左乙拉西坦对伴中央颞区棘波的儿童良性癫痫脑活动影响的静息态功能磁共振成像评价

Effect of levetiracetam in benign childhood epilepsy with centro-temporal spikes:a resting-state f MRI study based on amplitude of low frequence fluctuation

目的:采用基于静息态脑功能成像的低频振荡振幅(ALFF)算法,观察左乙拉西坦(LEV)治疗对伴中央颞区棘波的儿童良性癫痫(BECTS)的脑活动影响和作用机制。方法:纳入22例服用LEV的BECTS、22例未服药的BECTS和22名年龄和性别匹配的正常儿童,均在3T MRI仪器下采集fMRI数据,经数据预处理后,应用SPM8软件的方差分析比较三组被试的ALFF改变,并与癫痫病程、起病年龄及用药时间等临床指标进行相关分析。结果 :与正常儿童对照组比较,未治疗BECTS组和LEV治疗BECTS组的双侧Rolandic区ALFF均增加,而与未治疗BECTS组比较,LEV治疗BECTS组的双侧Rolandic区ALFF减低。未治疗BECTS组左侧中央前/后回和额下回ALFF值与其病程呈正相关,LEV治疗BECTS组左侧中央前回和右侧额上回与其用药时间呈负相关,左侧楔前叶和右侧颞中回与其用药时间呈正相关。结论:未经治疗的BECTS异常放电脑区内在脑活动增加,而LEV治疗可使其脑活动减低,并且可以影响语言、注意力和默认模式网络(DMN)的相关脑区,从静息态功能成像角度证实了LEV治疗BECTS的有效性。

Objective： To use amplitude of low frequence fluctuation（ALFF） to evaluate the brain functional change of benign childhood epilepsy with eentro-temporal spikes （BECTS） and the influence of levetiracetam （LEV） on BECTS. Methods： Twenty-two BECTS treated with LEV, twenty-two BECTS with no treatment and twenty-two age and sex-matched healthy children were included to preform functional magnetic resonance imaging （fMRI）. After data preprocessing, the difference of ALFF among the three groups was obtained by the analysis of variance, and their correlation with clinical index were report- ed. Results： Compared to the healthy group, the ALFF of bilateral Rolandic areas in both untreated group and the LEV group were increased. And compared to the non-treatment group, the ALFF of bilateral Rolandie areas in the LEV group were decreased. The ALFF of left precentral/postcentral gyrus and left inferior frontal gyms showed positive correlation with the duration of untreated BECTS, while the left precentral gyrus and the right superior frontal gyrus showed negative correlation with the duration of the LEV effects and the left precuneus and right middle temporal gyrus showed a positive correlation with the duration of the LEV effects in LEV group. Conclusion： The discharge areas of BECTS in brain show increased activities, and LEV can effectively reduce the intrinsic brain activity in these areas of BECTS and impact on the areas about language, attention and default mode network（DMN）. These evidences based on fMRI show that LEV is useful in the treatment of BECTS.