Altered Glymphatic-Related MRI Metrics and Brain Network Reorganization in Drug-Naive Children With Self-Limited Epilepsy With Centrotemporal Spikes.

OBJECTIVE: To explore cerebral waste clearance and its associations with brain network disturbances in drug-naive children with self-limited epilepsy with centrotemporal spikes (SeLECTS). METHODS: We included 67 children with SeLECTS and 52 healthy controls (HC). All patients underwent standardized cognitive assessments. Metrics derived from T1WI, DTI, and fMRI were used to indirectly assess glymphatic-related processes, including choroid plexus volume, perivascular space fraction, white matter free water (FW-WM), and gBOLD-CSF coupling. Functional brain networks were analyzed using graph theory. Linear models and partial correlation analyses were employed to examine between-group differences in imaging metrics and their associations with cognitive function and topological properties. Additionally, the mediating effects of network properties were explored. RESULTS: Compared with the HC group, the SeLECTS group exhibited increased FW-WM and reduced gBOLD-CSF coupling strength. Furthermore, gBOLD-CSF coupling was negatively correlated with processing speed (r = -0.376, FDRp = 0.017). At the network level, the SeLECTS group exhibited a decreased clustering coefficient and characteristic path length, accompanied by increased global efficiency. The degree centrality and nodal efficiency values of the median cingulate and paracingulate gyri were significantly reduced and negatively correlated with gBOLD-CSF coupling. In addition, nodal efficiency partially mediated the relationship between gBOLD-CSF coupling and processing speed. CONCLUSION: These preliminary findings suggest that cognitive impairment in SeLECTS may be associated with the interplay between disturbances in cerebral waste clearance and brain network reorganization.