Research Article: Resting-state functional MRI demonstrates brain network reorganization in neuromyelitis optica spectrum disorder (NMOSD)

Date Published: January 29, 2019

Publisher: Public Library of Science

Author(s): Kévin Bigaut, Sophie Achard, Céline Hemmert, Seyyid Baloglu, Laurent Kremer, Nicolas Collongues, Jérôme De Sèze, Stéphane Kremer, Fabrizio De Vico Fallani.


The relation between brain functional connectivity of patients with neuromyelitis optica spectrum disorder (NMOSD) and the degree of disability remains unclear.

Compare brain functional connectivity of patients with NMOSD to healthy subjects in resting-state functional MRI (rs-fMRI).

We compared the rs-fMRI connectivity in 12 NMOSD patients with 20 healthy subjects matched for age and sex. Graph theory analysis was used to quantify the role of each node using a set of metrics: degree, global efficiency, clustering and modularity. To summarize the abnormal connectivity profile of brain regions in patients compared to healthy subjects, we defined a hub disruption index κ.

Concerning the global organization of networks in NMOSD, a small-world topology was preserved without significant modification concerning all average metrics. However, visual networks and the sensorimotor network showed decreased connectivity with high interindividual variability. The hub disruption index κ was correlated to the Expanded Disability Status Scale (EDSS).

These results demonstrate a correlation between disability according to the EDSS and neuronal reorganization using the rs-fMRI graph methodology. The conservation of a normal global topological structure despite local modifications in functional connectivity seems to show brain plasticity in response to the disability.

Partial Text

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system characterized by severe relapses in regions with high aquaporin 4 (AQP4) expression such as the optic nerves, the spinal cord and specific brain areas.

Twelve patients with NMOSD defined according to the 2015 international consensus diagnostic criteria were recruited from the Strasbourg University Hospital [15]. Inclusion criteria were patients with defined NMOSD who were relapse-free. Healthy subjects had no personal history of neurological or psychiatric disease and had taken no medication, alcohol or drugs. The duration of the disease, the degree of the disability as assessed by the EDSS and presence of anti-AQP4 antibodies were collected.

Twelve NMOSD patients (six males and six females) were included with a mean age of 45.6 years (range, 25–66 years), a mean disease duration of 10.5 years, a mean EDSS of 3.5, and seven patients had anti-AQP4 antibodies (Table 1). Twenty healthy volunteers (11 males and nine females; range, 25–51 years) were included.

The application of graph theoretical analysis to fMRI provides a global view of the connectivity network for each individual and quantifies the role of each brain region within the network [11]. Thus, it is possible to identify decreased or increased connectivity in cortical regions in NMOSD patients.




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