brain barrier dysfunction in drug-resistant epilepsy: A multi-center feasibility study

Area of Science:

• Neurology
• Neuroimaging
• Vascular Biology

Background:

• Blood-brain barrier dysfunction (BBBD) is implicated in neurological disorders.
• Epilepsy is a neurological disorder where BBBD may play a role.

Purpose of the Study:

• To identify and compare brain regions with BBBD in patients with epilepsy (PWE) and healthy individuals using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).

Main Methods:

• DCE-MRI scans were performed on 50 drug-resistant epilepsy (DRE) patients and 58 healthy controls across four international epilepsy centers.
• Analysis focused on the presence and extent of BBBD, comparing PWE with controls.

Main Results:

• PWE exhibited significantly greater brain volume and a higher number of brain regions with BBBD compared to controls (p < 10⁻⁷).
• No significant differences in total brain volume with BBBD were found between focal and generalized epilepsy types, or between PWE with and without MRI-visible lesions.
• BBBD was detected in seizure onset zones in 82% of PWE, often near or within the suspected epileptogenic lesion.

Conclusions:

• Findings support the role of BBBD in the development of DRE.
• Microvascular stabilization emerges as a potential therapeutic strategy for epilepsy.