Disrupted structural and functional rich club organization of the brain connectome in patients with generalized tonic-clonic seizure.

Network studies have demonstrated that a small set of highly connected regions may play a central role in global information integration, together forming a rich club organization. Given that generalized tonic-clonic seizure (GTCS) has been conceptualized as a network disorder, we hypothesized that the rich club disturbances may be related to the network abnormalities of GTCS. Here, we used graph theoretical analysis to investigate the rich club organization of both structural and functional connectome in patients with GTCS (n = 50) and healthy controls (n = 60). We further measured the level of global efficiency and clustering in rich club and non-rich club organization. We, respectively, identified a small number of highly connected hubs as rich club organization from structural and functional networks. Patients were found to exhibit significantly reduced rich club connectivity among the central hubs. Meanwhile, both structural and functional network showed changed levels of global efficiency and clustering of rich club organization in GTCS. Furthermore, in patients, lower levels of rich club connectivity were found to be correlated with longer duration of illness and seizure frequency. Together, these findings suggest that GTCS is characterized by a selective disruption of rich club organization due to the long-term injurious effects of epileptic actions on the central hub regions, which potentially contribute to a reduced level of brain integration capacity among different functional domains and an added effect of illness on a preexisting vulnerability. Our findings emphasize a central role for abnormal rich club organization in the pathophysiological mechanism underlying GTCS. Hum Brain Mapp 37:4487-4499, 2016.