颞叶癫痫中全面强直阵挛发作的大脑结构变化基础

发布时间：2018-06-18 23:05

  本文选题：全面强直阵挛发作 + 颞叶内侧面癫痫　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:伴海马硬化的颞叶内侧面癫痫(temporal lobe epilepsy with hippocampal sclerosis,TLE-HS)是常见的耐药性局灶性癫痫,而继发性全面强直阵挛发作(secondary generalized tonic-clonic seizures,sGTCS)严重威胁着癫痫患者的人身安全和生活质量。本文旨在比较TLE-HS患者中伴和不伴sGTCS两组间的大脑皮层和皮层下结构的灰质体积差异,以探究TLE-HS患者发生sGTCS的潜在机制。方法:本文连续性纳入2014年4月至2016年6月在我院神经内科癫痫门诊就诊的单侧TLE-HS患者作为研究对象。利用统计参数成像8软件(Statistical Parametric Mapping 8,SPM8)对患者的3DT1图像进行大脑皮层的基于体素的形态学分析(voxel-based morphometric analysis,VBM),利用 FSL 软件对患者的 3DT1 图像进行皮层下结构(丘脑和基底节)的基于顶点的形态分析(vertex-wise shape analysis)。在本研究中,我们先比较单侧TLE-HS患者中伴或不伴有sGTCS两组间的皮层和皮层下灰质结构差异,再比较药物可治性sGTCS组与药物难治性sGTCS组两个亚组间的皮层和皮层下灰质结构差异。结果:本研究共收集到39例单侧TLE-HS患者,平均年龄为31.2±9.7岁,平均病程为15.6±10.4年,其中21例(53.8%)伴有sGTCS。相较于无sGTCS组,sGTCS组在同侧的腹侧苍白球(团块体素大小450 mm3,p校正=0.047)、内侧丘脑(团块体素大小1128 mm3,p校正=0.049)、额中回(团块体素大小60mm3,p校正0.05)及对侧的后扣带回(团块体素大小130 mm3,p校正0.05)有区域性的萎缩。相较于药物可治性sGTCS组,药物难治性sGTCS组在同侧的内侧丘脑(团块体素大小1240mm3,p校正=0.014)有更明显的区域性萎缩。结论:在TLE-HS患者中,丘脑和苍白球在sGTCS产生的病理生理机制中发挥了重要作用。
[Abstract]:Objective: temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) with hippocampal sclerosis (TLE-HS) is a common drug-resistant focal epilepsy, and secondary comprehensive tonic clonic seizures (secondary generalized tonic-clonic seizures, sGTCS) threatened personal safety and quality of life in epileptic patients. This article is aimed at this article. To compare the gray matter volume difference between the cerebral cortex and subcortical structures of the TLE-HS patients with and without sGTCS two in order to explore the potential mechanism of sGTCS in TLE-HS patients. Methods: the continuity of this article was included in the unilateral TLE-HS patients in the epilepsy clinic of the neurology department of our hospital from April 2014 to June 2016. The digital imaging 8 software (Statistical Parametric Mapping 8, SPM8) carries out a voxel based morphological analysis of the cerebral cortex (voxel-based morphometric analysis, VBM) of the patient's 3DT1 image (voxel-based morphometric analysis, VBM). The morphological analysis of the subcortical structure (the thalamus and base floor) of the patient's 3DT1 image is analyzed by FSL software (vertex-wise) Analysis. In this study, we compared the cortical and subcortical gray matter structure differences between the two groups of the unilateral TLE-HS patients with or without sGTCS two, and then compared the cortical and subcortical gray matter structure differences between the drug treatable sGTCS group and the two subgroups of the drug refractory sGTCS group. The average age was 31.2 + 9.7 years, and the average course of disease was 15.6 + 10.4 years, of which 21 cases (53.8%) were compared with sGTCS. without sGTCS. Group sGTCS was on the same side of the ventral pallidus (mass size 450 mm3, P corrected =0.047), medial thalamus (lump volume 1128 mm3, P correction = 0.049), middle frontal gyrus (lump volume 60mm3, P correction 0.05) and contralateral rear. The cingulate gyrus (mass 130 mm3, P correction 0.05) had regional atrophy. Compared to the drug treatable sGTCS group, the drug refractory sGTCS group had a more obvious regional atrophy in the ipsilateral medial thalamus (mass 1240mm3, P corrected =0.014). Conclusion: in TLE-HS patients, the thalamus and globus pallidus were produced in the pathophysiology machine of sGTCS. The system plays an important role.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1
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本文编号：2037175