Assessing the Functional-Structural Reorganization of Connector Hubs in Temporal Lobe Epilepsy

Recent years have seen a rise in investigations on the organizational principles of brain networks in healthy and pathological conditions. Temporal lobe epilepsy (TLE) is a compelling case as its focal pathology is accompanied by widespread network disruptions. However, how TLE affects functional connector hubs, regions supporting long-range and inter-network communication, remain poorly understood. We mapped connector hub reorganization in patients with TLE relative to healthy controls. Patients exhibited widespread connector hub reductions in the ipsilateral occipital, cingulate, precuneus and hippocampal regions as well as the bilateral pallidum. Hub reductions occurred alongside the emergence of new hubs in contralateral regions. We furthermore observed strong associations between hub reductions and microstructural alterations in subcortical structures and the hippocampus. These findings demonstrate widespread, asymmetric connector hub reorganization extending beyond the epileptogenic temporal lobe, revealing distinct patterns of network disruption and brain-wide reorganization.