静息态功能MRI评估常规MRI未见异常难治性癫痫患儿的研究

Resting state functional MRI study of refractory epilepsy in children with routine MRI negative

目的探讨MRI未见异常难治性癫痫(ITE)患儿的功能连接强度(FCS)变化,并评价其与病程和智商(IQ)的相关性。方法对15例ITE患儿、24例非难治性癫痫(NITE)患儿和25例健康儿童(HCS)进行静息态功能磁共振成像(rs-fMRI)检查。IQ评定采用神经心理测评。在整个大脑中进行协方差分析,然后使用Bonferroni校正进行3组之间的配对比较。结果3组间FCS差异有统计学意义。与HCS相比,ITE患者右侧颞上回、中回、双侧楔前叶等部位FCS降低,左侧额下回三角部、海马旁回、辅助运动区、尾状回、右侧距骨裂及周围皮质和中脑FCS增高。NITE组右侧眶上回、楔前回等部位FCS降低,双侧梭形回、海马旁回等部位FCS增高,右侧额上回、左侧颞下回FCS降低,右侧额中回、额下回、距骨裂及周围皮质FCS增高。相关分析显示,左侧尾状核FCS与言语智商(VIQ)、病程相关。结论ITE患者的额叶和颞叶FCS值较NITE患者明显改变,这可能与癫痫的耐药性有关。左侧尾状核的FCS与VIQ相关,提示尾状核可能成为改善ITE儿童认知障碍和癫痫发作的关键靶点。

Objective To investigate the changes of functional connection strength(FCS)in children with MRI-negative refractory epilepsy(ITE),and to evaluate its correlation with disease duration and IQ.Methods rsfMRI was performed in 15 children with ITE,24 children with non-intractable epilepsy(NITE)and 25 healthy children(HCS).IQ was assessed by neuropsychological measures.A covariance analysis was performed across the brain and then paired comparisons between the three groups were performed using Bonferroni correction.Results The FCS difference among the three groups was statistically significant.Compared with HCS,FCS were decreased in the right superior temporal gyrus,middle gyrus and bilateral anterior cuneiform lobes in ITE patients,while FCS were increased in the left inferior frontal triangle,parahippocampal gyrus,auxiliary motor area,caudate gyrus,right talus fissure,peripheral cortex and midbrain.In NITE group,FCS decreased in the right superior orbital gyrus and anterior cuneiform gyrus,increased in bilateral fusiform gyrus and parahippocampal gyrus,decreased in the right superior frontal gyrus and left inferior temporal gyrus,and increased in the right middle frontal gyrus,inferior frontal gyrus,talus fissure and surrounding cortex.Correlation analysis showed that left caudate FCS was associated with verbal intelligence(VIQ)and disease course.Conclusion The FCS values of frontal and temporal lobes in ITE patients were significantly changed compared with those in NITE patients,which may be related to drug resistance in epilepsy.FCS in the left caudate nucleus are associated with VIQ,suggesting that the caudate nucleus may be a key target for improving cognitive impairment and seizures in ITE children.