Tourette syndrome (TS) is a childhood-onset neurobehavioral disorder. At present, the topological disruptions of the whole brain white matter (WM) structural networks remain poorly understood in TS children. Considering the unique position of the topologically central role of densely interconnected brain hubs, namely the rich club regions, therefore, we aimed to investigate whether the rich club regions and their related connections would be particularly vulnerable in early TS children. In our study, we used diffusion tractography and graph theoretical analyses to explore the rich club structures in 44 TS children and 48 healthy children. The structural networks of TS children exhibited significantly increased normalized rich club coefficient, suggesting that TS is characterized by increased structural integrity of this centrally embedded rich club backbone, potentially resulting in increased global communication capacity. In addition, TS children showed a reorganization of rich club regions, as well as significantly increased density and decreased number in feeder connections. Furthermore, the increased rich club coefficients and feeder connections density of TS children were significantly positively correlated to tic severity, indicating that TS may be characterized by a selective alteration of the structural connectivity of the rich club regions, tending to have higher bridging with non-rich club regions, which may increase the integration among tic-related brain circuits with more excitability but less inhibition for information exchanges between highly centered brain regions and peripheral areas. In all, our results suggest the disrupted rich club organization in early TS children and provide structural insights into the brain networks.
Tourette syndrome (TS) is a childhood-onset neurobehavioral disorder. To date, TS is still misdiagnosed due to its varied presentation and lacking of obvious clinical symptoms. Therefore, studies of objective imaging biomarkers are of great importance for early TS diagnosis. As tic generation has been linked to disturbed structural networks, and many efforts have been made recently to investigate brain functional or structural networks using machine learning methods, for the purpose of disease diagnosis. However, few studies were related to TS and some drawbacks still existed in them. Therefore, we propose a novel classification framework integrating a multi-threshold strategy and a network fusion scheme to address the preexisting drawbacks. Here we used diffusion MRI probabilistic tractography to construct the structural networks of 44 TS children and 48 healthy children. We ameliorated the similarity network fusion algorithm specially to fuse the multi-threshold structural networks. Graph theoretical analysis was then implemented, and nodal degree, nodal efficiency and nodal betweenness centrality were selected as features. Finally, support vector machine recursive feature extraction (SVM-RFE) algorithm was used for feature selection, and then optimal features are fed into SVM to automatically discriminate TS children from controls. We achieved a high accuracy of 89.13% evaluated by a nested cross validation, demonstrated the superior performance of our framework over other comparison methods. The involved discriminative regions for classification primarily located in the basal ganglia and frontal cortico-cortical networks, all highly related to the pathology of TS. Together, our study may provide potential neuroimaging biomarkers for early-stage TS diagnosis.
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