耐药性内侧颞叶癫痫患者的功能影像磁共振研究

Functional magnetic resonance imaging study of drug-resistant medial temporal lobe epilepsy

目的采用功能磁共振功能连接密度(FCD)探索耐药与否的内侧颞叶癫痫患者脑功能活动的差异,并分析其与病程的相关性。方法采用回顾性研究方法,收集从2009年7月至2019年2月在东部战区总医院(南京大学医学院附属金陵医院)就诊的单侧海马硬化的内侧颞叶癫痫患者共146例,根据2010年国际抗癫痫联盟对耐药性癫痫的定义将其分为药物控制组(73例)和耐药组(73例)。对所有受试者均进行3.0 T静息态功能磁共振扫描,比较两组患者FCD的差异,并计算两组患者FCD差异脑区FCD值和病程的相关性。结果药物控制组和耐药组内侧颞叶癫痫患者的FCD显示出广泛差异。相比于药物控制组,耐药组在致痫灶侧岛叶、豆状核、丘脑、海马、中央前回FCD值明显降低。耐药组致痫灶侧楔前叶FCD值与病程呈负相关(r=-0.30,P=0.010)。结论耐药性内侧颞叶癫痫患者较药物控制组FCD值广泛降低,此外大脑可能存在进行性损伤,影像学差异有利于探究内侧颞叶癫痫患者耐药相关的病理生理机制,寻找可靠的耐药相关的神经影像标志物。

Objective To explore the changes of brain activity in drug-resistant or drug-controlled medial temporal lobe epilepsy patients by the method of functional connectivity density(FCD),and to analyze their correlation with the course of the disease.Methods According to the definition of drug-resistant epilepsy by the International League Against Epilepsy in 2010,146 patients with medial temporal lobe epilepsy who were clearly diagnosed as unilateral hippocampal sclerosis in Jinling Hospital,Nanjing University School of Medicine from July 2009 to February 2019 were divided into drug control group(n=73)and drug-resistant group(n=73).The 3.0 T resting state functional magnetic resonance scan was performed on all subjects to compare the difference in FCD between the two groups,and calculate the correlation between the FCD value of the brain area and the course of the disease between the two groups of patients.Results There was significant difference between the two groups in FCD.Compared with the drug control group,the drug-resistant group had significantly lower FCD values in the insula,lenticular nucleus,thalamus,hippocampus and precentral gyrus on the side of the epileptogenic focus.The FCD value of the precuneus on the side of the epileptogenic focus in the drug-resistant group was negatively correlated with the duration(r=-0.30,P=0.01).Conclusions The FCD of patients with drug-resistant medial temporal lobe epilepsy was lower than that of the drug control group.In addition,there may be progressive damage to the brain.The difference is helpful for exploring the pathophysiological mechanisms related to drug resistance in patients with medial temporal lobe epilepsy,and finding reliable neuroimaging markers related to drug resistance.