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.

Relationship Between Abnormal Gray Matter in Encephalic Region and Neuropsychological Test in Children with Temporal Lobe Epilepsy and Its Significance

Objective]To evaluate the relationship between the clinical manifestations or neuropsychological test and local brain atrophy in children with temporal lobe epilepsy（TLE）. Methods] Forty children with symptomatic TLE including 9 mesial temporal lobe epilepsy （MTLE） due to hippoeampal atrophy and 5 TLE due to neo-cortical lesions, 14 healthy children, 9 adult patients with MTLE and 9 healthy adult control were enrolled in this study. All subjects performed brain magnetic resonance imaging（MRI） to obtain the T1 strut ture image, and voxel-based morphometry （VBM） was used to analyze the images. All the children underwent a comprehensive neuropsychological test. Results]The volume of gray matter in ipsilateral hippocampus and peripheral region of TLE children decreased obviously, and there was significant correlation between the volume of gray matter and neuropsychological scores（ P〈0.05）. The volume of gray matter in ipsilateral hippocampus in the epileptic attack region of MTLE children with unilateral hippocampal atrophy decreased obvious- ly, and the ipsilateral cingulate gyrus and contralateral middle frontal lobe of them were atrophy. Cortical atro phy in pediatric patients with MTLE was less than that in adult patients. Conclusion]Children with MTLE is similar to adult patients and associated with the decrease of hippocampal and peri-hippoeampal cells. However, gray matter atrophy in children with TLE limits in frontal lobe and is less than that in adult patients. There is a significant association between the volume of gray matter in medial temporal and frontal regions and the scores on neuropsychological tests. The cognitive and behavior disorders in children with TLE are caused by the damage of neural network.