伴中央颞区棘波儿童良性癫痫脑自发活动的静息态功能磁共振研究

发布时间：2018-05-11 23:26

  本文选题：伴中央颞区棘波儿童良性癫痫 + 静息态功能磁共振　； 参考：《浙江大学》2014年博士论文

【摘要】：伴中央颞区棘波良性儿童癫痫(Benign epilepsy with centrotemporal spikes, BECTS),是临床上最为常见的儿童癫痫综合征之一。传统的观点认为,BECTS有着良好的预后,故也被称为儿童“良性”癫痫。但是,现代神经影像学的发展,尤其是功能性磁共振(Functional Magnetic Resonance Imaging, fMRI)技术为癫痫研究提供了无创的高空间分辨率的工具,已经有越来越多的结果表明有相当一部分患儿存在不同程度的认知及脑功能损伤。 近年兴起的静息态功能磁共振(Resting-state fMRI, rs-fMRI)技术,有别于传统的基于外在任务刺激的功能磁共振范式,它以探究脑内在自发活动。静息态功能磁共振技术具有无创、高分辨和简便易行的优点,为研究癫痫,特别是儿童癫痫的特征性脑自发活动提供了独特的机遇。 在本研究中,我们采用基于局部特征研究的功能磁共振数据分析方法对伴中央颞区棘波良性儿童癫痫患儿的癫痫活动进行描绘。首先,基于癫痫活动表现为局部神经活动同步性异常增高的电生理特性,我们采用局域一致性分析方法,观察癫痫活动引起的血氧水平代谢信号局部一致性的改变；其次,基于癫痫活动异常的高波幅脑电发放的特性,我们采用低频振幅分析的方法观察间期癫痫活动引起的血氧水平代谢信号振幅的改变。最后,利用血氧水平代谢信号改变的局部特征期望达到癫痫活动的检测。本研究希望促进静息态功能磁共振成像在癫痫临床方面的应用,以及加深对癫痫病理生理机制的认识。本论文共分三部分。第一部分伴中央颞区棘波儿童良性癫痫的静息态功能磁共振局部一致性研究 目的： 基于癫痫活动表现为局部神经元活动同步性增高的电生理特征,我们尝试采用局域一致性分析的静息态功能磁共振成像技术,对伴中央颞区棘波儿童良性癫痫患儿癫痫活动相关的血氧水平信号的局域一致性改变进行观察。方法： 30例伴中央颞区棘波儿童良性癫痫患儿参与了本研究,在3.0特斯拉的磁共振仪下进行了静息态功能磁共振数据采集。采用局域一致性分析的方法对这些功能磁共振成像数据进行分析,通过与20例健康儿童做对照分析,检测血氧水平代谢信号局域一致性改变的脑区。结果： 组间比较发现,BECTS患儿在双侧中央前回,右侧中央后回,右侧缘上回,左侧额上回,左侧额下回和顶上回的局域一致性值显著高于正常对照组；而在双侧颞叶,双侧眶额区和壳核的局域一致性值显著低于正常对照组。并且左侧额上回局域一致性值与病程成显著正相关关系。 结论： 本研究利用静息态fMRI信号的局域一致性,发现BECTS患者在中央区和前额区的ReHo值显著提高；而患儿在边缘系统的局域一致性值显著降低,暗示着患者的感觉整合功能受损。本研究对理解BECTS病患的神经生理学机制提供新的解释。 第二部分伴中央颞区棘波儿童良性癫痫的脑自发活动静息态功能磁共振研究 目的： 基于癫痫活动异常的高波幅脑电发放的特性,并可引起血氧水平依赖信号的改变的生理基础,本研究尝试采用基于低频振幅(ALFF)分析的静息态功能磁共振成像技术,对这些癫痫相关的血氧水平信号振幅改变进行观察。 方法： 30例伴中央颞区棘波儿童良性癫痫患儿参与了本研究,在3.0特斯拉的磁共振仪下进行了静息态功能磁共振数据采集。采用低频振幅的方法对这些功能磁共振成像数据进行分析,通过与20例健康儿童做对照分析,检测血氧水平代谢信号局域一致性改变的脑区。 结果： 组间比较发现,BECTS患者在双侧中央前回,右侧中央后回,右侧缘上回,右侧额叶和右侧苍白球的ALFF值显著高于正常对照组；而在左侧小脑,右侧颞下回,右侧额下回,左侧直回,左侧顶上回和左侧枕中回的ALFF值显著低于正常对照组。 结论： 本研究利用静息态fMRI低频振幅方法,探测BECTS患者BECTS病人自发神经活动异常的脑区。我们的结果表明显著低频振幅值增高的脑区主要集中在中央区。而且中央区的低频振幅值与总智商和操作智商和病程有关。这些发现暗示发作间期癫痫放电导致BECTS病人自发神经活动改变,右侧中央前回与弱的操作能力有关。 第三部分伴中央颞区棘波儿童良性癫痫患者的致癫灶个体静息态 fMRI定位研究 目的： 基于癫痫活动异常的高波幅脑电发放的特性,并可引起血氧水平依赖信号的改变的生理基础,针对未检测到患儿癫痫样放电,本研究尝试采用低频振幅(ALFF)1对多分析技术,并达到伴中央颞区棘波儿童良性癫痫活动的个体检测。 方法： 30例伴中央颞区棘波儿童良性癫痫患儿参与了本研究,在3.0特斯拉的磁共振仪下进行了静息态功能磁共振数据采集。采用低频振幅的方法对这些功能磁共振成像数据进行1对多(20例健康儿童)的个例分析,以评价低频振幅对癫痫活动的临床癫痫活动定侧能力。 结果： 组间比较发现,传统广义线性模型(GLM)方法等定位43%的癫痫样放电患者,而采用ALFF一对多的方法也能定位43%患者。但是,ALFF方法能定位53%的未检出癫痫样放电的患者。 结论： 本研究利用ALFF采用1对多参数检验统计方法来定位个体BECTS病人的脑自发活动异常脑区。结果显示,ALFF定位方法效果和传统GLM方法一致,此外,它还能能定位数据采集过程中没发生放电的癫痫患者。本研究为癫痫定位提供了新的补充手段。
[Abstract]:It is one of the most common children ' s epilepsy syndrome in clinic . The traditional point of view is that there is a good prognosis for the children , which is called " benign " epilepsy . However , the development of modern neuroimaging , especially the functional magnetic resonance imaging ( MRI ) , has provided a noninvasive high spatial resolution tool for epilepsy research , and there are more and more results showing that there are quite a few children with different degrees of cognition and brain function damage .

In recent years , the technique of resting state functional magnetic resonance ( rs - fmri ) is different from the traditional functional magnetic resonance paradigm based on external task stimulation . It has the advantages of non - invasive , high resolution and simple and easy operation , and provides unique opportunity for studying the characteristic brain spontaneous activity of epilepsy , especially children ' s epilepsy .

In this study , we used the functional magnetic resonance data analysis method based on local features to describe the seizure activity in children with benign epilepsy in the central temporal region . First , based on the electrophysiological characteristics of the abnormal increase of local neural activity , the local consistency analysis method was used to observe the changes of local consistency of blood oxygen level metabolic signals caused by seizure activity .
Secondly , based on the characteristics of high - amplitude EEG distribution , we use low - frequency amplitude analysis to observe the changes of the amplitude of blood - oxygen level metabolic signal caused by interval seizure activity . Finally , we hope to promote the application of resting - state functional magnetic resonance imaging in the clinical aspect of epilepsy and to deepen the understanding of the physiological mechanism of epilepsy .

Purpose :

Based on the electrophysiological characteristics of the increased synchronization of local neuronal activity in epileptic activity , we attempted to observe the local coherence of the blood oxygen level signal related to the seizure activity in children with benign epilepsy in children with central temporal region , using the static state functional magnetic resonance imaging technique of local consistency analysis .

Thirty patients with benign epilepsy with central temporal spikes participated in the study . The magnetic resonance data were collected under the magnetic resonance instrument of 3.0 Tesla . These functional magnetic resonance imaging data were analyzed by local coherence analysis .

Compared with the control group , the local consistency between the two groups was significantly higher than that in the normal control group .
The local consistency values of bilateral temporal lobe , bilateral orbital frontal area and shell nucleus were significantly lower than those of the normal control group .

Conclusion :

In this study , we found that the ReHo values in the central and forehead regions were significantly improved by using the local consistency of the resting - state MRI signals .
This study provides a new explanation for understanding the neurophysiology mechanism of patients with BECDs .

A study of the resting state function of the brain spontaneous activity in the second part with benign epilepsy in the central temporal region of the temporal region

Purpose :

Based on the characteristics of high amplitude brain electrical distribution in epileptic activity , and can cause the physiological basis of the change of blood oxygen level dependent signal , this study attempts to observe the change of blood oxygen level signal amplitude related to these epilepsy by using the static state functional magnetic resonance imaging technique based on low frequency amplitude ( ALFF ) analysis .

Method :

Thirty patients with benign epilepsy with central temporal spikes participated in the study . The magnetic resonance imaging data were collected under the magnetic resonance instrument of 3.0 Tesla . These functional magnetic resonance imaging data were analyzed by the method of low frequency amplitude . By contrast analysis with 20 healthy children , the brain regions with changes of local coherence of blood oxygen level were detected .

Results :

Compared with the control group , the ALFF values of the right frontal lobe and the right side were significantly higher than those of the normal control group .
The ALFF value was significantly lower in the left cerebellum , the right temporal gyrus , the right frontal gyrus , the left straight back , the left parietal gyrus , and the left occipital gyrus .

Conclusion :

The results showed that the low - frequency amplitude in the central region was mainly concentrated in the central region , and the low - frequency amplitude of the central region was related to the total IQ and the course of the course .

The third part is accompanied by the resting state of epileptic foci in patients with benign epilepsy in the central temporal region of the temporal region .

A Study on the Localization of MRI

Purpose :

Based on the characteristics of high amplitude brain electrical distribution in epileptic activity , and the physiological basis of the change of blood oxygen level dependent signal , this study attempted to use low frequency amplitude ( ALFF ) 1 to analyze multi - analysis technique and achieve the individual detection of benign epilepsy activity of children with central temporal region .

Method :

Thirty patients with benign epilepsy with central temporal spikes were involved in the study . Magnetic resonance data were collected under the magnetic resonance instrument of 3.0 Tesla . Individual analysis of these functional magnetic resonance imaging data was carried out by using low frequency amplitude method .

Results :

It was found that the traditional generalized linear model ( GLM ) method was used to locate 43 % of patients with epilepsy , while the ALFF method could be used to locate 43 % of patients . However , the ALFF method could position 53 % of patients with no epilepsy - like discharges .

Conclusion :

The results showed that ALFF was consistent with the traditional GLM method . In addition , it was able to locate epileptic patients with no discharge during data acquisition . This study provides new supplementary means for the localization of epilepsy .

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R742.1

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本文编号：1876120