颞叶癫痫脑功能异常对抑郁障碍的影响

Effect of brain dysfunction in temporal lobe epilepsy on depressive disorder

目的:研究癫痫性脑功能异常对抑郁障碍产生的影响,以利于临床的早期识别和防治。方法:选择颞叶癫痫患者共36名,根据贝克抑郁自评量表及汉密尔顿抑郁量表评分,分为颞叶癫痫伴抑郁组18例及非抑郁组18例。入组患者均行视频脑电图(VEEG)、3.0T头核磁共振(MRI)、静息态功能磁共振(RS-f MRI)及磁共振波谱(MRS)检查,并对两组患者的各项检查资料进行分析。结果:两组患者的性别、年龄、发作频率比较差异无统计学意义(P>0.05),两组的癫痫病程比较差异有统计学意义(P<0.05)。VEEG检查颞叶的发作间期痫性放电(IEDs)的侧别、颞叶与颞叶伴颞叶外IEDs两组间比较差异有统计学意义(P<0.05),抑郁组左侧受累更多见。局部一致性、低频振幅、低频振幅分数(3种RS-fMRI分析方法)基于全脑水平的单样本t检验显示抑郁组脑激活区多于非抑郁组,且抑郁组中线结构的激活突出;两样本独立t检验结果显示,抑郁组比非抑郁组激活更增强的脑区涉及丘脑以及默认网络中的前额、楔前叶、腹前扣带回、海马等脑区。抑郁组MRS检查5/18例颞叶放电优势侧海马的NAA、NAA/Cho+Cr减低,且3/5例有海马萎缩;非抑郁组未发现明显异常。结论:颞叶癫痫病程长,放电累及颞叶外脑区、优势半球侧受累,海马结构功能异常及脑默认网络活动增强等因素与抑郁障碍的发生有关。

Objective： To study the effect of epileptic brain dysfunction on depression by analysing the brain electrical activity , brain structure and functional imaging data from patients with temporal lobe epilepsy （TLE）. Methods： According to Beck depression self rating scale and Hamilton depression rating scale score, 36 cases were divided to two groups： depression group 18 cases, non-depression group 18 cases. All patients underwent video-electroencephalogram （VEEG） and 3.0T magnetic resonance imaging （MRI） and resting-state functional magnetic resonance imaging （ RS-fMRI）as well as magnetic resonance spectroscopy （MRS） examination, and then analyzing examination data of the two groups. Results： There were no significant differences in sex, age, seizure frequency between the two groups （P〉0.05）, the duration of epilepsy was different （P〈0.05）. Statistically significant differences were found in interictal epileptiform discharges （IEDs） which was restricted to temporal lobe or spread to other brain lobe including temporal lobe between the two groups in VEEG examination, and the advantage side of discharge （P 〈0.05）, the patients in depression group whose IEDs with left side advantage were more than non-depression group . Single sample t test based on whole brain level from local consistency, low frequency amplitude and low frequency amplitude fraction （three kinds of RS-fMRI analysis methods） showed that the active area in the brain in the depression group was more than the non- depression group, and the middle line structures was activated. Compared with the non-depression group, test results showed that stronger activate brain regions were included the thalamus and the frontal area, the preeuneus,the anterior cingulate cortex, the hippocampus which belonged to default-mode network. The NAA and NAA/Cho ＋Cr in the hippocampus of the ipsilateral dominant side of discharge were decreased in 5/18 patients with depression in MRS and 3/5 patients with hippoeampal atrophy, while the non-depression group had no such abnormalities. Conclusion： Factors such as the longer duration of TLE, discharge involving the multiple brain lobes and advantages hemisphere , abnormal structure and function of hippocampus and strength of brain default-mode network activity may be related to the occurrence of depression.