Glymphatic system dysfunction in patients with occipital lobe epilepsy

Abstract Background and Purpose We aimed to investigate the glymphatic system function in patients with occipital lobe epilepsy (OLE) and healthy controls using diffusion tensor image analysis along the perivascular space (DTI‐ALPS) index. Methods We retrospectively included 23 patients with OLE and 30 healthy controls. The participants underwent brain MRI, which was normal, and diffusion tensor imaging. We used the DSI Studio for data preprocessing, obtained the fiber orientation and diffusivities, and calculated the DTI‐ALPS index from the diffusivity values associated with the projection and association fibers in the left hemisphere. Results There were no differences in mean age (31.6 years [range: 13‐58] vs. 31.3 years [range: 20‐57], p = .912) and male sex ratio (10/23 [43.5%] vs. 15/30 [50.0%]) between the groups. Compared to healthy controls, the diffusivities in patients with OLE were higher along the Y ‐axis in the projection fiber and along the Z ‐axis in the association fiber and lower along the Y ‐axis in the association fiber. The DTI‐ALPS index in patients with OLE was lower than that in the healthy controls (1.421 ± 0.171 vs. 1.667 ± 0.271, p < .001, 95% confidence interval of difference = 0.117‐0.376, Test statistic t = 3.823). We found no association between the DTI‐ALPS index and clinical characteristics in OLE. Conclusion The DTI‐ALPS index in patients with OLE was significantly lower than that in healthy controls, suggesting glymphatic system dysfunction in OLE. The DTI‐ALPS index could help assess the glymphatic system function in patients with epilepsy.