| ObjectiveTo investigate the changes of metabolites in the brain regions related to consciousness of epileptic patients with complex partial seizures (CPS), secondary generalized tonic-clonic seizures (SGTCS) and primary generalized tonic-clonic seizures (PGTCS), and to further explore the mechanism of impaired consciousness during epileptic seizures.Methods57epileptic patients were divided into three groups, which included18patients with CPS,20patients with SGTCS, and19patients with PGTCS. We had chosen24cases of healthy people as a control group. All patients and the healthy control group were investigated with multi voxel3D proton magnetic resonance spectroscopy (1HMRS) measurements of N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr). The voxels were placed over the brain regions related to consciousness, such as the bilateral inferior frontal, bilateral supramarginal gyrus, bilateral cingulate gyrus, bilateral precuneus, bilateral thalamus and the upper brainstem.Resultsâ‘ The ratios of NAA/Cr and NAA/(Cr+Cho) in the bilateral thalamus and the upper brainstem in three groups of patients with epilepsy were lower than those in the control group (P<0.01, P<0.05). In addition, the ratios of NAA/Cr in the left inferior frontal gyrus in the PGTCS group were lower than those in the control group (P<0.05). However, the ratios of NAA/Cr and NAA/(Cr+Cho) in the right inferior frontal gyrus, bilateral supramarginal gyrus, bilateral cingulate gyrus, bilateral precuneus in three groups of patients with epilepsy compared with those in the control group, there were no statistically significant differences (P>0.05). Furthermore, the ratios of NAA/Cr and NAA/(Cr+Cho) in the corresponding brain regions between the three groups of patients showed no statistically significant differences (P>0.05).â‘¡The ratios of Cho/Cr in the right thalamus in the CPS group and the PGTCS group were higher than those in the control group (P<0.05), whereas there were no statistically significant differences in the ratios of Cho/Cr in the right thalamus in the SGTCS group compared with those in the control group (P>0.05). There were no statistically significant differences in the ratios of Cho/Cr in the bilateral inferior frontal gyrus, bilateral supramarginal gyrus, bilateral cingulate gyrus, bilateral precuneus, the left thalamus, and the upper brainstem in three groups of patients with epilepsy compared with those in the control group (P>0.05). There were also no statistically significant differences in the ratios of Cho/Cr in the corresponding brain regions between the three groups of patients (P>0.05).â‘¢In the SGTCS group and the PGTCS group, the course were not correlated with the ratios of NAA/Cr, NAA/(Cr+Cho) and Cho/Cr in the left inferior frontal gyrus, bilateral thalamus and brainstem upper(P>0.05). In the CPS group, the course were negatively correlated the ratios of NAA/(Cr+Cho) in the brainstem upper (P<0.05), whereas course were not correlated to the ratios of NAA/Cr and Cho/Cr in the left inferior frontal gyrus, bilateral thalamus as well as brainstem upper (P>0.05).â‘£In these three groups of patients, the seizure frequency per years were not correlated with the ratios of NAA/Cr, NAA/(Cr+Cho) and Cho/Cr in the left inferior frontal gyrus, bilateral thalamus and the upper brainstem (P>0.05).Conclusionsâ‘ The brain regions related to consciousness of epileptic patients with CPS, SGTCS and PGTCS, there may be lasting neuronal dysfunction of the bilateral thalamus and the upper brainstem. In addition, there may be also lasting neuronal dysfunction of the left inferior frontal gyrus in the epileptic patients with PGTCS.â‘¡The bilateral thalamus and the upper brainstem may be the sites which play a central role in the brain regions related to consciousness during CPS, SGTCS and PGTCS, and may be the basis of impaired consciousness. The left inferior frontal gyrus may be also involved in the occurrence of impaired consciousness in PGTCS. |
PDF Full Text Request