Epilepsy is a disorder of brain networks, that is usually combined with cognitive and emotional impairment. However, most of the current research on closed-loop pathways in epilepsy is limited to the neuronal level or has focused only on known closed-loop pathways, and studies on abnormalities in closed-loop pathways in epilepsy at the whole-brain network level are lacking. A total of 26 patients with magnetic resonance imaging-negative pharmacoresistant epilepsy (MRIneg-PRE) and 26 healthy controls (HCs) were included in this study. Causal brain networks and temporal-lag brain networks were constructed from resting-state functional MRI data, and the Johnson algorithm was used to identify stable closed-loop pathways. Abnormal closed-loop pathways in the MRIneg-PRE cohort compared with the HC group were identified, and the associations of these pathways with indicators of cognitive and emotional impairments were examined via Pearson correlation analysis. The results revealed that the abnormal stable closed-loop pathways were distributed across the frontal, parietal, and occipital lobes and included altered functional connectivity values both within and between cerebral hemispheres. Four abnormal closed-loop pathways in the occipital lobe were associated with emotional and cognitive impairments. These abnormal pathways may serve as biomarkers for the diagnosis and guidance of individualized treatments for MRIneg-PRE patients.

癫痫是一种大脑网络疾病，通常伴有认知和情绪障碍。然而，目前对癫痫闭环通路的研究大多局限于神经元水平或仅关注已知的闭环通路，而全脑网络水平上癫痫闭环通路异常的研究较少。不足。本研究共纳入 26 名磁共振成像阴性耐药性癫痫 (MRIneg-PRE) 患者和 26 名健康对照 (HC)。根据静息态功能 MRI 数据构建因果脑网络和时间滞后脑网络，并使用 Johnson 算法来识别稳定的闭环通路。与 HC 组相比，MRIneg-PRE 队列中的异常闭环通路被确定，并通过 Pearson 相关分析检查这些通路与认知和情绪障碍指标的关联。结果显示，异常的稳定闭环通路分布在额叶、顶叶和枕叶，并且包括大脑半球内部和之间功能连接值的改变。枕叶的四个异常闭环通路与情绪和认知障碍有关。这些异常通路可以作为 MRIneg-PRE 患者诊断和个体化治疗指导的生物标志物。