全面强直阵挛癫痫静息态功能连接脑网络研究

目的 采用静息态功能MRI (fMRI)功能连接分析技术,观察全面强直阵挛癫痫患者发作间期静息态脑网络的改变,探讨强直阵挛癫痫的病理生理机制.方法 52例全面强直阵挛癫痫患者与57名止常志愿者(对照组)参与了,本研究.采集闭眼静息态fMRI数据.分别以双侧丘脑,双侧后扣带皮质为种子点,观察丘脑网络、默认网络(DMN)在患者中的功能改变.结果 组内单样本t检验结果提示,以双侧丘脑为种子点的功能连接模式主要分布于额顶叶,而以双侧后扣带皮质为种子点的功能连接模式主要表现为默认网络.进一步组间比较发现,患者的丘脑与双侧运动皮层及右侧岛叶的功能连接增强,而与DMN脑区及基底节的功能连接减弱；而DMN内部与后扣带皮质的功能连接在双侧颞极、内侧前额叶和缘上回的功能连接减弱,而与双侧角回、丘脑和左侧额上回的功能连接增强.结论 丘脑是强直阵挛癫痫网络的重要节点,它与运动皮层间增强的功能连接可能与癫痫发作时患者肌肉的强直阵挛有关.而默认网络内功能连接的异常可能与癫痫发作时的意识丧失有关.即使在发作间期,全面强直阵挛癫痫的脑功能也有着显著改变.

Resting-state functional connectivity in patients with generalized tonic-clonic seizures

Objective： To investigate the alteration of brain functional networks underlying normal brain organization in patients with generalized tonic-clonic seizures （GTCS） using seed-based resting-state fMRI functional connectivity analyses. Materials and Methods： Resting-state fMRI datasets were acquired from 52 GTCS patients during interictal period and 57 matched healthy controls. The bilateral thalamus and posterior cingulate cortex （PCC） selected as seed region. The averaged time series within each seed was used to detect brain regions with fMRI signal correlated with the seed. Results： Within group comparison using one sample t-test showed significant functional connectivity pattern in thalamic network and in default mode network（DMN）. Compared to controls, bilateral thalamus showed increased functional connectivity with primary motor cortex and insula, while decreased functionalconnectivity were found in basal ganglia and DMN regions. Within DMN, decreased functional connectivity with bilateral PCC were found in bilateral temporal pole, medial prefrontal lobe and supramarginal gyms, while increased regions were found in bilateral angular gyms, thalamus and left superior frontal gyms. Conclusions：Thalamus is a key node of the epileptic network in GTCS. The increased functional connectivity between thalamus and primary motor area may be associated with the tonic and clonic during seizures. Additionally, decreased fimctional connectivity in the DMN suggested default brain functional may also be impaired in GTCS, which may be related to the loss of consciousness during seizures. These results demonstrated the impairment of brain function in GTCS patients even in interictal state, and imporved our understanding of the pathophysiological mechanisms of GTCS.