摘要目的:基于最小生成树（MST）的图论分析方法评估原发性全面强直-阵挛癫痫（IGE-GTCS）患者静息态大脑网络的拓扑改变，并进一步分析IGE-GTCS患者的抗癫痫药物反应和MST拓扑特征以及病程之间的关系。方法:该研究为横断面研究。回顾性收集2013年1月至2020年12月在南京大学医学院附属鼓楼医院接受头颅MRI检查的75例IGE-GTCS患者（IGE-GTCS组）和37名正常对照（对照组）。根据抗癫痫药物反应将IGE-GTCS患者分为药物控制良好（WC）亚组55例以及耐药（DR）亚组20例。首先计算被试全脑116个区域间的时间序列相关性以构建功能连接矩阵，对于每一个功能连接矩阵，采用Kruskal算法构建MST，并计算每一个MST的拓扑指标，包括叶分数、树层次和直径。2组间MST拓扑指标比较采用两样本 t检验。WC亚组与DR亚组病程与MST指标间的相关性分析采用Pearson相关性检验。 结果:相较于对照组，IGE-GTCS组的MST叶分数增加（ t=2.27， P=0.025），直径减低（ t=-2.24， P=0.027）；对照组与IGE-GTCS组树层次差异无统计学意义（ t=0.98， P=0.328）。WC亚组的MST叶分数（ t=-2.39， P=0.019）和树层次（ t=-2.52， P=0.014）较DR亚组显著减低，而WC亚组与DR亚组直径差异无统计学意义（ P=0.093）。相关分析显示WC亚组中的MST直径与病程呈正相关（ r=0.452， P<0.001），而DR组的MST直径与病程无显著相关性（ r=-0.062， P=0.847）。 结论:IGE-GTCS患者存在特异的全局脑网络拓扑改变，其大脑网络集中，效率增加；有效的抗癫痫药物治疗与脑网络异常的恢复有关。

abstractsObjective:To evaluate the topological alterations of resting-state brain networks in patients with idiopathic generalized epilepsy with generalized tonic-clonic seizure (IGE-GTCS) using minimum spanning tree (MST) based on graph theoretic analysis, and to further analyze the relationships between topological features, duration, and antiepileptic drug response.Methods:This study was a cross-sectional study. Retrospectively, 75 IGE-GTCS patients and 37 healthy controls (HC) who underwent brain MR imaging at the Affiliated of Nanjing University Medical School Drum Tower Hospital from January 2013 to December 2020 were enrolled. IGE-GTCS patients were grouped into well-controlled subgroup (WC; n=55) and drug-resistant subgroup (DR; n=20) according to their response to antiepileptic drugs. Firstly, the time series correlations between 116 regions of the whole brain of each subject were calculated to construct functional connectivity matrices. For each functional connectivity matrix, the Kruskal algorithm was used to MST, and the topological metrics of each MST were calculated, including leaf fraction, tree hierarchy, and diameter. The comparison of MST topological metrics between the two groups was performed using two-sample t-test. Pearson correlation analysis was used to calculate the correlation between disease duration and MST metrics in the WC subgroup and the DR subgroup. Results:Compared with the HC group, the MST leaf fraction ( t=2.27, P=0.025) increased in the IGE-GTCS patient group, and the diameter decreased ( t=-2.24, P=0.027), there was no statistically significant difference in tree hierarchy between IGE-GTCS patient group and HC group ( t=0.98, P=0.328). The MST leaf fraction ( t=-2.39, P=0.019) and tree hierarchy ( t=-2.24, P=0.027) in the WC subgroup was decreased compared with the DR subgroup, while there was no statistically significant difference in diameter between WC subgroup and DR subgroup ( P=0.093). The correlation analysis showed the MST diameter in WC subgroup was significantly correlated with disease duration ( r=0.452, P<0.001), while the MST diameter in DR subgroup was not significantly correlated with disease duration ( r=-0.062, P=0.847). Conclusions:Patients with IGE-GTCS exhibit specific alterations in the global topology of brain network, characterized by increased centralization and efficiency. The effective antiepileptic drug treatment is associated with a recovery of brain network abnormalities.