难治性癫痫患者脑网络效率的变化研究

目的 运用图论分析法探讨难治性癫痫患者脑网络效率的改变.方法 回顾性纳入2015年10月至2016年6月安徽医科大学附属省立医院神经外科收治的26例难治性癫痫患者（癫痫组）,另纳入同期招募的26名健康志愿者（健康对照组）.采集两组受试者静息态功能磁共振成像（fMRI）数据,使用GRETNA软件中Network Construction模块进行数据预处理得到脑网络的矩阵,运用Network Analysis模块进行脑网络分析,得到网络效率属性,以连接矩阵稀疏度（Sparsity）为阈值,并在阈值为0.05≤Sparsity≤0.40范围内比较两组的脑网络效率.结果 癫痫组与健康对照组的年龄、性别及受教育程度的差异均无统计学意义（均P ＞0.05）,而癫痫组患者的蒙特利尔认知评估量表（MoCA）评分较健康对照组显著偏低[分别为（19.6±2.7）分、（26.8±3.6）分,P=0.026].癫痫组患者全局网络效率在阈值为0.11≤Sparsity≤0.18范围下明显低于健康对照组（P＜0.05）,且在0.05≤Sparsity≤0.40范围内比较两组的局部网络效率均值发现,癫痫组患者除右侧海马较健康对照组局部效率降低外（P＜0.05）,右侧岛叶、左侧岛盖部额下回、左侧颞下回、左侧枕上回、右侧苍白球等脑区局部效率增高（均P＜0.05）.结论 难治性癫痫患者全局网络效率在一定阈值范围内明显低于健康受试者,并且局部脑区的局部效率出现异常,可能是难治性癫痫患者相关临床症状的神经网络基础.     

难治性颞叶癫痫患者脑功能网络节点的度属性研究

目的联合静息态功能磁共振成像(fMRI)技术和图论分析法从复杂网络节点度的角度探究难治性颞叶癫痫((ITLE)患者的脑功能改变。方法采集15例ITLE患者和15例正常被试的功能磁共振数据,应用软件GRETNA中Network Construction模块进行数据处理得到相应网络矩阵,而后采用Network Analysis模块分析其度属性,最后进行组间两独立样本t检验以得到存在差异的脑区。结果与正常对照组相比,ITLE组左侧背外侧额上回、左侧岛叶、双侧后扣带回、双侧海马、右侧杏仁核、左侧楔前叶、双侧苍白球、双侧颞上回的度值均发生了改变。结论难治性颞叶癫痫患者部分脑区的度属性发生了改变,这些脑区可能参与构成了其临床症状的神经基础。     

难治性癫痫患者楔前叶功能连接的静息态功能磁共振成像研究

目的应用静息态功能磁共振成像(rs-f MRI)探讨难治性癫痫患者楔前叶与全脑功能连接的改变及其意义。方法对23例难治性癫痫患者(癫痫组)及23名健康人(对照组)进行rs-f MRI检查,采集数据后采用功能连接的方法,分别计算以左侧楔前叶和右侧楔前叶为感兴趣区与全脑的功能连接,运用双样本t检验的统计学方法发现两组的显著性差异并进行分析。结果癫痫组左侧楔前叶与双侧顶下小叶、双侧岛叶、右侧缘上回、右侧额中回和双侧额下回的功能连接较对照组减弱(均P0.05);癫痫组左侧楔前叶与双侧海马旁回、双侧额上回、左侧后扣带回的功能连接较对照组增强(均P0.05)。癫痫组右侧楔前叶与左侧顶下小叶、右侧缘上回、右侧额中回、右侧额下回的功能连接较对照组减弱(均P0.05);癫痫组右侧楔前叶与双侧楔叶、左侧后扣带回的功能连接较对照组增强(均P0.05)。结论难治性癫痫患者静息状态下楔前叶与全脑的功能连接存在异常,"默认网络"功能的抑制可能是癫痫患者意识及认知等功能损害的重要原因。     

难治性癫痫患者脑默认网络结构连接的 DTI 研究

目的利用DTI探究难治性癫痫患者脑默认网络(DMN)神经纤维结构连接的变化情况及其意义。方法对2017年12月至2018年4月安徽医科大学附属省立医院癫痫外科收治的13例难治性癫痫患者(癫痫组)及同时期招募的14名健康人(健康对照组)进行DTI和T_1像磁共振数据采集。利用概率性纤维追踪技术获得DMN脑区间纤维束连接的分数各向异性(FA)值、横向扩散系数(RD)值,并构成DMN结构网络。比较癫痫组与健康对照组DMN结构连接的差异。结果与健康对照组相比,癫痫组患者DMN纤维束连接FA值普遍下降,RD值升高,差异有统计学意义(均P0.05)。结论难治性癫痫患者的DMN结构网络的神经纤维整合性和连通性明显下降,髓鞘受到破坏。这可能是导致患者DMN功能连接异常,并出现环境监控、记忆提取、社会认知、自我控制等能力障碍的重要原因。     

药物难治性癫痫患者脑内多种耐药基因表达的初步研究

目的研究药物难治性癫痫患者与正常对照组脑内多种药物耐药基因（ＭＤＲ１）表达的情况。方法　选择１５例药物难治性癫痫患者和５例对照组患者的脑组织标本,用逆转录聚合酶链反应（ＲＴ－ＰＣＲ）技术,以Ｂ－ａｃｔｉｎ为内参照对ＭＤＲ１基因进行扩增,经琼脂糖凝胶电泳分别得到２２６ｂｐ和５４８ｂｐ的条带,通过照相、扫描、计算ＭＤＲ１／ｂ－ａｃｔｉｎ比值进行半定量分析。结果统计学处理提示,药物难治性癫痫患者脑内ＭＤＲ１的表达明显高于对照组（Ｐ＜０．０１）。结论　Ｐ－糖蛋白为ＭＤＲ１的产物,能将药物从脑内排入血循环而降低脑内药物浓度。药物难治性癫痫患者因脑内ＭＤＲ１的高表达,导致脑内抗癫痫药物（ＡＥＤ）浓度较低而耐药。故应用ＭＤＲ１抑制剂也许可以提高ＡＥＤ在脑内的药物浓度,使癫痫的药物治疗效果更令人满意。     

胼胝体切开术对难治性癫痫患者认知功能的影响

目的 探讨胼胝体切开术对难治性癫痫患者认知功能的影响.方法 46例难治性癫痫患者按是否接受胼胝体切开术治疗分为手术组(24例)及对照组(22例);手术组给予胼胝体切开术及抗癫痫药物治疗,对照组仅给予抗癫痫药物治疗;6个月后根据治疗前后发作频率的变化评价疗效,治疗前及治疗后6个月时采用韦氏智力量表及事件相关电位P300评价两组患者的认知功能.结果 (1)手术组总有效率(83.3％)显著高于对照组(9.1％)(P＜0.01);(2)与术前比较,手术组术后智商(IQ)、言语及操作评分均明显提高(P＜0.05 ～0.01),P300潜伏期明显缩短、波幅明显提高(均P＜0.01);对照组IQ及P300潜伏期及波幅与治疗前比较差异无统计学意义.结论 胼胝体切开术可有效地治疗难治性癫痫,同时也改善患者的认知功能.     

难治性癫痫患者脑内MDR1的表达

研究发现大约有三分之一的癫痫患者对抗癫痫药物产生耐药反应。其中又有近60%的患者为难治性癫痫。这类药物难治性癫痫患者的耐药可能机制为脑内多药转运体的过高表达从而导致脑实质内药物浓度的下降。多药耐药基因1(multidrug resistance gene1MDR1)其编码蛋白PGP(P-glycoprotein)是脑内重要的多药转运体。本实验通过逆转录聚合酶链反应(RT-PCR),免疫组织化学和免疫蛋白印记的方法,对12例药物难治性癫痫患者脑内癫痫灶与12例对照组标本的MDR1表达进行研究。1资料与方法1.1研究对象12例药物难治性癫痫患者,均经过适当的抗癫痫药物正规…     

深部脑刺激治疗药物难治性癫痫的研究现状

癫痫是一种短暂性脑神经异常放电引起人体机能出现异常的一种疾病,该疾病目前已然波及全球5 000万余人,人们通常使用药物控制发作,尽管引入了各种新型抗癫痫发作药物(Anti-seizure medications,ASMs),仍有约1/3的患者无法通过ASMs正规治疗得到有效控制,进而发展为药物难治性癫痫(Drug-resistant epilepsy,DRE),持续的癫痫发作会对患者的身体、心理、家庭以及社会造成严重的负担。随着神经外科对立体定向技术的逐步深入研究,研究发现深部脑刺激(Deep brain stimulation,DBS)是一种广泛应用于精神和神经疾病的有效治疗手段,目前,DBS在治疗帕金森病(Parkinson’s disease,PD)方面已取得良好成效,同时该技术的可调节性、可逆性及良好的安全性促使人们通过DBS对精神神经系统疾病进行更深入的研究。目前世界各地已有一定数量的患有不同精神障碍或神经障碍的患者接受DBS治疗,其运用于DRE也得到了良好疗效,本文就DBS的神经调控机制、相关靶点、副作用及研究现状作如下概述,以期对DRE的治疗提供治疗新思路。     

功能磁共振成像在难治性癫痫的研究进展

近年来脑功能磁共振成像(fMRI)发展较快,对癫痫的研究,特别在难治性癫痫的病因诊断、痫灶定位、癫痫手术术前方案制定等方面的应用研究获得了重大进展。可用于检出微小或特殊的致痫灶如皮质发育障碍、微小动静脉畸形、动脉瘤和肿瘤等,更多用于术前脑功能的定位,术中癫痫灶的切除范围,术后功能恢复预测等。     

特发性全面性癫痫患儿中央执行网络的静息态fMRI研究

目的 探讨特发性全面性癫痫(IGE)患儿中央执行网络(CEN)的功能连接变化。方法 选取遵义医科大学附属医院2014年1月至2016年9月收治的24例IGE患儿与28例正常志愿者,进行T₂-FLAIR、rs-fMRI扫描。采用组独立成分分析(GICA)提取左侧CEN、右侧CEN进行分析。结果 与对照组比较,IGE组CEN功能连接降低的脑区包括双侧颞中回、枕中回及左侧颞下回;功能连接增高的脑区包括双侧顶下缘角回、双侧角回、双侧缘上回及左侧顶上回。相关性分析发现左侧角回与言语智商呈正相关。结论 IGE患儿核心认知网络CEN功能连接异常与认知能力损害有关。     

Treatment-related changes in functional connectivity in brain tumor patients: a magnetoencephalography study

Widespread disturbances in resting state functional connectivity between remote brain areas have been demonstrated in patients with brain tumors. Functional connectivity has been associated with neurocognitive deficits in these patients. Thus far, it is unknown how (surgical) treatment affects functional connectivity. Functional connectivity before and after tumor resection was compared in primary brain tumor patients. Data from 15 newly diagnosed brain tumor patients were analyzed. Patients underwent tumor resection, and both preoperative (up to five months prior to surgery) and postoperative (up to ten months following surgery) resting state magnetoencephalography (MEG) recordings. Seven of the patients (47%) underwent radiotherapy after neurosurgery. Functional connectivity was assessed by the phase lag index (PLI), a measure of the correlation between MEG sensors that is not sensitive to volume conduction. PLIs were averaged to one short-distance and two long-distance (interhemispheric and intrahemispheric) scores in seven frequency bands. We found that functional connectivity changed in a complex manner after tumor resection, depending on frequency band and functional connectivity type. Post-hoc analyses yielded a significant decrease of interhemispheric PLI in the theta band after tumor resection. This result proved to be robust and was not influenced by radiotherapy or a variety of tumor- and patient-related factors.     

Deep brain stimulation in patients with refractory temporal lobe epilepsy

PURPOSE: This pilot study prospectively evaluated the efficacy of long-term deep brain stimulation (DBS) in medial temporal lobe (MTL) structures in patients with MTL epilepsy. METHODS: Twelve consecutive patients with refractory MTL epilepsy were included in this study. The protocol included invasive video-EEG monitoring for ictal-onset localization and evaluation for subsequent stimulation of the ictal-onset zone. Side effects and changes in seizure frequency were carefully monitored. RESULTS: Ten of 12 patients underwent long-term MTL DBS. Two of 12 patients underwent selective amygdalohippocampectomy. After mean follow-up of 31 months (range, 12-52 months), one of 10 stimulated patients are seizure free (>1 year), one of 10 patients had a >90% reduction in seizure frequency; five of 10 patients had a seizure-frequency reduction of > or =50%; two of 10 patients had a seizure-frequency reduction of 30-49%; and one of 10 patients was a nonresponder. None of the patients reported side effects. In one patient, MRI showed asymptomatic intracranial hemorrhages along the trajectory of the DBS electrodes. None of the patients showed changes in clinical neurological testing. Patients who underwent selective amygdalohippocampectomy are seizure-free (>1 year), AEDs are unchanged, and no side effects have occurred. CONCLUSIONS: This open pilot study demonstrates the potential efficacy of long-term DBS in MTL structures that should now be further confirmed by multicenter randomized controlled trials.     

Changes in brain functional network connectivity after stroke简

Studies have shown that functional network connection models can be used to study brain net- work changes in patients with schizophrenia. In this study, we inferred that these models could also be used to explore functional network connectivity changes in stroke patients. We used independent component analysis to find the motor areas of stroke patients, which is a novel way to determine these areas. In this study, we collected functional magnetic resonance imaging datasets from healthy controls and right-handed stroke patients following their first ever stroke. Using independent component analysis, six spatially independent components highly correlat- ed to the experimental paradigm were extracted. Then, the functional network connectivity of both patients and controls was established to observe the differences between them. The results showed that there were 11 connections in the model in the stroke patients, while there were only four connections in the healthy controls. Further analysis found that some damaged connections may be compensated for by new indirect connections or circuits produced after stroke. These connections may have a direct correlation with the degree of stroke rehabilitation. Our findings suggest that functional network connectivity in stroke patients is more complex than that in hea- lthy controls, and that there is a compensation loop in the functional network following stroke. This implies that functional network reorganization plays a very important role in the process of rehabilitation after stroke.     

拉莫三嗪治疗顽固性癫痫的临床观察

对３０例顽固性癫痫病人进行拉莫三嗪开放添加剂治疗。为期三个月。以后仍服用，剂量１００－４００ｍｇ／ｄ３０例患者总的癫痫发作次数减少４６％，１３％完全控制。拉莫三嗪对控制各类癫痫发作均有效，总显效率达６７％，不良反应较少，主要是变态反应性皮疹，停药后消失，实验室检查完全正常。     

Interictal activity is an important contributor to abnormal intrinsic network connectivity in paediatric focal epilepsy

Patients with focal epilepsy have been shown to have reduced functional connectivity in intrinsic connectivity networks (ICNs), which has been related to neurocognitive development and outcome. However, the relationship between interictal epileptiform discharges (IEDs) and changes in ICNs remains unclear, with evidence both for and against their influence. EEG‐fMRI data was obtained in 27 children with focal epilepsy (mixed localisation and aetiologies) and 17 controls. A natural stimulus task (cartoon blocks verses blocks where the subject was told “please wait”) was used to enhance the connectivity within networks corresponding to ICNs while reducing potential confounds of vigilance and motion. Our primary hypothesis was that the functional connectivity within visual and attention networks would be reduced in patients with epilepsy. We further hypothesized that controlling for the effects of IEDs would increase the connectivity in the patient group. The key findings were: (1) Patients with mixed epileptic foci showed a common connectivity reduction in lateral visual and attentional networks compared with controls. (2) Having controlled for the effects of IEDs there were no connectivity differences between patients and controls. (3) A comparison within patients revealed reduced connectivity between the attentional network and basal ganglia associated with interictal epileptiform discharges. We also found that the task activations were reduced in epilepsy patients but that this was unrelated to IED occurrence. Unexpectedly, connectivity changes in ICNs were strongly associated with the transient effects of interictal epileptiform discharges. Interictal epileptiform discharges were shown to have a pervasive transient influence on the brain's functional organisation. Hum Brain Mapp 38:221–236, 2017. © 2016 Wiley Periodicals, Inc.