{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T09:06:23Z","timestamp":1789203983526,"version":"build-2803163510"},"reference-count":52,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R01NS140278\u201301"],"award-info":[{"award-number":["1R01NS140278\u201301"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH\u201017\u20101\u20100619"],"award-info":[{"award-number":["W81XWH\u201017\u20101\u20100619"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Patients with functional seizures (FS) frequently exhibit deficits in cognitive and functioning measures (CFM) similar in magnitude to those present in epilepsy. An association between glymphatic system function and CFM in various neuropsychiatric conditions has been reported. Our objective was to investigate the relationships between CFM and diffusion tensor imaging analysis along perivascular spaces (DTI\u2010ALPS) index as a measure of perivascular directional diffusivity related to neurofluid dynamics in FS after traumatic brain injury (TBI\u2010FS), TBI without functional seizures (TBI\u2010only), and healthy controls (HCs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 173 participants (40 HCs, 74 TBI\u2010FS, 59 TBI\u2010only) underwent diffusion magnetic resonance imaging at 3 T to establish their DTI\u2010ALPS index. CFM acquired in patient groups were Montreal Cognitive Assessment, Quality of Life in Epilepsy\u201031 (total score and cognitive subscale), and Global Assessment of Functioning (GAF). Group differences were analyzed using linear mixed models with hemisphere as a within\u2010subject factor. The primary group comparison was adjusted for age and sex. Correlations between CFM and DTI\u2010ALPS index were examined in patient groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CFM were significantly worse in TBI\u2010FS than TBI\u2010only on all measures. GAF showed a significant positive correlation with DTI\u2010ALPS index in the combined patient sample (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009.228,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.009). In the primary analysis, there was a significant main effect of group on DTI\u2010ALPS index (\n                      <jats:italic>F<\/jats:italic>\n                      <jats:sub>2, 330<\/jats:sub>\n                      \u2009=\u20093.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.031, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.021). DTI\u2010ALPS index was lower in TBI\u2010FS than in TBI\u2010only (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.026), and biological sex was a significant covariate (\n                      <jats:italic>F<\/jats:italic>\n                      <jats:sub>1, 330<\/jats:sub>\n                      \u2009=\u20095.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.017; females higher). A significant hemispheric asymmetry was found, with right hemisphere DTI\u2010ALPS index values lower than left (\n                      <jats:italic>F<\/jats:italic>\n                      <jats:sub>1, 340<\/jats:sub>\n                      \u2009=\u200935.30,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.094).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>TBI\u2010FS participants showed reduced CFM across all measures, with lower global functioning associated with lower DTI\u2010ALPS index values in the combined patient sample, suggesting a positive relationship between perivascular directional diffusivity related to neurofluid dynamics and global functioning. Patients with TBI\u2010FS showed reduced DTI\u2010ALPS index compared to TBI\u2010only participants, suggesting potential differences in perivascular function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70490","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:15:07Z","timestamp":1789200907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relationship between cognitive functioning and diffusion tensor imaging analysis along perivascular spaces as a diffusion magnetic resonance imaging marker of perivascular directional diffusivity in functional seizures after traumatic brain injury"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5936-6627","authenticated-orcid":false,"given":"Jerzy P.","family":"Szaflarski","sequence":"first","affiliation":[{"name":"Department of Neurology and UAB Epilepsy Center University of Alabama at Birmingham Heersink School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolphe","family":"Nenert","sequence":"additional","affiliation":[{"name":"Department of Neurology and UAB Epilepsy Center University of Alabama at Birmingham Heersink School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6888-9000","authenticated-orcid":false,"given":"Jane B.","family":"Allendorfer","sequence":"additional","affiliation":[{"name":"Department of Neurology and UAB Epilepsy Center University of Alabama at Birmingham Heersink School of Medicine  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4901-3852","authenticated-orcid":false,"suffix":"Jr.","given":"W. Curt","family":"LaFrance","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Neurology Rhode Island Hospital, Brown University  Providence Rhode Island USA"},{"name":"Center for Neurorestoration and Neurotechnology VA Providence Healthcare System  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215\u20100366(24)00132\u20109"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.01.006"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2006.07.005"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awaa224"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2020.08.024"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S437063"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebr.2021.100496"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/25424823251341870"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1092852918001499"},{"key":"e_1_2_14_11_1","volume-title":"Molecular imaging 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