BOLD-Functional Magnetic Resonance Imaging On Demonstrating The Brain Domains Of Language,Memory Of Patients With Epilepsy And Influencing Of Antiepileptic Drugs On These Cerebral Areas

Background:One of the unhealthy consequences of epilepsy is the damage of brain domains, especially memory, the capability to express and comprehension. Many facts can influence the brain domains. Among these reasons, neurologists pay close attention to antiepileptic drugs(AEDs). Neurologists usually take series of neuropsychological tests to comprehend the brain function of epileptic patients. Functional magnetic resonance imaging(fMRI) offers a tool for visualising regional brain activity. The areas detected with changes in blood-oxygen level-dependent (BOLD) contrast reflect local changes in the retio of deoxy- and oxyhemoglobin that occur during specific tasks and allow the mapping of neural networks involved in the performance of these tasks. fMRI plays an important role for us to understand the pathology of diagnosis, drug treatment and pre-operative appraisal of epileptic patients in order to decrease functional handicap.Objectives: (1) To observe the change of BOLD in the brain of patients with epilepsy. (2)To examine impairment of language and memory function in patients with epilepsy. (3)To contrast the change of BOLD and language, memory function examined by the neuropsychological tests after taking lamotrigine, in order to comprehend the influence of LTG on them.Methods: 20 patients with typical symptoms, EEG monitoring and 20 normal subjects had been investigated. They all experienced routine cranium axial view, anteroposterior axea, oblique coronal view and BOLD-fMRI scanning by using American GE company 3.0 Tesla magnetic resonance imaging system. During BOLD scanning, we adopted block design with the word generation task and Roland' s Hometown Walking Task. And WMS,WAIS or C-WISC were taken to detect memory or language function. Rechecked those tests after regular LTG medication one month later. Maps of the activated areas were generated and analysed by using software MATLAB. T-test was used to analyse the outcomes.Results: 1. Results of language function examination:The mean values and standard deviation(SD) before LTG medication of vocabulary, insight,verbal intelligence quotient(VIQ)and full intelligence quotient(FIQ) were 12.56±2.80,2.62±1.57,90.12±3. 56,92. 58+2.99. After LTG medication, they were 13.78±1.31,3.13±1.06,94.76±3.02,93. 77±3.10. And the control group were 13.85±2.14,3.21±1.27,96.09±4.31,94.11±3.17. The result of VIQ was significantly different between patients before treat and the control group;also different between with or without LTG medication(P<0. 05). Comparing FIQ with or without LTG and the control group, the results had no difference(P>0. 05). 2. Results of memory function examination: The mean Memory Quotient(MQ) and SD of the patients before treatment was 98.01±14.57, after treatment was 100.99±13. 78;and the control group was 101.24±13. 54. Compare MQ between patients before or after LTG medication with the control group, there was no difference(P>0. 05). 3. Results of language and memory function examined by BOLD:During language task stimulation, the main activating regions in all subjects are Broca's area and left superior frontal gyrus. The supplementary motor area(SMA), left middle frontal gyrus, right inferior frontal gyrus and left insula lobe were also been activated in all subjects. Left thalamus,occipital lobe,insula,cingulate gyrus,left and right superior temporal gyrus are included before LTG medication group too. During memory task stimulation, the main activation regions of all subjects are parahippocampal gyrus, left frontal,temporal and parietal lobe. Left thalamus, fusiform gyrus, left insula lobe, hippocampus ,occipital lobe and cingulae gyrus are included in the untreated group.Conclusion: 1. Though epileptic patients may have normal FIQ in initial stage of seizure, their insight,vocabulary and VIQ had already decreased;But patients'MQ is normal. 2. AEDs LTG might improve patients' language and memory functions. 3. BOLD-fMRI shows the language and memory functions of epileptic patients are lower than controls;and the patients had an extended region to compensate the impaired functions. 4. This conclusion of BOLD-fMRI may be helpful for clinican to guide operation, monitor therapeutic effect, evaluate prognosis of impairment of brain function and choose rehabilitation training methods of language and memory.