ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Brain Imaging Methods
Glymphatic system dysfunction in temporal lobe epilepsy with hippocampal sclerosis: MRI-based evaluation of circulatory markers and disease progression
Yingpeng Kuang 1
Dingwen Hu 1
Hui Chu 1
RongYu Zhang 1
Ziyu Diao 1
Kun Wang 1
XIAOMEI YUE 1
Yuna Chen 1
Shijun Qiu 2,3
Jie An 2
1. Guangzhou University of Chinese Medicine, Guangzhou, China
2. Department of Radiology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
3. State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
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Abstract
Objective: In this study, several MRI-derived glymphatic markers were utilized to evaluate alterations in glymphatic system (GS) function in patients with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS). Methods: we assessed 160 participants, including 80 patients with TLE-HS and 80 healthy controls (HCs). Glymphatic circulation was evaluated using MRI-based markers, including choroid plexus volume (CPV), perivascular space (PVS) volume, the fraction of white matter free water (FW-WM), and diffusion tensor imaging along the perivascular space (DTI-ALPS) index. Group differences were evaluated using two-sample tests, and associations were assessed using partial Spearman's rank correlations (ρ). Results: In patients with TLE-HS, the DTI-ALPS index (t = −2.65, P = 0.001), CPV/TIV (t = −2.65, P = 0.001), and PVS score (χ² test, χ² (3, N = 160) = 15.21, p = 0.0016) were significantly lower than in HCs, whereas the FW-WM (t = 5.70, P < 0.001) was significantly higher. Additionally, longer disease duration was significantly correlated with a decrease in DTI-ALPS (ρ = −0.375, P = 0.001), an increase in FW-WM (ρ = 0.316, P = 0.001), and an enlargement of CPV (ρ = 0.378, P = 0.001). Furthermore, a reduction in hippocampal volume (HPV) was closely correlative with a decrease in DTI-ALPS (ρ = 0.226, P = 0.048) and an enlargement of CPV (ρ = −0.345, P = 0.002). Conclusions: This study offers substantiated evidence of GS function in patients with TLE-HS using multiple MRI-derived indices of GS function. Moreover, longer disease duration was significantly associated with lower DTI-ALPS indices, higher FW-WM levels, and enlarged CPV, while reduced HPV was closely linked to decreased DTI-ALPS and increased CPV. These findings indicate that MRI-derived GS indices may serve as potential imaging biomarkers of disease chronicity in TLE-HS.
Summary
Keywords
Disease duration, Glymphatic system, Hippocampal Sclerosis, MRI, Neuroimaging, Temporal Lobe Epilepsy
Received
07 November 2025
Accepted
26 January 2026
Copyright
© 2026 Kuang, Hu, Chu, Zhang, Diao, Wang, YUE, Chen, Qiu and An. 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: Jie An
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