首发原发性癫痫患者治疗前后的脑静息态功能磁共振对比研究

发布时间：2018-06-19 02:13

  本文选题：原发性癫痫 + 静息态功能磁共振成像　； 参考：《内蒙古医科大学》2017年硕士论文

【摘要】：目的应用静息态功能磁共振成像(rfMRI)技术,采用低频振幅比率分析方法(fALFF)研究首发原发性复杂部分性发作(CPS)的癫痫患者在治疗前后的脑局部自发活动特征,探讨首发原发性癫痫患者治疗前后的脑功能改变情况及其与抗癫痫药物临床疗效的关系。方法收集2015年6月-2016年6月内蒙古医科大学附属医院神经内科诊断为原发性复杂部分性发作(CPS)患者14例,对符合标准的14例CPS患者和14例性别、年龄、利手、受教育程度相匹配的正常对照分别进行MRI检查,全部被试均采用GE Discovery 750 3.0T超导型磁共振扫描仪采集数据。常规序列包括常规轴位T2WI、T1WI,以排除颅内器质性病变,功能序列包括T1-3D BRAVO、静息态BOLD,患者组规律用药,治疗12周后再次检查。对病例组治疗前后的数据及健康对照组的数据进行数据预处理,计算其全脑fALFF值,然后治疗前后分别与健康对照行双样本t检验(two sample t-test),结果叠加在标准avg152T1像上进行显示,取阈值P=0.001(未校正),经过Alphasim校正,去除少于25个体素的区域(校正后P0.001),得到两组被试f ALFF统计差异脑图。结果fALFF值治疗前较正常对照组显著增高的脑区为双侧丘脑、后扣带回及左侧角回、顶下小叶;显著降低的脑区为双侧内侧前额叶、前扣带回。治疗后与对照组发现双侧丘脑异常激活脑区消失,双侧后扣带回、左侧角回异常激活脑区减小,而左侧顶下小叶激活脑区范围变大,另外发现于双侧额叶、楔前叶、左侧楔叶有新激活脑区(P0.001,簇大小≥25个体素数)。结论1、fALFF可观测原发性癫痫患者治疗前后的脑功能改变情况,为临床客观评价治疗情况及抗痫药物的疗效提供新的见解,也对其病理生理机制的进一步研究开辟新的思路。2、首发原发性癫痫患者静息状态下存在广泛异常激活及抑制脑区,与以往文献的观点一致,被认为是癫痫发病的神经基础。3、经12周抗癫痫治疗后,CPS患者部分异常脑区恢复正常,提示原发性癫痫的脑功能异常变化可经抗癫痫治疗逆转。4、治疗后发现小部分未逆转区及略扩大的左侧顶下小叶激活区,其病理生理学机制还需我们进一步探讨。
[Abstract]:Objective to study the characteristics of spontaneous brain activity in epileptic patients with primary complex partial seizure (CPS) before and after treatment with resting functional magnetic resonance imaging (fMRI) technique and the method of low-frequency amplitude ratio analysis (LAPR). To investigate the changes of brain function in patients with primary epilepsy before and after treatment and its relationship with the clinical efficacy of antiepileptic drugs. Methods from June 2015 to June 2016, 14 patients with CPS diagnosed by Department of Neurology, affiliated Hospital of Inner Mongolia Medical University, and 14 patients with CPS who met the criteria were collected. All subjects were examined by MRI using GE Discovery 7503.0T superconducting magnetic resonance scanner. Routine sequences included routine axial T _ 2WI _ T _ 1WI to exclude intracranial organic lesions. Functional sequences included T1-3D Bravo, resting BOLDD, regular medication in the patient group, and re-examination after 12 weeks of treatment. The data of patients before and after treatment and those of healthy control group were pretreated and the whole brain fALFF values were calculated. Two sample t-tests were performed before and after treatment, and the results were displayed on the standard avg152T1 images. The threshold value P0. 001 (uncorrected) was removed by Alphasim correction to remove less than 25 individual elements (P0. 001), and the difference brain map was obtained between the two groups. Results the significantly increased fALFF values were bilateral thalamus, posterior cingulate gyrus and left angular gyrus, inferior parietal lobule, and bilateral medial prefrontal lobe and anterior cingulate gyrus. After treatment and control group, bilateral thalamic abnormal activation brain disappeared, bilateral posterior cingulate gyrus decreased, left angle gyrus decreased, while left inferior parietal lobule became larger, and bilateral frontal lobe and prewedge lobe were also found. In the left cuneate lobe, there was a newly activated brain area (P0.001) with cluster size 鈮，

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