VEEG结合RS-fMRI对儿童良性癫痫伴中央颞区棘波患者的认知功能研究

发布时间：2018-03-07 22:27

本文选题：儿童良性癫痫伴中央颞区棘波　切入点：长时程视频脑电图　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的应用长程视频脑电(VEEG)及静息态功能磁共振成像(RS-fMRI)技术,研究儿童良性癫痫伴中央颞区棘波(BECTS)患者认知功能障碍的影响因素及脑功能网络的改变,探讨其认知功能损害的神经网络机制。方法收集于2015年4月至2017年3月就诊于天津医科大学总医院癫痫门诊及功能神经外科病区符合国际抗癫痫联盟(ILAE)2010年所制定的癫痫和癫痫综合征分类中有关BECTS诊断标准的25例患者,均为右利手且能配合整个检查过程。根据纳入及排除标准,最终入组22例患者,均行长程VEEG监测(至少包括一个完整睡眠周期),计算出慢波睡眠期棘慢波放电指数(SWI)并将其按SWI高低分为两组:SWI50%组(10例)及SWI≥50%组(12例),其中SWI50%组男6名,女4名,平均年龄(11.3±4.3)岁;SWI≥50%组男7名,女5名,平均年龄(9.9±3.0)岁。所有入组患者均行中国修订版韦氏智力量表评估及头颅MRI、RS-fMRI检查。应用MATLAB(2013a)平台下SPM8分析软件对RS-fMRI数据进行预处理及预处理后数据采用REST软件从局部一致性(ReHo)、低频振幅(ALFF)、低频振幅分数(fALFF)三种分析方法分别进行全脑水平单样本t检验和两独立样本t检验,并结合其临床资料、脑电图及认知功能测评结果进行综合对比分析。结果两组患者的年龄、性别、首发年龄、病程、总发作次数、受教育程度比较差异无统计学意义(P0.05)。SWI≥50%组患者的总智商(FIQ)、语言智商(VIQ)、操作智商(PIQ)均低于SWI50%组患者,比较差异有统计学意义(P0.05)。其中,VIQ子项目测试中的算术、词汇评分差异更明显,PIQ子项目测试中的填图、积木、图形拼凑评分差异更明显(P0.05)。FIQ、VIQ、PIQ分别与SWI呈负相关(P0.05),而与年龄、首发年龄、病程、总发作次数、受教育程度之间无相关性(P0.05)。从ReHo、ALFF、fALFF三种分析方法基于全脑水平单样本t检验结果显示SWI≥50%组脑激活区明显多于SWI50%组,除皮层激活增多外,中线结构激活突出;两独立样本t检验结果显示SWI≥50%组较SWI50%组异常激活增强的脑区包括双侧中央前回、运动前区及其皮质下结构,双侧前额叶,双侧颞叶前部,双侧岛叶,前扣带回(P0.05),激活减弱的脑区包括后扣带回、双侧颞下回后部、双侧枕叶、双侧小脑(P0.05)。结论1、BECTS患者慢波睡眠期频繁的异常放电是造成其语言、操作等认知功能受损的主要危险因素;2、BECTS患者在静息状态下,慢波睡眠期SWI高的其fMRI异常激活增强或减弱的脑区尚包括Rolandic区以外的区域,如前额叶、枕叶、岛叶、小脑、扣带回及基底神经核,提示慢波睡眠期频繁异常放电可导致脑局部神经元的异常活动,影响正常脑网络的形成并导致信息传递功能受损,这为我们理解并进一步研究BECTS患者合并高级神经功能包括认知、情绪、行为等活动障碍,提供了一个新的思路和研究方向,并为我们早期发现BECTS患者高级神经功能受损,早期给予辅导或药物治疗,预防及减轻脑损伤,提高BECTS患者生活质量提供了理论基础。3、BECTS患者除皮层功能受损外,尚发现皮层下结构如丘脑、壳核、尾状核等静息状态下的异常活动,其可能在癫痫发病及合并认知功能障碍上发挥着一定的作用,提示我们在今后的研究中,不应只关注皮层结构的异常,还应同时关注皮层下结构在癫痫发病及合并认知功能障碍中的作用。
[Abstract]:Objective to use long-term video EEG (VEEG) and resting state functional magnetic resonance imaging (RS-fMRI) technology, the research of benign childhood epilepsy with centrotemporal spikes (BECTS) change factors and brain functional network effects in patients with cognitive impairment, to explore the cognitive impairment of neural network mechanism. Methods from April 2015 to March 2017 in General Hospital Affiliated to Tianjin Medical University from epilepsy clinic department of Neurosurgery Ward and function in line with the International League Against Epilepsy (ILAE) of 25 patients developed epilepsy and epilepsy in 2010 about the diagnostic criteria of BECTS syndrome in the classification, were right-handed and can cooperate with the whole inspection process. According to the inclusion and exclusion criteria, 22 patients were enrolled in the final, both President VEEG monitoring (including at least one complete sleep cycle), calculated during slow wave sleep spike wave discharge index (SWI) and its SWI level divided into two groups: group SWI50% (10 cases SWI = 50%) and group (12 cases), SWI50% group male 6, female 4, average age (11.3 + 4.3); SWI = 50% group male 7, female 5, average age (9.9 + 3) years old. All patients underwent Chinese revised Wechsler Intelligence Scale the assessment form and head MRI, RS-fMRI examination. The application of MATLAB (2013a) platform SPM8 analysis software of pretreatment and pretreatment on RS-fMRI data using REST software from the local consistency (ReHo), low frequency amplitude (ALFF), fractional amplitude of low frequency (fALFF) three methods were all brain levels of single sample t test and two independent samples t test, and combined with the clinical data, analysis of EEG and cognitive function evaluation results were compared. Results of the two groups in age, gender, age of onset, course of disease, the total number of attacks, there was no significant difference between the level of Education (P0.05) total IQ.SWI more than 50% groups (FIQ), verbal IQ (VIQ), performance IQ (PIQ) were lower than SWI50% group, the difference was statistically significant (P0.05). Among them, the VIQ project in the test arithmetic, lexical score difference is more obvious, the PIQ project in the test blocks, mapping, graphics together score more obvious differences (P0.05).FIQ, VIQ, PIQ were negatively correlated with SWI (P0.05), and with age, age of onset, course of disease, the total number of attacks, there is no correlation between the level of Education (P0.05). From ReHo, ALFF, fALFF three kinds of analysis method of whole brain level based on a single sample t test showed that SWI = 50% group of activated brain regions were more than those in group SWI50% in addition, increased cortical activation, activation of midline prominent; two independent sample t test showed that SWI = 50% group than in SWI50% group of abnormal brain activation enhanced bilateral precentral gyrus, the premotor cortex and subcortical structures, prefrontal cortex, bilateral anterior temporal lobe, bilateral insula, anterior cingulate (P0 .05), including the activated brain region decreases the posterior cingulate, bilateral temporal gyrus, bilateral occipital lobe, bilateral cerebellum (P0.05). Conclusion: 1 BECTS patients with abnormal discharge, slow wave sleep stage frequently is the language, the main risk factors such as impaired cognitive function operation; 2 patients in the resting state, BECTS next, the slow wave sleep stage SWI high fMRI abnormal brain activation is increased or decreased including Rolandic area outside the region, such as the prefrontal cortex, occipital lobe, insula, cingulate gyrus and cerebellum, basal ganglia, suggesting that during slow wave sleep frequent abnormal discharge can lead to abnormal brain activity local neurons, influence normal brain network formation and cause the information transfer function is damaged, this is our understanding and further study of BECTS in patients with advanced neural function including cognition, emotion, behavior disorder and other activities, provides a new idea and research direction, and it is found that the BEC for our early TS patients with advanced nerve function damage, early counselling or medical treatment, prevention and mitigation of brain injury, and provide a theoretical basis to improve the quality of life of patients with.3, BECTS, BECTS in patients with cortical dysfunction, it is found that the subcortical structures such as the thalamus, putamen, caudate nucleus and other abnormal activity in resting state, which may play a certain the role in the pathogenesis of epilepsy and combined with cognitive dysfunction, we suggest that in the future, should not only pay attention to abnormal cortical structures, but also pay attention to role of subcortical structures in the pathogenesis of epilepsy and cognitive dysfunction in the merger.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

【参考文献】