不同手术入路治疗海马硬化性颞叶内侧癫痫的比较

目的 比较常用的四种手术方式在治疗海马硬化性颞叶内侧癫痫(MTLE/HS)中的优缺点.方法 106例顽固性MTLE/HS患者中23例行经皮层脑室入路选择性海马杏仁核切除术;23例行经侧裂选择性海马杏仁核切除术;30例行前内侧颞叶切除术;30例行经颞下选择性海马杏仁核切除术.随访6个月-9年.采用Engel分级量表评价癫痫治疗效果,并比较并发症发生率.结果 四种术式在对癫痫发作的治疗效果比较上差异无统计学意义,无手术死亡,在并发症发生率方面差异无统计学意义.结论 对于经严格筛选的MTLE/HS,四种手术方式在疗效和安全性方面相当,可根据个人手术经验加以选择.     

颞叶癫痫对前瞻性记忆的影响

目的 探讨颞叶癫痫对基于事件的前瞻性记忆(event-based prospective memory,EBPM)和基于时间的前瞻性记忆(time-based prospective memory,TBPM)的影响,验证颞叶参与前瞻性记忆的神经机制假说.方法 采用McDaniel等建立的前瞻性记忆神经心理学试验方法,测试62例颞叶癫痫患者(33例服用抗癫痫药物和29例未服用药物,颞叶癫痫组)和年龄、教育程度相匹配的30名健康者(健康对照组)的EBPM和TBPM.结果 颞叶癫痫组简易精神状态检查(MMSE)、数字广度测试(DS)、词汇流畅性测试(VFT)的成绩均低于健康对照组,且MMSE、VFT两组间差异有统计学意义.与健康对照组[ EBPM测试(6.83±1.34)分,TBPM测试(5.00±1.70)分]相比,颢叶癫痫组的EBPM测试[(3.95±2.77)分]和TBPM测试[(3.08±2.42)分]的成绩差异均有统计学意义(t=6.72、4.39,均P＜0.01),且TBPM测试得分均低于EBPM.其中服药和未服药两组间EBPM测试成绩[(3.82±2 70)、(4.10±2.90)分]差异无统计学意义(t=-0.40,P ＞0.05),两组间TBPM测试成绩[(2.55±2.20)、(3.69±2.55)分]差异亦无统计学意义(t=-1.90,P＞0.05).结论 颞叶癫痫患者存在前瞻性记忆损害,提示颞叶参与前瞻性记忆的神经机制过程;与EBPM相比,TBPM损害更明显,提示TBPM需要更多的自我发动过程.     

Mu opioid receptor mRNA expression, binding, and functional coupling to G-proteins in human epileptic hippocampus

Mu opioid receptors (MOR) are known to be involved in seizure activity. The main goal of the present study was to characterize the MOR mRNA expression, binding, as well as G protein activation mediated by these receptors in epileptic hippocampus of patients with pharmacoresistant mesial temporal lobe epilepsy (TLE). In contrast with autopsy samples, hippocampus obtained from patients with mesial TLE demonstrated enhanced MOR mRNA expression (116%). Saturation binding experiments revealed significantly higher (60%) B(max) values for the mesial TLE group, whereas the K(d) values were not statistically different. Although mesial TLE group demonstrated high levels of basal binding for the G proteins (136%), DAMGO-stimulated [(35)S]GTPγS binding did not demonstrate significant alterations. In conclusion, our present data provide strong evidence that the epileptic hippocampus of patients with pharmacoresistant mesial TLE presents significant alterations in MOR. Such changes may represent adaptive mechanisms to compensate for other as yet unknown alterations.     

Medial temporal contributions to successful face-name learning

The brain mechanisms that enable us to form durable associations between different types of information are not completely understood. Although the hippocampus is widely thought to play a substantial role in forming associations, the role of surrounding cortical regions in the medial temporal lobe, including perirhinal and parahippocampal cortex, is controversial. Using anatomically constrained functional magnetic resonance imaging, we assessed medial temporal contributions to learning arbitrary associations between faces and names. By sorting learning trials based on subsequent performance in associative and item-specific memory tests, we characterized brain activity associated with successful face-name associative learning. We found that right hippocampal activity was greater when corresponding face-name associations were subsequently remembered than when only a face or a name, but not both, were remembered, or when single-item information or associative information was not remembered. Neither perirhinal nor parahippocampal cortex encoding activity differed across these same conditions. Furthermore, right hippocampal activity during successful face-name association learning was strongly correlated with activity in cortical regions involved in multimodal integration, supporting the idea that interactions between the hippocampus and neocortex contribute to associative memory. These results specifically implicate the hippocampus in associative memory formation, in keeping with theoretical formulations in which contributions to across-domain binding differ among brain structures in the medial temporal region.     

Discriminating preictal and interictal states in patients with temporal lobe epilepsy using wavelet analysis of intracerebral EEG

Objective

Identification of consistent distinguishing features between preictal and interictal periods in the EEG is an essential step towards performing seizure prediction. We propose a novel method to separate preictal and interictal states based on the analysis of the high frequency activity of intracerebral EEGs in patients with mesial temporal lobe epilepsy.

Methods

Wavelet energy and entropy were computed in sliding window fashion from preictal and interictal epochs. A comparison of their organization in a 2 dimensional space was carried out using three features quantifying the similarities between their underlying states and a reference state. A discriminant analysis was then used in the features space to classify epochs. Performance was assessed based on sensitivity and false positive rates and validation was performed using a bootstrapping approach.

Results

Preictal and interictal epochs were discriminable in most patients on a subset of channels that were found to be close or within the seizure onset zone.

Conclusions

Preictal and interictal states were separable using measures of similarity with the reference state. Discriminability varies with frequency bands.

Significance

This method is useful to discriminate preictal from interictal states in intracerebral EEGs and could be useful for seizure prediction.     

儿童额顶叶工作记忆任务的功能性磁共振成像研究

目的:联合应用血氧水平依赖(BOLD)-fMRI和扩散张量成像(DTI)两种功能磁共振成像技术,研究正常儿童工作记忆任务中额顶叶皮层激活强度与额顶叶各部位白质纤维束扩散特性之间的关系.方法:搜集健康志愿者12例,男女各6例,平均年龄11.4岁.以步进式视觉累加实验(PVSAT)作为刺激模式,对所有儿童进行BOLDfMR...     

Temporal lobe epilepsy with hypothalamic hamartoma: a rare case

Refractory gelastic seizure is one of the most common clinical manifestations in patients with hypothalamic hamartoma (HH) and HH is usually regarded as the epileptogenic focus. A young female patient with a small HH and refractory seizures is reported here. However, both the seizure semiology and results of electroencephalogram monitoring indicated the right temporal region was the epileptogenic focus. Thus a standard right anterior temporal lobectomy was performed while the hamartoma preserved. There was a marked improvement in both seizure frequency and quality of life during a 13-month follow-up. The outcome supported the concept that independent epileptogenic focus outside of the hypothalamus might occur in patients with HH.

     

匹罗卡品致痫大鼠慢性期海马神经元突触重建的实验研究

目的 探讨颞叶癫痫海马的异常兴奋性与抑制性突触联系变化.方法 建立匹罗卡品致痫大鼠模型,在致痫后60 d左右,利用立体定位仪在活体内注射逆行性示踪剂荧光金(FG)至海马CAI、CA3区,免疫组化方法观察海马异常兴奋性突触联系,免疫荧光双标记法检测NPY中间神经元与FG的共表达,观察海马异常抑制性突触联系.结果 FG注人大鼠海马CA1区,实验组远离注射部位的CA1区、海马CA3区、下托可见FG标记的锥体细胞,实验组CA1区远离注射部位处、CA3区、门区均有FG标记的NPY中问神经元,对照组未见.FG注入大鼠海马CA3区,对照组及实验组CA3区全层、门区锥体细胞均可见大量FG标记,实验组中CA1区部分锥体细胞被FG标记,门区可见双标记的NPY中间神经元,对照组未见.结论 颞叶癫痫大鼠海马慢性期存在异常的兴奋性和抑制性回路重组,包括CAl区锥体细胞之间、下托-CA1区、CA1-CA3区异常的兴奋性联系,以及CA1区中间神经元之间、CA3-CA1区、门区-CA1区、门区-CA3区异常的抑制性神经网络.神经元网络的异常重组町能在颞叶癫痫慢性期的自发发作中起重要作用.

Abstract：

Objective To explore the aberrant formation of excitatory and inhibitory circuit rearrangements of hippoeampus in temporal lobe epilepsy.Methods Pilocarpine-induced animal model was established.At around Day 60 post-modeling,retrograde tracer fluorogold(FG)was injected in vivo into CA1 and CA3 areas of hippocampus by stereotaxic apparatus.Immunohistochemistry of FG was used to observe the aberrant excitatory circuit rearrangements.Double immunofluorescence with NPY(neuropeptide Y)and FG was performed to observe the aberrant inhibitory circuit rearrangements.Results After an iniection of FG into CA1 area.the FG-labeled pyramidal cells could be observed distantly from the zone of dye soread in CA1 area.CA3 area and subiculm.And the FG-labeled non-principal neurons could be seen in stratum oriens of CA1 and hilus in experimental group.Double immunofluorescence revealed that the FG-labeled NPY interneurons were located distantly from the zone of dye spread in CA1 area.CA3 area and hilus in experimental rats.When injection was administered in CA3 area.the FG-labeled pyramidal cells were visible in the whole CA3 area and hilus in both groups.Some pyramidal cells were present in CA1 in experimental group.Also some FG-labeled non-principle cells were foand in hilus and distantly from the zone of dve spread in CA1 area,And the FG-labeled NPY neurons could be seen in hilus in experimental rats.Conclusion Aberrant excitatory and inhibitory synaptic reconstruction exist in hippocampus in chronic phase of temporal lobe epilepsy,including excitatory synaptic connections among pyramidal cells in CA1 area.pyramidal cells between CAl and subiculum and pyramidal cells between CA1 and CA3,inhibitory synaptie connections among dendritie intemeurons in CA1 area,CA3 to CA1,hilus to CA1 and hilus to CA3area,These circuit arrangements may play an important role in the pathogenesis of epilepsy.     

载脂蛋白E基因敲除及高脂饮食小鼠皮质额叶区形态学及Mortalin表达的变化

目的 观察载脂蛋白E基因敲除(ApoE KO)及高脂饮食(HF)后小鼠额叶区形态学及Mortalin蛋白表达变化,以进一步探讨ApoE异常导致阿尔茨海默病及记忆损伤的可能机制.方法 10只野生型小鼠予普通饲料喂养作为对照(C)组,10只ApoE KO小鼠予普通饲料喂养作为KO组,10只ApoE KO小鼠予高脂饲料喂养作...     

仅有癫痫表现颞叶肿瘤的外科治疗和预后分析

目的 探讨仅有癫痫表现的颞叶脑肿瘤适合的治疗方式、策略和预后评估.方法 对仅有癫痫表现的38例颞叶脑肿瘤患者进行手术治疗,按病灶位于左侧和右侧分组,术中通过皮层脑电图监测对病灶和致痫灶准确定位,术前后对患者进行韦氏智力量表测试,术后随访.分析肿瘤的病理学特点.结果 38例患者行病灶切除术、致痫灶切除术、前颞叶切除术、海马杏仁核切除术、软膜下多处横切术或皮层热灼术.术后平均随访3.5年,按Engel术后效果分级,Ⅰ级28例(73.6%),Ⅱ级5例(13.2%),Ⅲ级3例(7.9%),Ⅳ级2例(5.3%).随访期间本组无复发.术后MQ下降有显著性(P＜0.05),病灶位于左侧组的患者术后IQ和MQ的下降有显著性(P＜0.05).结论 仅有癫痫表现的颞叶脑肿瘤有趋向良性的病理学特点.手术切除病灶或致痫灶的疗效满意.而术后短期内的认知功能受到影响.