血清SDF-1、CXCR4水平与颞叶癫痫患者认知功能的相关性分析

目的探讨颞叶癫痫(TLE)患者血清中基质细胞衍生因子-1(SDF-1)及趋化因子受体4(CXCR4)水平与TLE患者认知功能的相关性。方法选取120例体检健康者(健康对照组)、126例TLE无认知障碍患者(TLE无认知障碍组)及132例TLE伴认知障碍患者(TLE伴认知障碍组),用酶联免疫吸附测定检测各组血清SDF-1和CXCR4水平;同时测定各组人β淀粉样蛋白1-42(Aβ1-42)水平,并采用简易智力状态检查量表(MMSE)进行认知功能分级,分析SDF-1、CXCR4水平与认知功能的相关性。结果TLE无认知障碍组和TLE伴认知障碍组患者血清SDF-1和CXCR4水平高于健康对照组,TLE伴认知障碍组的血清SDF-1和CXCR4水平高于TLE无认知障碍组,差异有统计学意义(均P<0.05);血清SDF-1和CXCR4水平与Aβ1-42水平呈正相关,与MMSE评分呈负相关(均P<0.05)。结论SDF-1和CXCR4血清水平能够反映TLE患者认知功能损害的程度,有望成为诊断TLE认知障碍程度的预警指标。     

颞叶癫痫与认知功能

颞叶癫痫（temporal lobe epilepsy,TLE)是临床常见的难治性癫痫,是目前研究最多的脑叶癫痫,该重点讨论颞叶癫痫的认知功能特点。     

颞叶癫痫患者小脑结构与功能改变的磁共振成像研究进展

癫痫的发病机制非常复杂,至今仍未完全明确,目前熟知的机制是中枢神经系统兴奋与抑制失衡.随着MRI技术的发展,越来越多的研究利用先进的影像学技术,从小脑结构与功能改变的角度对癫痫发生机制进行探索,目前的研究发现不同类型癫痫患者的小脑结构与功能发生改变,本文针对颞叶癫痫(temporal lobe epilepsy,TLE...     

颞叶癫痫儿童灰质异常脑区与神经心理学测验的关系及意义

[目的]评估儿童颞叶癫痫（ TLE）临床表现和神经心理学测验成绩与局部脑萎缩的相关性.[方法]症状性TLE患儿14例（海马萎缩所致中颞叶癫痫 9例,颞叶新皮质损伤所致TLE 5例）,健康对照儿童14名;中颞叶癫痫（ MTLE）成人及其对照各9例.所有入组对象进行脑MRI获取T1结构像,用像素为基础的形态测定法分析图像.所有儿童进行综合神经心理学测验.[结果]TLE患儿同侧海马和海马外周区灰质体积显著减小,灰质体积减小与神经心理学测验成绩显著相关（P〈0.05）.单侧海马萎缩的MTLE患儿中,癫痫发作区域同侧的海马灰质体积显著减小,同侧扣带和对侧额中回皮质萎缩,皮质萎缩程度及范围较同类成人患者小.[结论]与成人MTLE患者相似,儿童MTLE与海马和海马外周的细胞减少有关;儿童TLE灰质萎缩的程度和范围较成人患者小,仅限于额叶区;中颞叶和额叶区灰质体积的减小与神经心理学测验成绩显著相关;TLE患儿的认知或行为障碍是神经网络损伤的结果.     

颞叶癫痫与认知功能

颞叶癫痫 ( temporal lobe epilepsy,TLE) 是临床常见的难治性癫痫 , 是目前研究最多的脑叶癫痫 . 该文重点讨论颞叶癫痫的认知功能特点 .     

左侧颞叶癫痫患者脑皮质计算功能重组的fMRI研究

目的采用任务相关功能性磁共振成像技术（fMRI）观察左侧颞叶癫痫（TLE）患者与健康人完成计算任务时脑区激活差异。 方法选取右利手、左侧TLE患者16例作为TLE组,另选取相匹配健康受试者16例作为对照组。2组受试者均进行简单加法、简单减法及退位减法计算任务,同时进行脑部fMRI检查。采用神经影像学统计参数图（SPM-5）软件进行数据处理和分析,并比较2组间脑区激活差异。 结果计算任务中,TLE组的计算正确率为76.30%,显著低于对照组的96.80%（P<0.05）;而TLE患者组的计算反应时间为（2589±213.20）ms,与对照组的（1765±134.90）ms比较,差异有统计学意义（P<0.05）。对照组激活强度高于左侧颞叶癫痫组的脑区有左侧中央旁小叶、左侧中央后回、双侧顶下小叶、左侧角回、双侧缘上回、左侧额中回、左额上回、双侧后扣带回、双侧岛叶、双侧颞上下回、右侧海马、海马旁回、双侧丘脑和小脑。左侧颞叶癫痫组激活强度高于对照组的脑区有双侧顶上小叶、双侧前扣带回和右侧额中下回。 结论左侧TLE患者计算相关的脑功能区具有半球内及半球间重组,额顶叶可在计算功能的代偿中发挥一定的作用;任务相关fMRI技术可为无创评价TLE患者计算认知功能提供重要证据。     

颞叶癫痫合并额叶运动症状对癫痫严重程度及预后的影响

目的：颞叶癫痫（TLE）是临床最常见药物难治性癫痫（DRE）。额叶运动症状的出现，提示颞外网络受累，可能是TLE患者预后不佳的重要因素。本研究针对确诊为TLE患者额叶运动症状的出现情况，并通过前瞻性研究分析其对预后预测作用，为临床诊疗决策提供依据。 方法：本研究共前瞻性入组符合国际抗癫痫联盟（ILAE）2017癫痫诊断及分类标准的颞叶癫痫患者151例。所有患者均采集临床发作症状学病史，记录合并额叶运动症状：头眼向对侧偏转、不对称姿势、过度运动的症状学特征，同时进行16小时连续长程视频脑电监测。采用VA-2量表对癫痫严重程度进行评分。对患者进行1年的前瞻性随访，依据ILAE 2010定义对DRE进行诊断。 结果：颞叶癫痫患者合并额叶运动症状（TLE/F+）42例，发生率27.81%。与不合并额叶运动症状的颞叶癫痫患者（TLE/F-）相比，TLE/F+组患者的发作频率（P = 0.002）、VA-2评分更高（P = 0.000），抗癫痫药物使用（TLE/F+ vs. TLE/F-：83.33% vs. 64.22%；P = 0.029）及多药联合率更高（TLE/F+ vs. TLE/F-：38.10% vs. 22.02%；P = 0.036）。多因素分析结果显示：头眼向对侧偏转是发作频率（OR = 8.246，95%CI = 1.977~34.405，P = 0.004）、VA-2评分的共同危险因素，其中头眼向对侧偏转（β = 0.277，P = 0.000）、过度运动（β = 0.343，P = 0.003）与VA评分独立相关。随访1年后TLE/F+组患者（21/42，50.0%）较TLE/F-组患者（16/107，15.0%）诊断难治性癫痫的比例更高（P = 0.000）。 结论：颞叶癫痫患者中约27.81%的合并额叶运动症状，与发作严重程度密切相关。颞叶癫痫患者出现额叶运动症状可能提示了不良的发作预后，应在临床诊疗中早期识别并予以积极干预。     

右侧颞叶癫痫发作间期静息态脑功能磁共振成像研究

目的运用低频振幅(ALFF)分析对难治性颞叶癫痫患者发作间期的脑功能进行研究,分析其在静息状态下脑功能改变的特征。方法实验组16例及健康对照组16例行静息态f MRI检查。利用DPARSF软件对静息态数据进行分析,分析两组间ALFF改变的脑区,并分析ALFF改变脑区与患病病程长短的相关性。结果与正常对照组相比实验组全脑ALFF值升高的脑区主要分布于脑桥、中脑及其周围、右侧额叶和颞叶、前扣带回、左侧尾状核、壳核和枕叶等区域。ALFF降低的脑区主要分布于后扣带回,楔前叶、顶下小叶、内侧前额叶及左侧额叶等脑区(P0.05)。难治性右侧颞叶癫痫(TLE)与患病病程呈正相关的脑区,主要分布于右侧的颞上回及左侧额下回区域;呈负相关的脑区,主要分布于内侧前额叶、右侧顶下小叶、左侧颞叶等脑区(P0.05)。结论难治性右侧TLE患者发作间期静息状态下存在广泛的脑功能网络异常,并与患者发病病程具有一定的相关性;ALFF分析法可以有效地反映癫痫患者异常的神经功能网络,有助于解释难治性TLE的病理生理机制。     

1H-MRS在颞叶癫痫中的应用进展

手术切除颞叶癫痫（temporal lobe epilepsy,TLE）的致痫灶具有良好的效果。1H-MRS作为一种非侵袭性的磁共振功能成像技术,成为近年来应用于癫痫研究的新方法。作者就1H-MRS在TLE中的应用进展进行综述。     

海马萎缩与头皮脑电相互矛盾1例分析

起源于颞叶的简单部分发作或复杂部分发作或继发性全身发作特征的癫痫称颞叶癫痫（temporal lobe epilepsy,TLE）。颞叶癫痫是最常见的难治性癫痫,目前认为颞叶切除术后效果好,也是治疗颞叶癫痫的首选方法Ⅲ。笔者收治1例海马萎缩与头皮脑电相互矛盾病例,分析如下。     

颞叶癫痫患者静息态fMRI功能连接强度的研究

目的采用基于全脑体素水平的静息态功能磁共振成像(restingstate functional magnetic resonance imaging,rs-f MRI)功能连接强度(functional connectivity strength,FCS)方法分析颞叶癫痫(temporal lobe epilepsy,TLE)患者脑网络水平改变。材料与方法对30例TLE患者(TLE组)和27名年龄、性别和受教育程度相匹配的健康志愿者(正常对照组)进行rs-f MRI数据采集及行为学测评。对rs-f MRI数据后处理,得到全脑FCS图。两组被试间年龄、受教育年限等各项临床基本资料以及各项神经心理学测评结果的差异采用双样本t检验进行比较,两组间性别的差异采用卡方检验进行比较。采用一般线性模型比较TLE组与正常对照组全脑FCS的差异。采用线性相关分析评价组间差异脑区的FCS值与行为学评分的关系。结果与正常对照组相比,TLE组在左侧颞上回、右侧颞上回、右侧额上回以及右侧额中回等脑区FCS值显著减低(P0.05,错误发现率法校正)。TLE患者贝克抑郁自评量表评分与右侧额上回FCS值呈负相关(r=-0.433,P=0.024);特质焦虑问卷评分与左侧颞上回FCS呈负相关(r=-0.434,P=0.024)。结论本研究发现TLE患者多个脑区的全脑功能连接强度明显降低,有助于进一步揭示颞叶癫痫发病的神经机制。     

Tractography of the parahippocampal gyrus and material specific memory impairment in unilateral temporal lobe epilepsy

INTRODUCTION: Temporal lobe epilepsy (TLE) is associated with disrupted memory function. The structural changes underlying this memory impairment have not been demonstrated previously with tractography. METHODS: We performed a tractography analysis of diffusion magnetic resonance imaging scans in 18 patients with unilateral TLE undergoing presurgical evaluation, and in 10 healthy controls. A seed region in the anterior parahippocampal gyrus was selected from which to trace the white matter connections of the medial temporal lobe. A correlation analysis was carried out between volume and mean fractional anisotropy (FA) of the connections, and pre-operative material specific memory performance. RESULTS: There was no significant difference between the left and right sided connections in controls. In the left TLE patients, the connected regions ipsilateral to the epileptogenic region were found to be significantly reduced in volume and mean FA compared with the contralateral region, and left-sided connections in control subjects. Significant correlations were found in left TLE patients between left and right FA, and verbal and non-verbal memory respectively. CONCLUSION: Tractography demonstrated the alteration of white matter pathways that may underlie impaired memory function in TLE. A detailed knowledge of the integrity of these connections may be useful in predicting memory decline in chronic temporal lobe epilepsy.     

Abnormalities of language networks in temporal lobe epilepsy

Functional magnetic resonance imaging (fMRI) in patients with temporal lobe epilepsy (TLE) has demonstrated reorganisation of language functions with greater involvement of the non-dominant hemisphere. The structural brain connections supporting this atypical language dominance have not previously been identified. We performed fMRI of language functions and imaging of white matter connections using MR tractography in 14 patients with unilateral TLE and hippocampal sclerosis and 10 controls. Verb generation and reading comprehension paradigms were used to define functional regions which were used to generate starting regions for tractography. Controls and right TLE patients had a left-lateralised pattern of both language-related activations and the associated structural connections. Left TLE patients showed more symmetrical language activations, along with reduced left hemisphere and increased right hemisphere structural connections. Subjects with more lateralised functional activation had also more highly lateralised connecting pathways. We provide evidence for structural reorganisation of white matter tracts that reflects the altered functional language lateralisation in left TLE patients. The combination of fMRI and tractography offers a promising tool for studying the reorganisation of language functions in many neurological conditions and may prove useful in predicting language deficits following temporal lobe surgery.     

2型糖尿病认知障碍患者的磁共振成像研究进展

2型糖尿病(type 2 diabetes mellitus,T2DM)会导致大脑结构和功能异常,增加认知障碍的风险.但是,目前我们对T2DM认知障碍发病机理仍不清楚.而磁共振成像研究的进展进一步确定了T2DM导致认知障碍的相关神经因素.我们系统地回顾了有关T2DM患者神经影像学改变的文献,这些改变包括结构、大脑功能以...     

静息态功能磁共振在颞叶癫痫的应用新进展

颞叶癫痫是成人最常见的局灶性癫痫。目前诊断癫痫的方法仍然以症状、电生理居多,脑电图检查中,发作期间的癫痫样放电是诊断癫痫的重要依据,但患者发作期较为短暂,捕捉异常脑电波信号具有一定困难,因此某种程度上,需要借助MRI进一步诊断。但仅依靠普通MRI检查在识别这些患者的癫痫发生区方面仍存在固有的困难。然而,借助改进的定位技术,颞叶癫痫通常可以正确识别。近年来,对于颞叶癫痫的研究已经转移到“功能”磁共振上。在“静止状态”下与大脑打交道。本文对目前可以分析颞叶癫痫患者静止状态的fMRI数据的诸多方法进行概述,包括低频振幅、基于种子的功能连接分析、区域同质性分析、独立成分分析、图分析等。      

应用度中心度方法研究不同病程颞叶癫痫患者脑网络与执行功能的关系

目的应用度中心度(degree centrality,DC)方法研究不同病程颞叶癫痫(temporal lobe epilepsy,TLE)患者全脑水平功能连接的改变,及其与执行功能的关系。材料与方法利用注意网络测试(attention network test,ANT)对21例病程≤5年、19例病程5年的TLE患者和30例健康对照组的执行功能进行研究;计算所有被试静息态功能磁共振(resting-state functional magnetic resonance imaging,rsf MRI)下的DC值图,提取差异脑区的DC值与执行控制反应效率进行相关性分析。结果患者组执行控制网络效率较对照组明显下降(P0.05)。与对照组相比,病程≤5年患者组DC降低的脑区位于右侧海马旁回,病程5年患者组DC降低的脑区位于右侧尾状核、左侧额叶,DC升高的脑区位于左侧中央前回、中央后回;病程5年患者组较病程≤5年患者组DC升高的脑区位于左侧岛叶(P0.01,Alphasim校正)。其中,病程5年患者组右侧尾状核DC值与执行控制网络效率成负相关(P0.05)。结论 TLE患者执行功能受损;不同病程患者脑区连接强度(点)有差异,不同病程患者执行功能与不同脑区连接有关,仅仅发现在病程较长患者部分脑区存在代偿作用,且尾状核的功能连接强度与执行功能有关。     

Voxel-by-voxel comparison of automatically segmented cerebral gray matter--A rater-independent comparison of structural MRI in patients with epilepsy.

Quantitative evaluation of MRI in patients with epilepsy can give more information than qualitative assessment. Previously developed volume-of-interest-based methods identified subtle widespread structural changes in the neocortex beyond the visualized lesions in patients with malformations of cortical development (MCD) and hippocampal sclerosis (HS) and also in MRI-negative patients with juvenile myoclonic epilepsy (JME). This study evaluates a voxel-based automated analysis of structural MRI in epilepsy. After fully automated segmentation of cerebral gray matter from structural T1-weighted, high-resolution MRI scans, we applied the automated and objective technique of statistical parametric mapping (SPM) to the analysis of gray matter of 35 control subjects, 10 patients with partial seizures and MCD, 10 patients with left temporal lobe epilepsy (TLE) and HS, 10 patients with left TLE and normal MR quantitation of the hippocampus, and 20 patients with JME. At a corrected threshold of P < 0.05, significant abnormalities were found in 3/35 controls; in all 10 patients with MCD, 6 of whom had additional lesions beyond the margins of the visualized abnormalities; in 2/10 TLE patients with HS; in 2/10 MRI-negative TLE; and in 4/20 JME patients. Group comparisons between control subjects and HS patients identified the affected left temporal lobe with an increase in gray matter in the posterior temporal lobe, but did not identify hippocampal atrophy. The group of MRI-negative TLE patients showed no abnormalities compared with control subjects. Group comparison between control subjects and JME patients identified a mesial frontal increase in gray matter. The SPM-based voxel-by-voxel comparison of gray matter distribution identified MCD and abnormalities beyond the visualized lesion in individual MCD patients. The method did not reliably identify HS in individual patients or identify abnormalities in individual MRI-negative patients with TLE or JME in a proportion larger than the chance findings in the control group. Using group comparisons, structural abnormalities in the neocortical gray matter of patients with TLE and HS were lateralized to the affected temporal lobe. In patients with JME as a group, an increase in gray matter was localized to the mesial frontal area, corroborating earlier quantitative MRI findings.     

Pannexins蛋白在颞叶癫痫患者脑组织中的表达及临床意义

目的:观察颞叶癫痫患者脑组织Pannexins蛋白(Panx1、Panx2)的表达,探索其在颞叶癫痫发病机制中的作用.方法:收集32例颞叶癫痫患者(实验组)和7例无癫痫病史的手术患者(对照组)的颞叶脑组织,采用免疫组化方法研究2组脑组织中的Panx1、Panx2蛋白的表达.结果:实验组与对照组比较,Panx1、Panx...     

The value of neuroimaging in diagnosis of epilepsy

Neuroimaging examines the relationship between abnormalities of brain function in epilepsy patients (seizures, impaired cognitive function, psychiatric co-morbidity etc.) and focal or more widespread brain pathology. Since the mid-1980s, the introduction of magnetic resonance imaging (MRI) into clinical neurology has had an impact on the diagnosis, treatment, and research of epilepsy only comparable with the advent of the electroencephalography (EEG) fifty years ago. MRI plays the important role of identifying single or multiple structural lesions responsible for the epileptic seizures. Thus, visual assessment of MRI plays an important role in the differentiation between symptomatic, cryptogenic, and idiopathic epilepsies. This diagnostic step leads to therapeutic decisions (medical treatment vs. surgery) and prognostic evaluations. If a structural lesion identified with MRI correlates with seizure-type, EEG and other clinical data, the likelihood of rendering the patient seizure free with epilepsy surgery is increased. Clinical research into epilepsy uses quantitative MRI (volumetry, T2-relaxometry, magnetic resonance spectroscopy [MRS], voxel-based morphometry) to reduce those cases initially labeled as cryptogenic. Quantitative MRI questions the belief that there is epilepsy without structural brain abnormality at all. Functional MRI (fMRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT) demonstrate changes associated with epileptic seizures and pathology, and changes associated with EEG abnormalities and their cessation. Functional neuroimaging is also used for the identification of functional brain tissue before surgery. Physiologically or pathologically active neuronal tissue is believed to be identified by glucose or oxygen consumption (PET), cerebral blood flow (PET, SPECT, perfusion MRI), and cerebral blood oxygenation (blood oxygenation level dependent [BOLD] fMRI). PET also offers the opportunity to visualize the in-vivo distribution of neuronal receptors which are implicated in the generation, the spread, and the cessation of seizures.