The Multi Model MRI Study Of Brain Function And Structure In Partial Epilepsy

Object To analysis the cognitive function and emotional state of the patients with partial epilepsy, and to explore the difference between partial epilepsy subjects and healthy subjects in term of brain function in resting state, white matter integrity, and density and volume of gray matter by using the multi modal MRI including blood oxygenation level dependent functional magnetic resonance imaging(BOLD-fMRI), three dimension MRI(3D) and diffusion tensor imaging(DTI) techniques.Methods 60 patients with partial epilepsy and 60 healthy controls with equivalent gender, age and education level are assessed by digital span test and verbal fluency test of Wechsler adult intelligence scale (WAIS), logic memory test of Wechsler adult memory scale (WMS), self-rating depression scale (SDS), self-rating anxiety scale (SAS).The patients with epilepsy and the health controls undergo multi modal MRI scan including resting-state BOLD-fMRI, DTI and 3D. The regional homogeneity (ReHo) approach and functional connectivity analysis are used to analyze resting-state BOLD-fMRI; the voxel-base analysis (VBA) are used to analyze fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of DTI; while the voxel-based morphometry (VBM) method are used to process the gray matter density and volume data obtained by 3D.Results 60 patients with partial epilepsy and 60 healthy controls with equivalent gender, age and education level recieve MRI scan. Some data are excluded because of head movement. The final data include those from 52 patients (26 males/26 females) and 54 healthy controls (33 males/21 females) in BOLD-fMRI part; 56 patients (26 males/30 females) and 60 healthy controls (38 males/22 females) in DTI part; 60 patients (28 males/32 females) and 60 healthy controls (38 males/22 females) in 3D part. The study finds that:1) Digital span test, immediate and delay logical memory test scores are significantly lower in patients compared with controls(p=0.000, p=0.000, p=0.000). In verbal fluency test, the patients produce significantly less correct words than the controls (p=0.000), and the repeated and error words produced by the patients and the controls are of no significant difference (p=0.107, p=0.227). Digital span test, verbal fluency test and logical memory test scores are similar between the patients with complex partial seizure and secondary generalized seizure (p=0.439, p=0.473, p=0.403, p=0.228). The scores of SDS and SAS are significantly higher in patients compared with controls(p=0.001, p=0.001); The scores of SDS and SAS are of no significant difference between the patients with complex partial seizure and secondary generalized seizure(p=0.443, p=0.173).2) As far as BOLD-fMRI data are concerned:(1) ReHo analysis:patients with partial epilepsy showed significantly decreased ReHo in left inferior parietal lobule, postcentral gyrus and precentral gyrus, right thalamus, cerebellum, precuneus and paracentral lobule, bilateral insula compared with control subjects; no region with significantly increased ReHo in patients is found. (2) Default mode network (DMN):The DMN of patients include left precuneus and adjacent posterior cingulate cortex (Pcu/PCC), angular gyrus, cingulate gyrus; the DMN of controls include left Pcu/PCC, right angular gyrus, bilateral medial frontal lobe and temporal lobe. (3) Functional connectivity:Compared with control subjects, patient with partial epilepsy show significantly decreased functional connectivity of DMN region in left inferior parietal lobule, supramarginal gyrus, parahippocampa gyrus and superior temporal gyrus, bilateral uncus; while no region with significantly increased functional connectivity in patients is found.3) As far as DTI data are concerned:(1) Compared with healthy controls, patients with partial epilepsy show significantly decreased FA values in left parahippocampa gyrus, uncus, cerebellum posterior lobe uvula, fusiform gyrus, right middle temporal gyrus, middle frontal gyrus, caudate, subcallosal gyrus, cerebellum anterior lobe culmen, cingulate gyrus, temporal lobe and frontal lobe sub-gyral white matter, bilateral superior temporal gyrus; while significantly increased FA values in left corpus callosum, middle temporal gyrus, anterior cingulate and medial globus pallidus. (2) Compared with healthy controls, patients with partial epilepsy show significantly increased ADC values in left middle frontal gyrus, inferior frontal gyrus, superior temporal gyrus, middle temporal gyrus, inferior temporal gyrus and cerebellum posterior lobe declive, right medial frontal gyrus, frontal lobe sub-gyral white matter, Subcallosal Gyrus, subcallosal gyrus, parahippocampa gyrus and posterior cerebellum, bilateral fusiform gyrus and uncus; while no region with significantly decreased ADC value in patients is found.4) As far sa 3D data are concerned:(1) Compared with healthy controls, patients with partial epilepsy show significantly increased gray matter density in bilateral lateral globus pallidus and Putamen; while no region with significantly decreased gray matter density in patients is found. (2) Compared with healthy controls, patients with partial epilepsy show significantly decreased gray matter volume in left orbital gyrus, medial frontal gyrus, paracentral lobule, transverse temporal gyrus and superior temporal gyrus, right inferior parietal lobule, posterior cingulate, inferior occipital gyrus and cuneus, bilateral precentral gyrus, insula, anterior cingulate, precuneus and anterior cerebellum lobe; while no region with significantly increased gray matter volume in patients is foundConclusions 1. The cognitive function of the partial epilepsy patients is impaired, with depression and anxiety as common symptoms in the patients. The neuropsychic scale is the convenient and effective method to estimate the neuropsychic state of epilepsy patients.2. The resting-state brain function and functional connectivity is abnormal in in left inferior parietal lobule, medial parietal lobe, precentral gyrus, insula, thalamus, limbic lobe and superior temporal gyrus of partial epilepsy patients. It may be the potential pathophysiological mechanism.3. The wide abnormality in integrity of white matter and gray matter suggest a extensive neural network disorder that might be the neuropathological basis of partial epilepsy and correlate with the impaired cognition, depression and anxiety.4. The multi modal MRI can detect the extensive changes of brain function and structure in MRI-negative partial epilepsy.