利用脑局部一致性方法对儿童全身强直发作性癫痫的研究

目的　应用静息态功能磁共振局部一致性方法研究儿童全身强直发作性癫痫患者脑区异常活动,探讨其发生的病理生理机制。 方法　对8例儿童全身强直发作性癫痫患者和30例正常儿童进行磁共振扫描,并计算全脑局部一致性的值,进行组间比较并研究局部一致性与病程的相关性。 结果　与对照组相比,癫痫组ReHo值增高的脑区为大脑深部核团（扣带回,丘脑,楔前叶等）,运动相关脑区,额下回,枕叶,颞叶和小脑;ReHo值降低的脑区为双侧额中回、右侧颞中回、左侧颞上回、双侧中央后回、左侧舌回。全身强直发作性癫痫与病程呈正相关的脑区为左侧楔前叶、左侧顶上小叶、右侧中央前回、右侧中央后回;与病程呈负相关的脑区为右侧楔前叶、右侧角回、中央旁小叶。 结论　局部一致性分析方法可以有效地反映癫痫患者异常的神经功能变化,有助于发现强直发作性癫痫发生的病理生理机制。     

基于ReHo方法的大学生网络成瘾静息功能磁共振成像研究

目的:探讨网络成瘾大学生静息状态脑功能特点。方法:采用ReHo分析方法 ,19名网络成瘾大学生及19名对照进行磁共振脑功能成像,比较两组平均脑ReHo图的差异。结果:IAD组ReHo值升高区域主要集中在小脑、脑干、扣带回(右侧)、双侧海马旁回、右侧额叶(直回,额中回及额下回)、左侧额上回、左侧楔前叶、右侧中央后回、右侧枕中回、右侧颞下回、左侧颞上回及颞中回;ReHo降低的区域仅表现在左侧顶叶的楔前叶。结论:网络成瘾大学生局域一致性存在异常,大部分脑区同步性增强,小脑、脑干、边缘叶、额顶叶同步性增强可能与网络成瘾奖赏通路有关。     

初发颞叶癫痫患者的静息态功能磁共振ReHo研究

癫痫是一种常见的神经内科疾病,伴有沉重的经济负担和社会资源的消耗。颞叶癫痫(TLE)是其中的重要类型。本研究采用局部区域一致性(ReHo)分析方法来探索初发TLE患者的脑部功能变化,发现TLE患者相较于正常对照区域一致性值升高的区域位于左侧岛叶,右侧扣带回;而健康对照区域一致性值高于患者的区域位于右侧壳核。但这些区域一致性值改变与抑郁量表得分无相关性。结果提示与癫痫症状相关的脑区在初发患者静息状态下已经出现了改变,并提示了皮层-丘脑-纹状体环路的改变。本次实验为初步探索初发TLE患者的病理生理学机制提供证据。     

静息态脑功能技术对平衡针治疗中枢机制的分析应用

背景：平衡针治疗疾病疗效显著,但缺乏相关现代科学理论机制。 目的：利用静息态脑功能成像技术探讨平衡针疗法的中枢作用机制。 方法：纳入10例腰椎间盘突出腰腿痛患者及10例正常受试者,于平衡针针刺前后进行功能磁共振扫描,通过AFNI软件对与双侧杏仁核表现为显著联系的脑区进行功能连接分析,并对平衡针刺后腰椎间盘突出患者及正常受试者的脑功能连接的差异进行探讨。 结果与结论：经平衡针治疗后10例腰椎间盘突出患者疼痛均有好转。脑功能连接分析显示腰椎间盘突出患者丘脑、脑干、腹前核、腹外侧核、额内侧回、额上回、额叶眶上回、额下回、颞上回、颞中回、海马回、扣带回、岛叶等脑区功能连接增强。正常受试者双侧颞中回、双侧眶上回、双侧尾状核头、双侧岛叶、左侧腹背侧核、双侧额上回、左侧额中回、前扣带回、右侧顶下小叶与杏仁核连接增强;双侧小脑齿状核、小脑蚓、左侧小脑坡、双侧舌回、左侧枕中回、右侧额上回、右侧中央前回、双侧顶下小叶、右侧顶上小叶、右侧中央后回与杏仁核连接下降。提示通过静息脑功能成像技术对杏仁核的研究有助于更深入理解平衡针灸治疗腰腿痛的中枢机制。     

fMRI颞叶癫痫默认模式网络的研究

许多功能磁共振研究已经发现人脑的一些皮层区域在静息状态下出现共激活,这些区域形成连通的功能网络,称为"默认模式网络".本文研究颞叶癫痫患者的默认模式网络,运用独立成分分析(Independent component analysis)分离出12例颞叶癫痫患者和12例正常对照的默认模式网络,进行组内分析得到两组被试的统计图,进行组间分析比较两组被试的默认模式网络的差异.结果 表明默认模式网络均存在于颞叶癫痫患者和正常对照中,然而,在默认模式包含的网络中,颞叶癫痫患者前扣带回腹侧(ventral anterior cingulated cortex,vACC)、前额中分(medial prefrontal cortex,MPFC)、楔前叶(precuneus)、以及海马旁回区域比正常对照表现出代谢增强.这一结果有助于从脑功能的角度了解癫痫患者某些临床症状的发病机理,为今后癫痫诊治的发展提供一定的帮助.     

精神分裂症患者吸烟的静息态功能磁共振研究

目的:精神分裂症患者高吸烟率的原因尚不明确,静息态功能磁共振是一个比较好的工具来探索该现象的神经影像学机制。方法:采用局部一致性(Regional homogeneity,ReHo)的方法比较吸烟精神分裂症患者和不吸烟精神分裂症患者,以及不吸烟精神分裂症患者和正常不吸烟对照者之间的静息态功能磁共振(fMRI)图像。结果:设P0.001,与不吸烟精神分裂症患者相比,吸烟精神分裂症患者在左内侧额回ReHo值下降,左侧小脑后叶与左侧舌回ReHo值升高,且吸烟精神分裂症患者左侧小脑后叶的ReHo值与患者每日吸烟支数显著相关(r=0.635,P=0.027);与正常不吸烟对照组相比,不吸烟精神分裂症患者双侧内侧额回、右侧颞叶、左侧楔叶ReHo值升高,右侧前扣带回、双侧中央后回、双侧丘脑ReHo值下降。结论:吸烟精神分裂症患者存在左侧小脑后叶,左内侧额回与左侧舌回的局部一致性异常,此发现可能有助于我们探索精神分裂症患者人群吸烟的脑影像学机制。     

颞叶癫痫患者全脑皮层厚度分析

观察并探讨颞叶癫痫(TLE)患者脑皮层厚度变化。 对71例颞叶癫痫患者(左侧癫痫组40例、右侧癫痫组31例)及17名健康对照组进行三维扰相梯度回波序列(3D-SPGR)扫描,采集数据通过Freesurfer软件进行大脑模型重建;再利用Brainstorm软件配准、平滑,以双样本独立t检验分别比较癫痫组与对照组,和癫痫组间皮层厚度的差异,并将具有统计学意义(P<0.01)的区域在标准脑模板上标注显示。 结果显示,与正常组比较,癫痫组均出现部分颞叶及颞叶意外脑区皮层厚度增大的现象,但异常脑区存在不同(左侧27个,右侧11个);癫痫组间比较,左侧癫痫组患者在左侧额下回眶部皮层增厚现象更为明显。 颞叶癫痫患者的情感及认知等障碍可能与多个脑区皮层增厚的问题有关。     

脑结构形态学改变是精神分裂症的遗传内表型

目的 通过对首发精神分裂症患者及其未患病同胞的磁共振成像脑结构分析,探讨遗传因素对脑结构改变的影响程度,为发现精神分裂症的遗传内表型提供实验依据.方法 采用优化的基于体素的形态学研究方法对15例首发精神分裂症患者、19名首发精神分裂症患者未患病同胞及38名正常对照的大脑磁共振图像进行处理,采用一般线性模型进行统计分析.结果 与正常对照组相比,患者组在双侧颢叶、双侧枕叶、左侧岛叶、左侧额叶额上回及右豆状核苍白球灰质有明显减少;在双侧顶叶及双侧边缘叶扣带回灰质增加;未患病同胞组在右侧颞叶、双侧枕叶、左侧岛叶及左侧额叶中央前回等区域灰质明显减少;在左侧顶叶及双侧小脑后叶灰质增加.患者较同胞左侧顶叶楔前叶灰质有增加,未发现两者其他区域存在明显差异.结论 精神分裂症患者及其同胞存在相似的脑结构异常,遗传因素可能是导致精神分裂症脑结构异常的重要因素,提示脑结构形态学改变是精神分裂症的遗传内表型.     

双相障碍患者脑灰质体积变化性别差异性研究

目的:寻找不同性别双相障碍患者灰质体积减少脑区差异,探讨不同性别患者临床表现差异性的病理学机制。方法:以26位女性正常人、26例女性双相障碍患者、25位男性正常人、24例男性双相障碍患者作为研究对象,匹配年龄、受教育程度等。进行头部结构磁共振扫描,对平滑后的灰质图像进行双样本t检验,分析不同性别双相障碍患者灰质体积减少的脑区。结果:与女性对照组相比,女性双相障碍患者右侧舌回、右侧楔叶、右侧枕中回、右侧扣带回后部、右侧中央前后回脑区体积下降。与男性对照组相比,男性双相障碍患者体积下降的脑区包括右侧颞上回、右侧颞中回、右侧海马旁回、右侧额中回、右侧额下回、右侧楔前叶、右侧顶下小叶及右侧小脑后叶。结论:双相障碍患者体积下降脑区具有性别差异性,男性患者体积下降的脑区多在右侧颞叶皮层以及额叶及小脑后叶,而女性患者体积下降脑区多在右侧枕叶皮层以及扣带回后部及中央前后回脑区;这种差别可能与双相障碍患者临床表现的性别差异有关。     

单、双侧正中神经刺激法作额－顶导联SEP检测脑内病变的研究

本研究提示双侧刺激法作ＳＥＰ异常检出率（８７％），高于单侧法（７６％），双侧法更适合检测脑叶病灶和小病灶。发现基底节区和顶叶是ＳＥＰ早成分最重要的神经结构，丘脑皮质投射有两条不同的传导途径，故额—顶导联有助于鉴别脑内不同部位病灶，其倾向为基底节区病灶基本为额—顶ＳＥＰ异常，中央沟前病灶多为额ＳＥＰ异常，而中央沟后病灶大多为顶区ＳＥＰ异常。ＳＥＰ早成分异常不但与病灶部位有关，也与深感觉受损有关，病灶大小也影响ＳＥＰ的完整性，纯运动障碍和浅感觉异常可以引起ＳＥＰ晚成分的异常。     

Impaired attention network in temporal lobe epilepsy: A resting FMRI study

Attention deficit is a common symptom in the patient with mesial temporal lobe epilepsy (mTLE). Although presumption has been proposed by the previous study that mTLE may have impaired attention networks, no fMRI study has addressed the alteration of the dorsal attention network in mTLE. Twenty-four patients with bilateral mTLE and the same number of gender- and age-matched healthy controls participated in the current fMRI study. The resting-state network corresponding to the dorsal attention network (DAN) was extracted by using independent component analysis (ICA) from each participant. Functional connectivity in the DAN was then compared between the patients and controls. In addition, the scores of Trail Making Test (TMT) in the patients were correlated to the z-score of the voxels showing significant difference between the two groups. Compared with the controls, the patients with mTLE presented decreased functional connectivity in almost all the regions within the DAN. Moreover, there were negative correlations between the TMT scores and the z-scores in the voxels showing decreased or increased functional connectivity in mTLE. Our results suggested that the alteration of DAN might underpin the impairment of top-down attention function in mTLE. Our fMRI study may contribute to the understanding of neuro-pathophysiological mechanism of attention impairments in patients with mTLE.     

Association Between the Basal Ganglia and Large-Scale Brain Networks in Epilepsy

Epilepsy may affect connectivity between the putamen and cortex even during the resting state. Putamen is part of the basal ganglia resting state network (BG-RSN) which is anti-correlated with the default mode network (DMN) in healthy subjects. Therefore, we aimed at studying the functional brain connectivity (FC) of the putamen with the cortical areas engaged in the DMN as well as with the primary somatomotor cortex which is a cortical region engaged in the BG-RSN. We compared the data obtained in patients with epilepsy with that in healthy controls (HC). Functional magnetic resonance imaging (fMRI) was performed in 10 HC and 24 patients with epilepsy: 14 patients with extratemporal epilepsy (PE) and 10 patients with temporal epilepsy (PT). Resting state fMRI data was obtained using the 1.5 T Siemens Symphony scanner. The Group ICA of fMRI Toolbox (GIFT) program was used for independent component analysis. The component representing the DMN was chosen according to a spatial correlation with a mask typical for DMN. The FC between the putamen and the primary somatomotor cortex was studied to assess the connectivity of the putamen within the BG-RSN. A second-level analysis was calculated to evaluate differences among the groups using SPM software. In patients with epilepsy as compared to HC, the magnitude of anti-correlation between the putamen and brain regions engaged in the DMN was significantly lower. In fact, the correlation changed the connectivity direction from negative in HC to positive in PE and PT. The disturbed FC of the BG in patients with epilepsy as compared with HC was further illustrated by a significant decrease in connectivity between the left/right putamen and the left/right somatomotor cortex, i.e. between regions that are engaged in the BG-RSN. The FC between the putamen and the cortex is disturbed in patients with epilepsy. This may reflect an altered function of the BG in epilepsy.     

Increased Functional MEG Connectivity as a Hallmark of MRI-Negative Focal and Generalized Epilepsy

Epilepsy is one of the most prevalent neurological diseases with a high morbidity. Accumulating evidence has shown that epilepsy is an archetypical neural network disorder. Here we developed a non-invasive cortical functional connectivity analysis based on magnetoencephalography (MEG) to assess commonalities and differences in the network phenotype in different epilepsy syndromes (non-lesional/cryptogenic focal and idiopathic/genetic generalized epilepsy). Thirty-seven epilepsy patients with normal structural brain anatomy underwent a 30-min resting state MEG measurement with eyes closed. We only analyzed interictal epochs without epileptiform discharges. The imaginary part of coherency was calculated as an indicator of cortical functional connectivity in five classical frequency bands. This connectivity measure was computed between all sources on individually reconstructed cortical surfaces that were surface-aligned to a common template. In comparison to healthy controls, both focal and generalized epilepsy patients showed widespread increased functional connectivity in several frequency bands, demonstrating the potential of elevated functional connectivity as a common pathophysiological hallmark in different epilepsy types. Furthermore, the comparison between focal and generalized epilepsies revealed increased network connectivity in bilateral mesio-frontal and motor regions specifically for the generalized epilepsy patients. Our study indicated that the surface-based normalization of MEG sources of individual brains enables the comparison of imaging findings across subjects and groups on a united platform, which leads to a straightforward and effective disclosure of pathological network characteristics in epilepsy. This approach may allow for the definition of more specific markers of different epilepsy syndromes, and increased MEG-based resting-state functional connectivity seems to be a common feature in MRI-negative epilepsy syndromes.     

Functional and Structural Alterations in Temporal Lobe Tumor Patients: Evidence of Functional Compensation in the Human Brain

Patients with temporal lobe tumor are frequently accompanied by cognitive impairments. This study aims to combine diffusion tensor imaging(DTI) with resting-state functional magnetic resonance image(fMRI) to explore the underlying cognitive alternation and functional reorganization in patients with temporal lobe tumor.Twenty patients with right temporal lobe tumor and seventeen healthy volunteers were recruited in this study. Independent component analysis(ICA) was utilized to divide the whole brain into six sub functional networks, and DTI combined with graph-based topological analysis was used to calculate the structural properties of whole-brain and sub functional networks. Besides, the rich hubs in both patients and healthy controls(HCs)were identified and a further analysis of their internal functional and structural connectivity was also conducted. The E_(global) in self-referential network(SRN) of patients is higher than HCs, while decreased E_(global) of dorsal attention network(DAN) and default mode network(DMN) were found in patients. For the patients, brain regions with increased nodal efficiency(E_(nodal)) were located in the frontal lobe(corresponding to SRN). Six identical hubs were found in two groups. Compared patients with HCs, significant between-group differences in both functional and structural connectivity were observed between right insula(INS.R) and right lenticular nucleus, putamen(PUT.R). The findings provide evidence that impaired cognition are closely related to functional and structural abnormalities and the compensatory roles of frontal lobe were also identified in patients.The proposed combination of DTI and f MRI promises a widespread utilization in clinical research on the mechanisms of neurological diseases.     

Prestimulus hemodynamic activity in dorsal attention network is negatively associated with decision confidence in visual perception

Attention is thought to improve most aspects of perception. However, we recently showed that, somewhat surprisingly, endogenous attention can also lead to low subjective perceptual ratings (Rahnev et al., 2011). Here we investigated the neural basis of this effect and tested whether spontaneous fluctuations of the attentional state can lead to low confidence in one's perceptual decision. We measured prestimulus functional magnetic resonance imaging activity in the dorsal attention network and used that activity as an index of the level of attention involved in a motion direction discrimination task. Extending our previous findings, we showed that low prestimulus activity in the dorsal attention network, which presumably reflected low level of attention, was associated with higher confidence ratings. These results were explained by a signal detection theoretic model in which lack of attention increases the trial-by-trial variability of the internal perceptual response. In line with the model, we also found that low prestimulus activity in the dorsal attention network was associated with higher trial-by-trial variability of poststimulus peak activity in the motion-sensitive region MT+. These findings support the notion that lack of attention may lead to liberal subjective perceptual biases, a phenomenon we call "inattentional inflation of subjective perception."     

Morpho-Physiologic Characteristics of Dorsal Subicular Network in Mice after Pilocarpine-Induced Status Epilepticus

The goal of this study was to examine the morpho-physiologic changes in the dorsal subiculum network in the mouse model of temporal lobe epilepsy using extracellular recording, juxtacellular and immunofluorescence double labeling, and anterograde tracing methods. A significant loss of total dorsal subicular neurons, particularly calbindin, parvalbumin (PV) and immunopositive interneurons, was found at 2 months after pilocarpine-induced status epilepticus (SE). However, the sprouting of axons from lateral entorhinal cortex (LEnt) was observed to contact with surviving subicular neurons. These neurons had two predominant discharge patterns: bursting and fast irregular discharges. The bursting neurons were mainly pyramidal cells, and their dendritic spine density and bursting discharge rates were increased significantly in SE mice compared with the control group. Fast irregular discharge neurons were PV-immunopositive interneurons and had less dendritic spines in SE mice when compared with the control mice. When LEnt was stimulated, bursting and fast irregular discharge neurons had much shorter latency and stronger excitatory response in SE mice compared with the control group. Our results illustrate that morpho-physiologic changes in the dorsal subiculum could be part of a multilevel pathologic network that occurs simultaneously in many brain areas to contribute to the generation of epileptiform activity.     

Confirmatory factor analysis of the california verbal learning test in patients with epilepsy: relationship to clinical and neuropathological markers of temporal lobe epilepsy

Latent constructs involved in California Verbal Learning Test (D. C. Delis, J. H. Kramer, E. Kaplan, & B. A. Ober, 1987) performance were examined using confirmatory factor analysis in 388 epilepsy surgery candidates. Eight factor models were compared. A single-factor model was examined, along with 7 models accommodating constructs of auditory attention, inaccurate recall, and delayed recall in different combinations. The retained model consisted of 3 correlated factors: Auditory Attention. Verbal Learning, and Inaccurate Recall. Validity of this factor structure was examined in a subsample of patients with left and right temporal lobe epilepsy. All 3 factors were related to seizure focus and magnetic resonance imaging hippocampal volume. Only Verbal Learning was related to hippocampal neuropathology, supporting the distinction between learning and attention in the factor structure.     

基于弥散张量成像的儿童失神癫痫认知控制网络的结构连接研究

已有研究表明儿童失神癫痫患者的认知控制网络（CCN）中功能连接发生了改变。为了探索这些改变相应的结构基础,采用基于弥散张量成像（DTI）的纤维束追踪技术,对9名儿童失神癫痫患者和12名正常对照,分别构建了每个人CCN网络的结构连接,然后对两组间的纤维束连接的条数、长度、连接强度、平均部分各向异性值（FA）和平均弥散度（MD）等参数使用双样本T检验进行了统计比较。结果发现患者组CCN网络中主要纤维束上平均FA值显著降低,MD值显著增加（P_s<0.05,Bonferroni 校正）,并且左侧前额叶皮层到丘脑的纤维束上平均FA值与病程呈显著的负相关关系（P=0.011）。本研究结果为儿童失神癫痫患者CCN网络的功能连接异常提供了相应的结构基础,这些白质纤维异常的连接可能是导致患者认知控制功能异常的重要原因之一。     

原发性癫痫患者焦虑心理状态的相关因素分析

目的探讨原发性癫痫患者焦虑心理状态的相关因素。方法选取原发性癫痫患者50例,完成焦虑自评量表(SAS)、蒙特利尔认知评估量表(MoCA)、匹兹堡睡眠质量指数问卷(PSQI)和Epworth嗜睡量表(ESS)评估,将其中SAS总分≥53分者作为焦虑组,将SAS总分<53分者作为非焦虑组,对比分析两组患者各评定量表结果,并对原发性癫痫患者焦虑心理状态相关因素进行分析。结果焦虑组12例(占24%),非焦虑组38例(占76%),癫痫患者中有焦虑者与未合并焦虑者各量表评定有差异性。相关性分析显示SAS总分与PSQI总分、主观睡眠质量、睡眠障碍和日间功能障碍呈正相关(r=0.382,0.268,0.288,0.421;P<0.05),与MoCA总分、视空间/执行功能、记忆力、注意力、抽象能力和定向力呈负相关(r=-0.382,-0.265,-0.266,-0.454,-0.266,-0.292;P<0.05),行逐步回归分析,进入回归方程的因素有PSQI总分(β=0.954)、PSQI子项目日间功能障碍(β=2.954)和MoCA子项目注意力(β=-2.424)。结论原发性癫痫患者中合并焦虑者与PSQI总分、PSQI子项目日间功能障碍和MoCA子项目注意力有相关性。     

癫痫病人的心理健康调查

目的 了解癫痫病人的心理健康水平，提高癫痫病人的治疗效果。方法 对42例癫痫病人进行症状自评量表（SCL-90）、汉密尔顿抑郁量表（HAMD）及汉密尔顿焦虑量表（HAMA）评定。结果 癫痫病人的心理健康水平比较低，常有明显的焦虑和抑郁等。结论 对癫痫病人在抗癫痫治疗的同时，应特剐关注病人的心理健康，加强心理治疗，必要时及时应用抗抑郁或抗焦虑药物。