Identification of abnormal closed-loop pathways in patients with MRI-negative drug-resistant epilepsy

To identify abnormal changes in closed-loop pathways among magnetic resonance imaging-negative drug-resistant epilepsy (MRI − -DRE) patients and to examine the associations of these abnormalities with emotional and cognitive impairments. A total of 26 patients with MRI − -DRE and 26 healthy controls (HCs) were included in this study. Causal brain networks and temporal-lag brain networks were constructed from rs-fMRI data, and the Johnson algorithm was used to identify stable closed-loop pathways. Abnormal closed-loop pathways in the MRI − -DRE group were identified by comparison with HCs, and associations with indicators of cognitive and emotional impairments were examined using Pearson correlation analysis. The results reveal that the abnormal stable closed-loop pathways were distributed across frontal, parietal, and occipital lobes, and included altered FC values both within and between cerebral hemispheres. Four abnormal closed-loop pathways in the occipital lobe were associated with emotional and cognitive impairments. These abnormalities may serve as biomarkers for diagnosis and guidance of individualized treatments for MRI − -DRE.