人颞叶内侧癫痫海马组织星形胶质细胞水通道蛋白4和内向整流性钾离子通道4.1的再分布

目的研究人颞叶内侧癫痫海马组织星形胶质细胞水通道蛋白4(AQP4)和内向整流性钾离子通道4.1(Kir4.1)的分布。方法对10例颞叶内侧癫痫(MTLE)和6例非颞叶内侧癫痫(non-MTLE)手术切除海马组织,应用光镜及透射电镜观察组织学及超微结构,免疫荧光组织化学法观察星形胶质细胞AQP4和Kir4.1的分布。结果 MTLE海马组织星形胶质细胞大量增生伴明显肿胀,神经元显著固缩。non-MTLE海马组织中,AQP4和Kir4.1在星形胶质细胞血管周围足突(pAST-ef)分布多于其他部位,呈现极性分布特点;而在MTLE海马组织中,AQP4和Kir4.1在pAST-ef分布减少,其他部位分布增加,极性分布改变。结论海马组织星形胶质细胞上AQP4和Kir4.1极性分布变化可能与颞叶内侧癫痫发生相关。     

颞叶癫痫患者视频脑电图的表现

目的分析颞叶癫痫(TLE)患者的视频脑电图(VEEG)表现。方法选取2017年6月至2018年6月南阳市中心医院收治的210例TLE患者为研究对象,对所有患者的VEEG资料进行分析。结果 210例患者中有87例有背景活动异常,所占比例为41.43%,多为内侧颞叶癫痫(MTLE),发作间期、发作期的异常房电波主要为尖慢波、棘波、尖波,MTLE异常发电主要为前颞区,外侧颞叶癫痫异常放电主要为中、后颞区。结论 VEEG发作期、发作间期、背景活动异常等表现与特征能为TLE的临床诊断与治疗提供有力依据。     

颞叶癫痫儿童灰质异常脑区与神经心理学测验的关系及意义

[目的]评估儿童颞叶癫痫（ TLE）临床表现和神经心理学测验成绩与局部脑萎缩的相关性.[方法]症状性TLE患儿14例（海马萎缩所致中颞叶癫痫 9例,颞叶新皮质损伤所致TLE 5例）,健康对照儿童14名;中颞叶癫痫（ MTLE）成人及其对照各9例.所有入组对象进行脑MRI获取T1结构像,用像素为基础的形态测定法分析图像.所有儿童进行综合神经心理学测验.[结果]TLE患儿同侧海马和海马外周区灰质体积显著减小,灰质体积减小与神经心理学测验成绩显著相关（P〈0.05）.单侧海马萎缩的MTLE患儿中,癫痫发作区域同侧的海马灰质体积显著减小,同侧扣带和对侧额中回皮质萎缩,皮质萎缩程度及范围较同类成人患者小.[结论]与成人MTLE患者相似,儿童MTLE与海马和海马外周的细胞减少有关;儿童TLE灰质萎缩的程度和范围较成人患者小,仅限于额叶区;中颞叶和额叶区灰质体积的减小与神经心理学测验成绩显著相关;TLE患儿的认知或行为障碍是神经网络损伤的结果.     

人颞叶内侧癫痫海马组织星形胶质细胞Syntrophin的表达变化

目的观察人颞叶内侧癫痫(MTLE)海马组织星形胶质细胞syntrophin的表达变化。方法 2015年4月至2016年7月,17例癫痫患者手术切除的海马组织,依据苏木素-伊红(HE)染色及胶质原纤维酸性蛋白、神经元核抗原免疫组织化学染色结果,分为MTLE组13例和非MTLE组4例。免疫荧光双重组织化学法及免疫荧光组织化学法观察syntrophin的表达。结果 MTLE组星形胶质细胞大量增生,神经元明显减少。syntrophin在星形胶质细胞膜及足突处表达。与非MTLE组相比,MTLE组syntrophin在血管周围星形胶质细胞足突处分布减少,在其他部位分布增加。图像分析显示,与非MTLE组相比,MTLE组syntrophin蛋白量显著增多(t=5.421,P0.001)。结论海马组织syntrophin在星形胶质细胞上的分布及其整体表达变化可能与MTLE发生相关。     

颞叶内侧癫痫全脑灰质基于体素的MRI形态分析

目的应用MRI基于体素的形态学测量方法（VBM）,分析颞叶内侧癫痫患者全脑灰质结构的改变。方法对23例颞叶内侧癫痫患者（其中右侧病变11例,左侧病变12例）,13例年龄性别与之匹配的健康志愿者行全脑扫描,应用磁化准备快速梯度回波成像序列获取三维结构图像。数据分析采用以SPM99软件包为基础的全自动VBM技术进行处理。结果与健康对照组比较,颞叶内侧癫痫患者显示了患侧和对侧海马,以及丘脑、扣带回等边缘系统结构灰质密度的减少。额叶及小脑皮层等结构也显示弥漫灰质密度的减少。结论VBM法操作简单,不但可检测颞叶内侧癫痫海马结构的异常,还可显示海马结构以外弥漫脑灰质结构的异常。     

难治性颞叶内侧癫痫手术的术中配合及护理

癫痫是最常见的神经系统疾病之一。它是一种致残率高、临床反复发作、病程漫长的疾病。其中,颞叶癫痫分为颞叶内侧癫痫、病灶性颞叶癫痫和颞叶外侧新皮质癫痫。颞叶内侧癫痫主要起源于内侧结构杏仁核、海马、钩回、海马旁回,占颞叶癫痫90%以上的病例。普遍的临床实践已经证明,难治性颞叶内     

海马横切术对顽固性颞叶内侧型癫痫患者术后癫痫的疗效分析

目的研究海马横切术对顽固性颞叶内侧型癫痫(MTLE)患者术后癫痫控制有效率及认知功能的影响。方法选择2017年2月～2018年3月我院顽固性MTLE患者68例,依照治疗方案不同分为观察组和对照组各34例。对照组行前颞叶切除术治疗,观察组行海马横切术治疗,比较两组术后并发症发生率、随访1年癫痫控制有效率,评估韦氏成人智力量表评分:操作智商(PIQ)、语言智商(VIQ)、总智商(FIQ)。结果随访1年观察组术后癫痫控制总有效率为94.12%,高于对照组的70.59%,差异有统计学意义(P0.05);术后1年观察组VIQ、PIQ、FIQ评分均高于对照组,差异均有统计学意义(P0.05);观察组术后并发症发生率为2.94%,与对照组的11.76%比较,差异无统计学意义(P0.05)。结论海马横切术治疗顽固性MTLE患者临床效果显著,能提高术后癫痫控制有效率,改善认知功能,安全性较高。     

内侧颞叶癫痫脑微结构变化磁共振研究进展

内侧颞叶癫痫（mTLE）是最常见的难治性癫痫,其发病机制不清,多与内侧颞叶及颞叶外脑区异常有关,如海马硬化和相关大脑皮层萎缩。随着磁共振及其后处理技术的进步,显示内侧颞叶及其与之相关区域的微结构变化,对mTLE的发病机制研究、术前准确定位及术后评估中有重要作用。本文对mTLE的脑微结构变化MRI的研究进展进行综述。     

动脉自旋标记成像用于平扫MR阴性发作间期癫痫患儿

目的 观察动脉自旋标记（ASL）成像对平扫MR阴性的发作间期癫痫患儿的诊断价值。方法 纳入56例平扫MR未显示结构异常的发作间期癫痫患儿，采用视觉分析法将ASL显示灌注异常分为低灌注或高灌注，与临床及视频脑电图（VEEG）定位癫痫灶结果进行一致性检验，并分析ASL异常灌注的影响因素。结果 56例中，52例（52/56，92.86%）为癫痫局灶性发作，4例（4/56，7.14%）为全身性发作。39例（39/56，69.64%）ASL显示灌注异常，37例（37/52，71.15%）为局灶性发作、2例（2/4，50.00%）为全身性发作；其中20例（20/39，51.28%）ASL显示灌注异常定位与临床定位癫痫灶完全一致，9例（9/39，23.08%）部分一致；ASL定位癫痫灶与临床定位结果具有中等一致性（Kappa=0.46，P<0.01）。于发作1天内行ASL是唯一与MR和临床定位癫痫灶一致性相关的因素（P<0.05）[OR=3.81，95% CI（1.16，12.44），P=0.027]。结论 ASL技术可于发作间期有效定位平扫MR阴性癫痫患儿的癫痫灶。     

联合磁源性影像和磁共振波谱技术评估颞叶癫痫的价值

目的：探讨磁源性成像（MSI）和磁共振波谱（^1H—MRS）技术结合在颞叶癫痫诊断定位中的价值。方法：设健康对照者10例，特发颞叶癫痫患者8例，应用MEG定位痫性病灶，选取MEG异常区域、对侧相应区域和双颞叶内侧区域测量NAA／Cho值，并观察是否存在海马硬化。结果：8例患者MEG检查结果均异常，6例MEG异常相应区域MRS检查NAA／Cho值减少，符合率为62．5％；MRI显示海马硬化2例，MRI正常6例，颞叶内侧MRS扫描未见明显改变。结论：联合MSI和MRS技术可进一步提高颞叶癫痫致痫灶的定位准确性。     

Gray matter atrophy associated with duration of temporal lobe epilepsy

Hippocampal sclerosis is the most common abnormality associated with medial temporal lobe epilepsy (MTLE). Converging evidence supports that hippocampal sclerosis progresses with time. However, it is unclear whether extrahippocampal atrophy in patients with MTLE, similarly to hippocampal sclerosis, is an unremitting progressive process. In this article, we investigate the relationship between duration of epilepsy and gray matter concentration reduction in patients with MTLE within and outside the hippocampus. We employed a voxel-based morphometry study of MRI of the entire brain of 36 patients with drug refractory MTLE and 49 neurologically healthy age-matched controls. We performed a voxel-based parametric and nonparametric investigation of the association between gray matter concentration, age and duration of epilepsy. We complemented the investigation by extracting the gray matter concentration of regions of interest (ROIs) within the limbic system, and we investigated the association between the gray matter concentration on the ROIs and duration of epilepsy. Patients with MTLE exhibited gray matter concentration reduction that is negatively correlated with the duration of epilepsy within the ipsilateral hippocampus, temporal lobes as well as extratemporal limbic structures that are closely connected with the hippocampus. In conclusion, longer duration of refractory epilepsy was associated with a more intense hippocampal and extrahippocampal atrophy in patients with MTLE. The mechanism of progressive neuronal damage in MTLE may be related to active seizure activity within a limbic network, and early seizure control may prevent further brain atrophy in patients with refractory MTLE.     

Diffusion tensor imaging in medial temporal lobe epilepsy with hippocampal sclerosis

Interictal diffusion imaging studies in patients with medial temporal lobe epilepsy (MTLE) accompanied by hippocampal sclerosis (HS) have shown an increased diffusivity in the epileptogenic hippocampus. In this study, we wanted to explore the whole brain in order to determine if MTLE could have an impact on the organization and the architecture of a large cerebral network and to identify clinical factors that could mediate diffusion abnormalities. Diffusion tensor imaging (DTI) and statistical parametric mapping of the entire brain were performed in 35 well-defined MTLE patients and in 36 healthy volunteers. SPM analyses identified three abnormal areas: an increased diffusivity was detected in the epileptic hippocampus and the ipsilateral temporal structures associated with a decreased anisotropy along the temporal lobe, a decreased diffusivity was found in the contralateral non-sclerotic hippocampus, the amygdala, and the temporal pole, and finally, a decreased anisotropy was noted ipsilaterally in posterior extratemporal regions. Duration of epilepsy, age at onset, and the frequency of generalized tonic-clonic seizures or partial complex seizures did not correlate with the presence of diffusion abnormalities. Region of interest analysis in the hippocampus/parahippocampus demonstrated a correlation between lower ipsilateral diffusivity values and occurrence of epigastric aura and between higher anisotropy values in both hemispheres and history of febrile seizures. In conclusion, this study showed that diffusion abnormalities are not restricted to the pathologic hippocampus and involve a larger network. This pattern may indirectly reflect the epileptogenic network and may be interpreted as a cause or a consequence of epilepsy.     

Combined MEG/EEG analysis of the interictal spike complex in mesial temporal lobe epilepsy

We studied the functional organization of the interictal spike complex in 30 patients with mesial temporal lobe epilepsy (MTLE) using combined magnetoencephalography (MEG)/electroencephalography (EEG) recordings. Spikes could be recorded in 14 patients (47%) during the 2- to 3-h MEG/EEG recording session. The MEG and EEG spikes were subjected to separate dipole analyses; the MEG spike dipole localizations were superimposed on MRI scans. All spike dipoles could be localized to the temporal lobe with a clear preponderance in the medial region. Based on dipole orientations in MEG, patients could be classified into two groups: patients with anterior medial vertical (AMV) dipoles, suggesting epileptic activity in the mediobasal temporal lobe and patients with anterior medial horizontal (AMH) dipoles, indicating involvement of the temporal pole and the anterior parts of the lateral temporal lobe. Whereas patients with AMV dipoles had strictly unitemporal interictal and ictal EEG changes during prolonged video-EEG monitoring, 50% of patients with AMH dipoles showed evidence of bitemporal affection on interictal and ictal EEG. Nine patients underwent epilepsy surgery so far. Whereas all five patients with AMV dipoles became completely seizure-free postoperatively (Class Ia), two out of four patients with AMH dipoles experienced persistent auras (Class Ib). This difference, however, was not statistically significant. We therefore conclude that combined MEG/EEG dipole modeling can identify subcompartments of the temporal lobe involved in epileptic activity and may be helpful to differentiate between subtypes of mesial temporal lobe epilepsy noninvasively.     

Imaging of odor perception delineates functional disintegration of the limbic circuits in mesial temporal lobe epilepsy

Metabolic and neuro-receptor abnormalities within the extrafocal limbic circuits are established in mesial temporal lobe epilepsy (MTLE). However, very little is known about how these circuits process external stimuli. We tested whether odor activation can help delineate limbic functional disintegration in MTLE, and measured cerebral blood flow with PET during birhinal smelling of familiar and unfamiliar odors, using smelling of odorless air as the baseline condition. Patients with MTLE (13 left-sided, 10 right-sided) and 21 controls were investigated. In addition to odor activation, the analysis included functional connectivity, using right and left piriform cortex as seed regions. Healthy controls activated the amygdala, piriform, anterior insular, and cingulate cortices on both sides. Smelling of familiar odors engaged, in addition, the right parahippocampus, and the left Brodmann Area (BA) 44, 45, 47. Patients failed to activate the amygdala, piriform and the anterior insular cortex in the epileptogenic hemisphere. Furthermore, those with left MTLE did not activate the left BA 44, 45 and 47 with familiar odors, which they perceived as less familiar than controls. Congruent with the activation data each seed region was in patients functionally disconnected with the contralateral amygdala+piriform+insular cortex. The functional disintegration in patients exceeded the reduced activation, and included the contralateral temporal neocortex, and in subjects with right MTLE also the right orbitofrontal cortex. Imaging of odor perception may be used to delineate functional disintegration of the limbic networks in MTLE. It shows an altered response in several regions, which may underlie some interictal behavioral problems associated with this condition.     

Safety and seizure control in patients with mesial temporal lobe epilepsy treated with regional superselective intra‐arterial injection of autologous bone marrow mononuclear cells

Temporal lobe epilepsy (TLE) is a highly prevalent syndrome among people with epilepsy, and is usually refractory to drug treatment. Structural and physiological changes, such as hippocampal sclerosis, are often present in TLE patients. The objective of this study is to evaluate the feasibility and safety of intra‐arterial infusion of autologous bone marrow mononuclear cells (BMMC) in adults with medically refractory mesial TLE (MTLE) and unilateral hippocampal sclerosis (HS). We enrolled 20 patients who had been diagnosed with MTLE‐HS and were refractory to medical treatment. All patients underwent a neurological evaluation, magnetic resonance imaging with hippocampal volumetry, video‐electroencephalography (EEG) with ictal recording, and a neuropsychological test battery focusing on verbal and nonverbal memory domains. After bone marrow aspiration and subsequent cell preparation, the BMMC were infused by selective posterior cerebral artery catheterization. Patients were followed for 6 months. Safety of the procedure, seizure frequency, neuropsychological evaluation, EEG variables, routine brain magnetic resonance imaging and hippocampal volumetry were considered measurements of outcome. Any serious intercurrent clinical event or adverse effects related to the procedure were reported. No additional lesions and no significant hippocampal volumetric changes were observed. EEG recordings showed a decrease in theta activity and spike density. At 6 months, eight patients (40%) were seizure free. A significant increase in the memory scores over time was observed. The BMMC autologous transplant for the treatment of temporal lobe epilepsy is feasible and safe. The seizure control achieved in this novel study supports the therapeutic potential of stem cell transplants in MTLE‐HS patients. Copyright © 2016 John Wiley & Sons, Ltd.     

Voxel-based morphometry of the thalamus in patients with refractory medial temporal lobe epilepsy

Previous research has suggested that patients with refractory medial temporal lobe epilepsy (MTLE) show gray matter atrophy both within the temporal lobes as well as in the thalamus. However, these studies have not distinguished between different nuclei within the thalamus. We examined whether thalamic atrophy correlates with the nuclei's connections to other regions in the limbic system. T1-weighted MRI scans were obtained from 49 neurologically healthy control subjects and 43 patients diagnosed with chronic refractory MTLE that was unilateral in origin (as measured by ictal EEG and hippocampal atrophy observed on MRI). Measurements of gray matter concentration (GMC) were made using automated segmentation algorithms. GMC was analyzed both voxel-by-voxel (preserving spatial precision) as well as using predefined regions of interest. Voxel-based morphometry revealed intense GMC reduction in the anterior portion relative to posterior thalami. Furthermore, thalamic atrophy was greater ipsilateral to the MTLE origin than on the contralateral side. Here we demonstrate that the thalamic atrophy is most intense in the thalamic nuclei that have strong connections with the limbic hippocampus. This finding suggests that thalamic atrophy reflects this region's anatomical and functional association with the limbic system rather than a general vulnerability to damage.     

发作间期18F-FDG联合13N-NH3·H2O PET脑显像在颞叶内侧癫痫术前定位中的价值

目的：探讨发作间期18F-FDG联合13N-NH3·H2O PET脑显像在颞叶内侧癫痫术前定位中的价值。方法：收集行头部MRI、18F-FDG及13N-NH3·H2O PET/CT检查并经术中深部脑电图（DEEG）及皮层脑电图（ECoG）证实的颞叶内侧癫痫患者17例。所有PET图像采用感兴趣区（ROI）分析,对18F-FDG及13N-NH3·H2O PET显像结果进行比较。结果：18F-FDG PET显像对癫痫灶准确定侧12例（70.6%）,准确定位5例（29.4%）;13N-NH3·H2O PET显像准确定侧9例（52.9%）,准确定位4例（23.5%）。两种显像方法对癫痫灶定侧性能具有中度一致性（Kappa=0.638,P=0.005）,定侧准确性经McNemar检验,差异无统计学意义（P>0.05）。综合分析两种显像结果对癫痫灶准确定位8例（47.1%）。结论：发作间期18F-FDG PET显像对颞叶内侧癫痫有较高的定侧准确性,13N-NH3·H2O PET显像亦可以有效定侧颞叶癫痫。联合两种显像剂显像,优势互补,定位准确性明显提高,且癫痫灶低代谢、高灌注的表现使诊断特异性增加,更有助于颞叶癫痫灶的准确定位。