{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:14:49Z","timestamp":1787242489690,"version":"build-2736575974"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T00:00:00Z","timestamp":1557964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R00 NS097618"],"award-info":[{"award-number":["R00 NS097618"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 NS075270"],"award-info":[{"award-number":["R01 NS075270"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32 EB021937"],"award-info":[{"award-number":["T32 EB021937"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32 GM07347"],"award-info":[{"award-number":["T32 GM07347"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Focal seizures in temporal lobe epilepsy (TLE) are associated with widespread brain network perturbations and neurocognitive problems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To determine whether brainstem connectivity disturbances improve with successful epilepsy surgery, as recent work has demonstrated decreased brainstem connectivity in TLE that is related to disease severity and neurocognitive profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We evaluated 15 adult TLE patients before and after (&gt;1 yr; mean, 3.4 yr) surgery, and 15 matched control subjects using magnetic resonance imaging to measure functional and structural connectivity of ascending reticular activating system (ARAS) structures, including cuneiform\/subcuneiform nuclei (CSC), pedunculopontine nucleus (PPN), and ventral tegmental area (VTA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      TLE patients who achieved long-term postoperative seizure freedom (10 of 15) demonstrated increases in functional connectivity between ARAS structures and fronto-parietal-insular neocortex compared to preoperative baseline (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.01, Kruskal\u2013Wallis), with postoperative connectivity patterns resembling controls\u2019 connectivity. No functional connectivity changes were detected in 5 patients with persistent seizures after surgery (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.9, Kruskal\u2013Wallis). Among seizure-free postoperative patients, larger increases in CSC, PPN, and VTA functional connectivity were observed in individuals with more frequent seizures before surgery (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.05 for each, Spearman's rho). Larger postoperative increases in PPN functional connectivity were seen in patients with lower baseline verbal IQ (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.03, Spearman's rho) or verbal memory (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.04, Mann\u2013Whitney\n                      <jats:italic toggle=\"yes\">U<\/jats:italic>\n                      ). No changes in ARAS structural connectivity were detected after successful surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>ARAS functional connectivity disturbances are present in TLE but may recover after successful epilepsy surgery. Larger increases in postoperative connectivity may be seen in individuals with more severe disease at baseline.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyz128","type":"journal-article","created":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T16:13:29Z","timestamp":1553789609000},"page":"417-428","source":"Crossref","is-referenced-by-count":16,"title":["Brainstem Functional Connectivity Disturbances in Epilepsy may Recover After Successful Surgery"],"prefix":"10.1227","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1831-2091","authenticated-orcid":false,"given":"Hern\u00e1n F J","family":"Gonz\u00e1lez","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee"},{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E","family":"Goodale","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee"},{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica L","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin F","family":"Haas","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bennett A","family":"Landman","sequence":"additional","affiliation":[{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee"},{"name":"Department of Electrical Engineering, Vanderbilt University, Nashville, Tennessee"},{"name":"Department of Computer Science, Vanderbilt University, Nashville, Tennessee"},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria L","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee"},{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Electrical Engineering, Vanderbilt University, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario J","family":"Englot","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee"},{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical center, Nashville, Tennessee"},{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,3]]},"reference":[{"issue":"23","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"2483","DOI":"10.1212\/WNL.0000000000003407","article-title":"What can we do for people with drug-resistant epilepsy?","volume":"87","author":"Engel","year":"2016","journal-title":"Neurology"},{"issue":"21","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1001\/jama.2008.771","article-title":"Epilepsy surgery for pharmacoresistant temporal lobe epilepsy","volume":"300","author":"Choi","year":"2008","journal-title":"JAMA"},{"issue":"9","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1001\/jama.2012.220","article-title":"Early surgical therapy for drug-resistant temporal lobe epilepsy","volume":"307","author":"Engel","year":"2012","journal-title":"JAMA"},{"key":"bib4-20231011","first-page":"630853","article-title":"A review of the epidemiology of temporal lobe epilepsy","volume":"2012","author":"Tellez-Zenteno","year":"2012","journal-title":"Epilepsy Res Treat"},{"issue":"2","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1097\/WCO.0000000000000430","article-title":"Cognition in epilepsy","volume":"30","author":"Witt","year":"2017","journal-title":"Curr Opin Neurol"},{"issue":"4","key":"bib6-20231011","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1111\/epi.13334","article-title":"Progression of gray matter atrophy in seizure-free patients with temporal lobe epilepsy","volume":"57","author":"Alvim","year":"2016","journal-title":"Epilepsia"},{"key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.nicl.2016.05.002","article-title":"Combined 18 F-FDG-PET and diffusion tensor imaging in mesial temporal lobe epilepsy with hippocampal sclerosis","volume":"12","author":"Aparicio","year":"2016","journal-title":"Neuroimage Clin"},{"issue":"10","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1111\/epi.13510","article-title":"Regional and global connectivity disturbances in focal epilepsy, related neurocognitive sequelae, and potential mechanistic underpinnings","volume":"57","author":"Englot","year":"2016","journal-title":"Epilepsia"},{"issue":"11","key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1136\/jnnp-2017-315732","article-title":"Functional connectivity disturbances of the ascending reticular activating system in temporal lobe epilepsy","volume":"88","author":"Englot","year":"2017","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1212\/WNL.0000000000005733","article-title":"Relating structural and functional brainstem connectivity to disease measures in epilepsy","volume":"91","author":"Englot","year":"2018","journal-title":"Neurology"},{"issue":"4","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1227\/NEU.0b013e31823c3a30","article-title":"Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors","volume":"70","author":"Englot","year":"2012","journal-title":"Neurosurgery"},{"issue":"8","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1111\/j.1528-1167.2011.03160.x","article-title":"Measuring patient satisfaction following epilepsy surgery","volume":"52","author":"Macrodimitris","year":"2011","journal-title":"Epilepsia"},{"issue":"6","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1111\/epi.13384","article-title":"Expanding the spectrum of cognitive outcomes after temporal lobe epilepsy surgery: a prospective study of theory of mind","volume":"57","author":"Giovagnoli","year":"2016","journal-title":"Epilepsia"},{"issue":"s6","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1046\/j.1528-1157.42.s6.1.x","article-title":"Neuropsychological changes after surgical treatment for temporal lobe epilepsy","volume":"42","author":"Wachi","year":"2001","journal-title":"Epilepsia"},{"issue":"21","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1212\/WNL.0000000000002700","article-title":"A reappraisal of mortality after epilepsy surgery","volume":"86","author":"Sperling","year":"2016","journal-title":"Neurology"},{"issue":"1","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"23153","DOI":"10.1038\/srep23153","article-title":"Functional connectome before and following temporal lobectomy in mesial temporal lobe epilepsy","volume":"6","author":"Liao","year":"2016","journal-title":"Sci Rep"},{"issue":"11","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1111\/epi.13867","article-title":"Postoperative seizure freedom does not normalize altered connectivity in temporal lobe epilepsy","volume":"58","author":"Maccotta","year":"2017","journal-title":"Epilepsia"},{"key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.yebeh.2017.12.041","article-title":"A modern epilepsy surgery treatment algorithm: incorporating traditional and emerging technologies","volume":"80","author":"Englot","year":"2018","journal-title":"Epilepsy Behav"},{"issue":"6","key":"bib19-20231011","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/NEN.0b013e3182588293","article-title":"Neuroanatomic connectivity of the human ascending arousal system critical to consciousness and its disorders","volume":"71","author":"Edlow","year":"2012","journal-title":"J Neuropathol Exp Neurol"},{"issue":"1","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/1522-2594(200007)44:1<162::AID-MRM23>3.0.CO;2-E","article-title":"Image-based method for retrospective correction of physiological motion effects in fMRI: RETROICOR","volume":"44","author":"Glover","year":"2000","journal-title":"Magn Reson Med"},{"issue":"3","key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1089\/brain.2012.0073","article-title":"Conn: a functional connectivity toolbox for correlated and anticorrelated brain networks","volume":"2","author":"Whitfield-Gabrieli","year":"2012","journal-title":"Brain Connect"},{"issue":"1","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.neuroimage.2007.01.054","article-title":"Amplitude of low frequency fluctuation within visual areas revealed by resting-state functional MRI","volume":"36","author":"Yang","year":"2007","journal-title":"Neuroimage"},{"issue":"2","key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.neuroimage.2011.09.015","article-title":"Fsl","volume":"62","author":"Jenkinson","year":"2012","journal-title":"Neuroimage"},{"issue":"2","key":"bib24-20231011","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S1361-8415(02)00054-3","article-title":"BrainSuite: an automated cortical surface identification tool","volume":"6","author":"Shattuck","year":"2002","journal-title":"Med Image Analysis"},{"issue":"260","key":"bib27-20231011","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/01621459.1952.10483441","article-title":"Use of ranks in one-criterion variance analysis","volume":"47","author":"Kruskal","year":"1952","journal-title":"J Am Stat Assoc"},{"key":"bib28-20231011","doi-asserted-by":"crossref","first-page":"118","DOI":"10.3389\/fnhum.2013.00118","article-title":"The influence of the amplitude of low-frequency fluctuations on resting-state functional connectivity","volume":"7","author":"Di","year":"2013","journal-title":"Front Hum Neurosci"},{"issue":"suppl 1","key":"bib29-20231011","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/j.1528-1167.2010.02908.x","article-title":"The serotonin axis: shared mechanisms in seizures, depression, and SUDEP","volume":"52","author":"Richerson","year":"2011","journal-title":"Epilepsia"},{"issue":"12","key":"bib30-20231011","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1111\/epi.12427","article-title":"Surgical versus medical treatment for refractory epilepsy: outcomes beyond seizure control","volume":"54","author":"Perry","year":"2013","journal-title":"Epilepsia"},{"key":"bib31-20231011","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S0079-6123(09)17711-7","article-title":"Consciousness and epilepsy: why are complex-partial seizures complex","volume":"177","author":"Englot","year":"2009","journal-title":"Prog Brain Res"},{"issue":"3","key":"bib32-20231011","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S1525-5050(02)00029-X","article-title":"The role of subcortical structures in human epilepsy","volume":"3","author":"Norden","year":"2002","journal-title":"Epilepsy Behav"},{"issue":"12","key":"bib33-20231011","doi-asserted-by":"crossref","first-page":"3764","DOI":"10.1093\/brain\/awq316","article-title":"Impaired consciousness in temporal lobe seizures: role of cortical slow activity","volume":"133","author":"Englot","year":"2010","journal-title":"Brain"},{"issue":"6","key":"bib34-20231011","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1212\/01.WNL.0000141086.91077.CD","article-title":"Ictal neocortical slowing in temporal lobe epilepsy","volume":"63","author":"Blumenfeld","year":"2004","journal-title":"Neurology"},{"issue":"8","key":"bib35-20231011","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1093\/cercor\/bhh048","article-title":"Positive and negative network correlations in temporal lobe epilepsy","volume":"14","author":"Blumenfeld","year":"2004","journal-title":"Cereb Cortex"},{"issue":"36","key":"bib36-20231011","doi-asserted-by":"crossref","first-page":"9066","DOI":"10.1523\/JNEUROSCI.2014-08.2008","article-title":"Remote effects of focal hippocampal seizures on the rat neocortex","volume":"28","author":"Englot","year":"2008","journal-title":"J Neurosci"},{"issue":"41","key":"bib37-20231011","doi-asserted-by":"crossref","first-page":"13006","DOI":"10.1523\/JNEUROSCI.3846-09.2009","article-title":"Cortical deactivation induced by subcortical network dysfunction in limbic seizures","volume":"29","author":"Englot","year":"2009","journal-title":"J Neurosci"},{"issue":"3","key":"bib38-20231011","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.neuron.2014.12.058","article-title":"Decreased subcortical cholinergic arousal in focal seizures","volume":"85","author":"Motelow","year":"2015","journal-title":"Neuron"},{"issue":"1-2","key":"bib39-20231011","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jns.2009.08.017","article-title":"Non-motor functions in parkinsonian patients implanted in the pedunculopontine nucleus: focus on sleep and cognitive domains","volume":"289","author":"Alessandro","year":"2010","journal-title":"J Neurol Sci"},{"issue":"4","key":"bib40-20231011","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1037\/neu0000179","article-title":"Modulation of attentional processing by deep brain stimulation of the pedunculopontine nucleus region in patients with parkinsonian disorders","volume":"29","author":"Fischer","year":"2015","journal-title":"Neuropsychology"},{"issue":"3","key":"bib41-20231011","first-page":"1964","article-title":"Restoring conscious arousal during focal limbic seizures with deep brain stimulation","volume":"27","author":"Kundishora","year":"2017","journal-title":"Cereb Cortex"},{"issue":"6","key":"bib42-20231011","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1073\/pnas.0811168106","article-title":"Predicting human resting-state functional connectivity from structural connectivity","volume":"106","author":"Honey","year":"2009","journal-title":"Proc Natl Acad Sci USA"},{"issue":"2","key":"bib43-20231011","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1089\/brain.2015.0382","article-title":"Linking functional connectivity and structural connectivity quantitatively: a comparison of methods","volume":"6","author":"Huang","year":"2016","journal-title":"Brain Connect"},{"issue":"5","key":"bib44-20231011","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/j.1528-1167.2011.03022.x","article-title":"Neuropsychological outcomes after epilepsy surgery: systematic review and pooled estimates","volume":"52","author":"Sherman","year":"2011","journal-title":"Epilepsia"},{"issue":"12","key":"bib45-20231011","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1111\/ene.13113","article-title":"The course of language functions after temporal lobe epilepsy surgery: a prospective study","volume":"23","author":"Giovagnoli","year":"2016","journal-title":"Eur J Neurol"},{"issue":"5","key":"bib46-20231011","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/1073858403255624","article-title":"Why do seizures cause loss of consciousness?","volume":"9","author":"Blumenfeld","year":"2003","journal-title":"Neuroscientist"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/86\/3\/417\/33418087\/nyz128.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:50:19Z","timestamp":1786121419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyz128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,16]]},"references-count":44,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyz128","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,16]]}}}