| Part Ⅰ:Diffusion tensor imaging of patients with epilepsy based on spatial statistical method of fiber bundle skeleton tracingObjective:Epilepsy is a chronic recurrent disease,which is short-term brain dysfunction caused by sudden abnormal discharge of brain neurons.Previous studies have confirmed that epilepsy is mainly gray matter damage.However,in recent years,due to the development of imaging technology,the study of white matter in brain has found that there are changes in white matter in patients with epilepsy,and diffusion tensor imaging(DTI)can visualize the white matter pathway.This study mainly discusses the structural changes of white matter in patients with epilepsy through diffusion tensor imaging of resting functional magnetic resonance and tracked spatial statistical(TBSS)method based on fiber bundle skeleton tracing,and analyzes the significance of fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD)and radial diffusivity(rd)in the structural damage of white matter in patients with epilepsy,So as to provide objective imaging evidence for the diagnosis,surgical treatment,prognosis and efficacy evaluation of patients with epilepsy.Method:26 patients with epilepsy and 42 healthy controls were matched in gender,age,education and hand preference.All subjects were examined by resting fMRI and EEG.Based on TBSs,white matter regions with significant differences in FA,MD,ad and RD between epileptic patients and normal healthy controls were observed.Results:compared with the healthy control group,FA in patients with epilepsy decreased significantly,and MD,ad and RD increased significantly.The differences between groups were mainly in thalamic anterior radiation,corticospinal tract,corpus callosum,cingulate gyrus,tongs,pincers,fronto occipital tract,inferior longitudinal tract,superior longitudinal tract and uncinate tract.Conclusion:the results of this study show that patients with epilepsy have bilateral symmetrical white matter structure damage.It is of great significance to analyze the changes of white matter structure in patients with epilepsy based on TBSs.Part Ⅱ The study of epileptic brain structure network based on diffusion tensor imagingObjective:The structural basis of neural network connection is the connection of white matter fiber bundles in multiple functional areas of the brain.At present,the evaluation of complex structure networks is mainly based on the knowledge of graph theory,which transforms the brain network into nodes and edges,and constructs the brain topology network,so as to reveal the brain network connection and the processing and transmission mechanism of information inside the brain.In our study,we constructed a structural brain network based on DTI technology and TBSs,calculated the network topology parameters of the whole brain network and local brain regions,and analyzed the network characteristics of the global and local brain regions of patients with epilepsy.Method:26 patients with epilepsy and 42 healthy controls were matched in gender,age,education and hand preference.All subjects were examined by resting fMRI and EEG.DTI data preprocessing and brain network construction using Gretna software(http://www.nitrc.Org/projects/gretna/)The whole brain and local area graph theory indexes were calculated and counted.The main parameters include:global efficiency,local efficiency,aggregation coefficient,feature path length,standard aggregation coefficient,standard feature path length and small world attribute.Result:1.The global efficiency,local efficiency and aggregation coefficient of epilepsy patients decreased significantly,and the length of feature path increased.There was no significant difference between the two groups in standard aggregation coefficient and standard feature path length.2.The nodal degrees of the right olfactory cortex and the left paracentral lobule decreased significantly in patients with epilepsy.The node local efficiency and node aggregation coefficient decreased significantly in the right olfactory cortex and the right rectus gyrus.3.The functional connections of right posterior cingulate gyrus right precuneus and left precuneus right precuneus in patients with epilepsy were weakened.Conclusion:The topological structure of epilepsy patients’ network changes,mainly the global efficiency,local efficiency and aggregation coefficient are significantly reduced,and the length of characteristic path is increased;At the same time,functional connections between different brain regions decreased.Part Ⅲ The effect of cognitive behavior intervention on anxiety,depression and quality of life in patients with epilepsyObjective:epilepsy is not only a neurological defect,but also a psychological and mental problem,which seriously affects personal,family and social functions.Epilepsy comorbidity,anxiety and depression are the most common,among which the incidence of recurrent seizures in patients with epilepsy is 20%-55%.Anxiety and depression of epileptic comorbidity are caused by neurobiochemistry and physiology,which also involves the limbic system and a variety of neurotransmitters.Serotonin plays a decisive role in the pathogenesis of anxiety and depression of epileptic comorbidity.However,compared with patients with other nervous system diseases,the pharmacological interaction between the treatment of the two diseases makes it very complex.Antidepressants may cause or aggravate seizures.In the process of clinical diagnosis and treatment,traditional Chinese medicine students are unwilling to use antidepressants for patients with epilepsy or patients refuse to take antidepressants,which has been identified as the main obstacle to the treatment of depression in patients with epilepsy.Therefore,some psychological treatments have been widely used to control epilepsy and improve mental and psychological problems.Cognitive behavioral therapy(CBT)is the most commonly used psychotherapy in the process of clinical diagnosis and treatment.It mainly changes the thinking and behavior of patients through cognitive behavioral therapy to achieve the therapeutic effect.A large number of studies have confirmed that it has a good impact on the mood and quality of life of patients with mental diseases and chronic physical diseases.This study takes epilepsy patients as the research object,adopts cognitive behavioral therapy,discusses its impact on anxiety,depression and quality of life,and carries out hierarchical analysis,so as to further explore the efficacy evaluation of cognitive behavioral therapy on different populationsMethod:95 patients with epilepsy included in the outpatient department or ward of the Department of Neurology of Suzhou Hospital Affiliated to Nanjing Medical University met the diagnostic criteria for epilepsy issued by the international anti epilepsy alliance in 2017,CBT group(n=46)and control group(n=49).All subjects completed 8 weeks of assessment and cognitive behavioral intervention from October 2020 to April 2021.Self rating Anxiety Scale(SAS),Hamilton Depression Scale(HDMA)and epilepsy quality of life-31 scale(QOLIE-31)were used to assess anxiety,depression and quality of life at baseline and endpoint.Result:1.Changes of anxiety,depression and quality of life before and after interventionIntra group analysis showed that the scores of anxiety and depression after the intervention were lower than those before the intervention.Compared with the control group,the score of depression scale in CBT intervention group decreased before and after the intervention,with a statistical difference(p<0.05).At the end of the 8th week,there was no significant difference in the scores of anxiety and depression between the two groups(p>0.05).Compared with the quality of life before and after the intervention,there were significant differences in emotional health,energy/fatigue,cognitive function,social function,drug impact,total comprehensive quality of life,onset anxiety and total score between the two groups(p<0.05).The changes of comprehensive quality of life,seizure anxiety and total score in CBT group before and after intervention were higher than those in the control group,and the difference was statistically significant(p>0.05).At the end of the 8th week,emotional health,overall quality of life and seizure anxiety were higher than those in the control group(p<0.05).2.Comparison of seizure frequency between the two groupsBefore intervention,there was no significant difference in seizure frequency between the two groups(P>0.05);After the intervention,the frequency of seizures in CBT group was significantly lower than that before the intervention(P<0.05).The frequency of seizures in the control group was lower than that before the intervention(P>0.05).Compared with the control group,the frequency of seizures in CBT group was significantly reduced(P<0.05).3.Effect of intervention on anxiety and depression based on generalized estimation modelCompared with the control group,the score of CBT intervention in the total population of depression decreased,and the difference was statistically significant.The analysis of anxiety score found that compared with the control group,CBT intervention had no statistical significance in the total anxiety population,but it was found that the CBT intervention group decreased more significantly than the control group in women and people using antiepileptic drugs;4.Based on the intervention effect analysis of the generalized estimation model of self rating Anxiety Scale(SAS)and Hamilton Depression Scale(HDMA),the analysis showed that compared with the control group,the CBT intervention group significantly increased in the dimensions of total score,seizure anxiety,cognitive function and drug influence(p<0.05).Stratified analysis found that the total score,cognitive function and drug impact score of the CBT intervention group in the combined drug group were higher than those of the single drug group,with a statistically significant difference(p<0.05).The total score,seizure anxiety and cognitive function score of the CBT intervention group in the single drug group were higher than those in the combined drug group(p<0.05).The total score and cognitive function score of male patients in CBT intervention group were higher than those of female patients(p<0.05).The total score,onset anxiety,energy/fatigue,cognitive function and drug influence of female patients in CBT intervention group were higher than those of male patients(p<0.05).Conclusion:1.Cognitive behavioral intervention can improve the anxiety and depression of patients with epilepsy,and the effect is not significant in the total anxiety population,but further analysis shows that the effect is more significant in women and antiepileptic drug users.Cognitive behavioral intervention has a significant effect on the general population of depression.2.Cognitive behavioral intervention can significantly improve the frequency of seizures.3.After cognitive-behavioral intervention,the quality of life of patients with epilepsy was significantly improved in the dimensions of overall quality of life,emotional health and seizure anxiety.Further stratified analysis showed that the dimensions of quality of life of people of different genders and types of antiepileptic drugs changed differently. |
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