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Recently, accumulating morphometric studies have revealed structural alterations outside the basal ganglia, such as in the brainstem, cerebellum and sensorimotor cortex, suggesting that blepharospasm may result from network disorders. However, the temporal and causal relationships between structural alterations and whether there are disease duration-related hierarchical structural changes in these patients remain largely unknown. Structural MRI was performed in 62 patients with blepharospasm, 62 patients with hemifacial spasm and 62 healthy controls to assess the structural alterations using voxel-based morphology and structural covariance networks. The use of the causal structural covariance network, modularity analysis and functional decoding were subsequently performed to map the causal effect of grey matter change pattern, hierarchical topography and functional characterizations of the structural network throughout the disease duration of blepharospasm. Greater grey matter volume in the left and right supplementary motor areas was identified in patients with blepharospasm compared to that in patients with hemifacial spasm and healthy controls, whereas no significant difference was identified between patients with hemifacial spasm and healthy controls. In addition, increased grey matter volume covariance between the right supplementary motor area and right brainstem, left superior frontal gyrus, left supplementary motor area and left paracentral gyrus was found in patients with blepharospasm compared to healthy controls. Further causal structural covariance network, modularity analysis and functional decoding showed that the right supplementary motor area served as a driving core in patients with blepharospasm, extending greater grey matter volume to areas in the cortico-basal ganglia\u2013brainstem motor pathway and cortical regions in the vision\u2013motor integration pathway. Taken together, our results suggest that the right supplementary motor area is an early and important pathologically impaired region in patients with blepharospasm. With a longer duration of blepharospasm, increased grey matter volume extends from the right supplementary motor area to the cortico-basal ganglia motor and visual\u2013motor integration pathways, showing a hierarchy of structural abnormalities in the disease progression of blepharospasm, which provides novel evidence to support the notion that blepharospasm may arise from network disorders and is associated with a wide range of grey matter abnormalities.<\/jats:p>","DOI":"10.1093\/brain\/awac341","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T17:39:27Z","timestamp":1663781967000},"page":"1542-1553","source":"Crossref","is-referenced-by-count":32,"title":["Supplementary motor area driving changes of structural brain network in blepharospasm"],"prefix":"10.1093","volume":"146","author":[{"given":"Jinping","family":"Xu","sequence":"first","affiliation":[{"name":"Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 518055 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhan","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangqiang","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine , Guangzhou 510060 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaomin","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linchang","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine , Guangzhou 510060 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zilin","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhicong","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinsheng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingmao","family":"Hu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 518055 , China"},{"name":"School of Artificial Intelligence, University of Chinese Academy of Sciences , Beijing 100049 , China"},{"name":"CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 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