原发性全面强直阵挛癫痫大脑-小脑功能连通性的静息态功能磁共振成像研究

目的探讨原发性全面强直阵挛癫痫(generalized tonic-clonic seizure,G T C S)发作间期静息态下大脑和小脑之间功能连通性的改变特点。材料与方法对19例原发性GTCS患者(GTCS组)及22名年龄、性别、受教育程度、利手等相匹配的健康对照组志愿者(HC组)采集静息态功能磁共振数据,计算并比较两组被试全脑低频振幅(amplitude of low-frequency fluctuations,ALFF)值,分别以大脑(小脑)ALFF差异区为种子区计算其与小脑(大脑)所有体素之间静息态功能连接(resting state functional connectivity,rs FC)并进行组间比较,提取组间显著差异脑区ALFF/rs FC值与患者国立医院癫痫严重程度量表(national hospital seizure severity scale,NHS3)评分做相关分析。结果相对于正常对照组,GTCS组右侧楔前叶、左侧额中回ALFF值显著升高,而右侧海马、右侧小脑脚2区、左侧小脑4/5区ALFF值显著降低;以各大脑(小脑)ALFF差异区为种子区域,GTCS患者组左侧小脑8区、右侧小脑4/5区rs FC值显著升高(左侧额下回、右侧颞中回rs FC值显著降低);GTCS患者组NHS3评分与左侧小脑8区rs FC值之间呈显著正相关(r=0.48,P=0.036),与右侧颞中回rs FC值之间呈显著负相关(r=-0.34,P=0.042)。结论 GTCS发作间期存在大脑和小脑之间静息态功能连通性异常,这些功能连通性的异常可能与GTCS患者的发病机理和临床表现有关。

Cerebro-cerebellar functional connectivity in patients with generalized tonic-clonic seizure: a resting state functional MRI study

Objective: To explore the altered features of cerebro-cerebellar functional connectivity in resting-state during the interictal time of generalized tonic-clonic seizure (GTCS). Materials and Methods: Nineteen patients with GTCS and 22 age-, sex-, education- and handedness-matched healthy controls (HCs) were recruited. All the individuals' resting-state fMRI data were acquired in a Siemens 3.0 T MR. Firstly, amplitude of low-frequency fluctuations (ALFF) was applied to investigate the changes of whole brain spontaneous functional activity caused by GTCS. Then resting-state functional connectivity (rsFC) was calculated between seeds regions based on ALFF group differences in cerebrum (cerebellum) and all voxels in cerebellum (cerebrum). Finally, the correlation analysis was performed between ALFF/rsFC and NHS3 scores in brain regions with significant group differences. Results: Compared with the HCs, the patients with GTCS exhibit significantly increased ALFF in the right hippocampus, right cerebellar_crus2 and left cerebellar_4_5, but significantly decreased in the right precuneus and left middle frontal gyrus. Seed-based rsFC analysis showed that rsFC in patients with GTCS was significantly increased in the left cerebellar_8, right cerebellar_4_5, and right cerebellar_4_5, but significantly decreased in the left inferior frontal gyrus and right middle temporal gyrus. Furthermore, correlation analysis exhibit the positively correlated between NHS3 scores and rsFC of the left cerebellar_8 (r=0.48, P=0.036) in patients with GTCS, but negatively correlated between NHS3 scores and rsFC of the right middle temporal gyrus (r=-0.34, P=0.042) in patients with GTCS. Conclusion:Cerebro-cerebellar resting-state functional connectivity was abnormal during the interictal time of GTCS, which may be associated with the pathophysiological mechanism and clinical manifestations in patients with GTCS.