氟马西尼造成的脑弥散成像改变对癫痫灶的定位研究

目的探讨癫痫患者应用氟马西尼之后,用磁共振弥散成像(diffusion-weighted magnetic imaging,DWI)检测脑组织发生的改变,从而确定癫痫灶的位置。方法选择准备手术的癫痫患者20例,其中检查前2个月内服用过苯二氮卓类药物(benzodiazepine,BZD)有9人,另取17位未发做过癫痫的健康者作为对照。在患者清醒和完全的发作间期进行磁共振弥散成像基线扫描,然后静脉推注氟马西尼(flumazenil,FMZ),注射10min后,再次进行DWI检查。所有的病人测量下列双侧结构的表观弥散系数(apparent diffusion coefficient,ADC):海马、海马旁回、丘脑、中央白质、与癫痫灶相连的皮质。健康对照者进行了DWI检查,测量了上述结构。我们还对20位患者进行了注射FMZ前后的视频脑电图比较。结果与健康对照者对比,颞叶癫痫患者发病侧海马的发作间期ADC基线明显升高(P<0.05)。在注射氟马西尼后,不同感兴趣区的平均ADC变化如下:近期服用过BZD的患者癫痫发作侧的海马ADC下降(P<0.05);癫痫发作侧的海马旁回ADC下降(P<0.05),而近期没有服用过BZD的患者,未发现上述变化。在视频脑电监测中,服用BZD的患者也更易用FMZ诱发出癫痫波。在颞叶以外癫痫我们没有观察到统一的变化模式。结论近期服用过BZD药物的颞叶癫痫患者中,注射氟马西尼引起的ADC改变和癫痫灶的位置密切相关。核磁共振弥散成像清楚地表明了颢叶癫痫患者潜在癫痫灶的位置,是一个有效检测方法。

Detecting epileptogenic focus by brain diffusion imaging after injection of flumazenil

Objective We use diffusion-weighted magnetic imaging(DWI)to detect the effects of flumazenil(FMZ)on epileptogenic focus,and localize the epileptogenic focus.Methods 20 patients, male 15 men and female 5 were taken from the epilepsy surgery program,out of 9 patients were pretreated with benzodiazepine(BZD).17 healthy volunteers served as controls.Baseline DWI scans was performed at complete rest in all patients awake.DWI measurements were started 10min after the injection of FMZ.In all patients and volunteers,apparent diffusion coefficient(ADC)was measured bilaterally in the following structures:hippocampus,parahippocampal gyrus,central white matter,and cortex of the convexity remote from the epileptogenic zone.And all patients received VEG monitoring during injection of FMZ.Results In the temporal lobe epilepsy(TLE)patients,the interictal ADC was elevated in the hippocampus on the ictogenic side.After FMZ injection,in the patients who took BZD recently,significant decreases of the ADC in the AH and PHG on the seizure onset side were observed.During VEG monitoring,these patients could be elicited epileptiform activity by FMZ more easily.In the patients who did not take benzodiazepine(BZD) recently,the significant decreases of the ADC in the AH on the seizure onset side could not be recorded.No clear pattern of ADC changes could be observed in the patients with extratemporal lobe epilepsy(ETE). Conclusions In the TLE patients who take BZD recently,the ADC changes induced by FMZ closely relate to epileptogenic focus localization.DWI may he a sensitive tool for presurgical evaluation of epilepsy.