ORIGINAL RESEARCH article
Front. Immunol.
Sec. Multiple Sclerosis and Neuroimmunology
This article is part of the Research TopicCNS Immunity – Paradox of Maintenance, Repair and DestructionView all 5 articles
EEG biomarkers of microstructural damage in normal-appearing white matter among patients with neuromyelitis optica spectrum disorder: A DTI-EEG combined study
Provisionally accepted
Lili Yang1*
Hui Qiu1
Yun Qin2
Zijun Li1Congyu Xu3Yan Xie1Kai Chen1
Shuai Ma1Lingling Dong1
Dezhong Yao2
Huang Rui1
Song Tan1- 1Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, China
- 2University of Electronic Science and Technology of China School of Electronic Science and Engineering, Chengdu, China
- 3Chengdu University of Technology, Chengdu, China
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Objective: This study aimed to explore the potential of EEG in monitoring the extent of white matter microstructural damage in patients with neuromyelitis optica spectrum disorder (pwNMOSD) for the first time. Methods: Thirty-two pwNMOSD and 20 healthy controls were recruited and all received DTI scan, while the pwNMOSD underwent also resting state EEG (rs-EEG). DTI indices were compared between two groups to identify impaired WM tracts in pwNMOSD. Correlations between the 240 rs-EEG indices (including spectral and functional connectivity indices in five frequency bands of six brain regions) and the fractional anisotropy (FA) of the impaired WM fiber tract were calculated to identify the rs-EEG biomarkers of WM microstructural damage. The relationships of the identified rs-EEG biomarkers with disease characteristics and cognitive function were further analyzed. Results: Seventeen of the 20 main WM tracts were found to have microstructural damage in pwNMOSD. The functional connectivity indices were significantly and positively correlated with the FA of WM tracts in pwNMOSD, especially the coherence and phase locking value strengths in the theta and gamma frequency bands (r=0.40-0.61). Different patterns between the rs-EEG indices in different frequency bands and the integrity of WM tracts were revealed. These identified rs-EEG indices were significantly related to patients' disease characteristics (number of attacks (r=-0.44), expanded disability status scale score (r=-0.41--0.47), serum anti-glial fibrillary acidic protein level (r=-0.43)) and cognitive functions (symbol digit modality test score, r=0.46). Interpretation: The functional connectivity of rs-EEG may serve as important biomarkers of WM microstructural damage in NMOSD.
Keywords: Diffusion Tensor Imaging, functional connectivity, Neuromyelitis Optica, Resting-state EEG, white matter microstructural damage
Received: 30 Jul 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Yang, Qiu, Qin, Li, Xu, Xie, Chen, Ma, Dong, Yao, Rui and Tan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lili Yang
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