| BackgroundEpilepsy,EP for short,is a kind of chronic brain disease which is caused by a variety of pathogen.Neurons in the brain repeatly abnormal discharge cause dysfunction of the brain.Epilepsy is a chronic disease of the central nervous system,some scholars in the relevant years believe that epilepsy is a kind of diseases of abnormal brain network.Epilepsy disease characterized by recurrent outbreak, usually transient, occasionally appear to be status epilepticus. Functional encephalopathyjust after stroke,is currently the second multiple disease of the central nervous system disorders, and epilepsy is the most kind of functional encephalopathy.Epilepsy affects about ninety million people in the world, about nine million distribute in China,epilepsy can occur in all ages, all regions and all races.Even after standard drug treatment, about 20%-30% of epilepsy patients still can’t obtain effective seziure control, then this kind of epilepsy can be called drug refractory epilepsy, which brings great challenges to the clinical treatment.Seizures are usually asymptomatic and repeat, however, when it is the period between seizures, abnormal neurons can still automatically polarize,which can present sharp wave, spike wave or spike-slow wave forms on EEG record.The slow, chronic discharges affect the brain for a long time, causing brain disfunctions of epilepsy patients,such as memory damage, language damage and cognitive damage.Epilepsy finally causes a significant drop in the patient’s life quality and brings heavy mental burden and economic burden to society and family.Childhood generalised tonic—clonic seizure (GTCS) is a type of systemic onset seizure, it is harm to children’s brain development and children’s physical and mental health. At present the neural mechanism of this seizure is not very clear, and the establishment of the imaging diagnostic criteria of the position of the epileptic focus requires the full understanding of the pathogenesis. We hope for the diagnosis and treatment of children with early noninvasive imaging method for screening, to determine the epilepsy type and effective treatment as early as possible. Magnetic resonance imaging (MRI) can play a good role in the above aspects.In recent years, with the progress of science and technology and development of the medical research, Resting-state fMRI (namely rs-fMRI) develops rapidly,and when compared with the traditional state fMRI which is based on the external task stimulation, rs-fMRI can be used to study the inner spontaneous neuronal activity of the brain.There are many advantages of RS-fMRI imaging technology,such as no-traumatic, high resolution, easy to implement and many other advantages. RS-fMRI suits for epilepsy disease research and for observe the characteristic of children epilepsy spontaneous brain activity.In our study MRI imaging technology is used to study childhood general tonic-clonic epilepsy, the main content is divided into the following four parts:The first part, Study on childhood general tonic-clonic epilepsy using regional homogeneity analysis method;The second part, Study on childhood general tonic-clonic epilepsy using Amplitude of low frequency fluctuation analysis based on Resting-state functional MRI;The third part, Magnetic resonance research of cerebral gray matter volume change in childhood general tonic-clonic epilepsy;The fourth part, Resting-state functional magnetic resonance imaging (rs-fMRI) in the applicational research progress of epilepsy diagnosis and treatment(Review).The aim of this study is to explore the pathophysiology of childhood general tonic-clonic epilepsy through a variety of magnetic resonance imaging analysis method,to understand the cause of epileptic clinical manifest,and to provide clinical basis for treatment, prognosis judgement, related research in the future.Part 1 Study on childhood generalised tonic-clonic seizure using regional homogeneity analysis methodObjective Regional homogeneity(ReHo) analysis method of resting state functional MRI are applied to study abnormal brain activity of childhood generalised tonic-clonic seizure patients,and try to detect the pathophysiological mechanism of it.Methods Resting-State fMRI scanning were performed to 12 patients with childhood general tonic-clonic epilepsy and 30 heathy children.The MRI data was compared and analyzed by using ReHo analysis method, the ReHo value were calculated and compared in both two groups.Result Compared with control group, the brain regions of increased ReHo value in experimental group are located in left parahippocampal gyrus, left superior temporal gyrus, right insular lobe, right caudate nucleus, bilateral cingulate gyrus;on the other hand,compared with control group, the brain regions of decreased ReHo value in experimental group are left frontal lobe, left cuneus lobe, left occipital lobe, the medial part of left frontal lobe, right middle temporal gyrus, the middle of right occipital lobe.Conclusion ReHo analytical method can effectively reflect abnormal neurological functional change of the epilepsy patients, and help to research and explain the pathophysiology of childhood general tonic-clonic epilepsy.Part 2 Study on childhood general tonic-clonic seizure using Amplitude of low frequency fluctuation analysis based on Resting-state functional MRIObjective Apply amplitude of low frequency fluctuation analysis which is based on Resting-state functional MRI to study abnormal brain activity in patients with childhood general tonic-clonic seizure and to explore the pathophysiological mechanisms of epilepsy.Methods Use resting state functional imaging technology to observe change of cerebral blood oxygen level dependent signal in childhood general tonic-clonic seizure patients.We do resting-state fMRI scanning for 12 patients with childhood general tonic-clonic seizure and 30 heathy children,and calculate the participants ALFF value of the whole brain after data processing,and we use two sample t test method to observe the brain regions of increased or decreased ALFF value in childhood general tonic-clonic epilepsy patients which compared with normal control group.Results Compared with control group, the brain regions of increased ALFF value in epilepsy group are located in right putamen,left cingulate cortex,right posterior thalamus and parahippocamal gyrus. Compared with control group, the brain regions of decreased ALFF value in epilepsy group are located in left medial frontal lobe,left posterior middle temporal gyrus,right posterior inferior temporal gyrus and right superior occipital lobe.Conclusion Amplitude of low frequency fluctuation analysis based on resting state functional magnetic resonance imaging can effectively reflect the abnormal neural function change in epilepsy patients, and observe brian activity changes which are caused by epilepsy.Increased ALFF values reflect the brain regions facilitate generation and transmision of brian epileptic activity;the decrease of ALFF values reflect brain regions inhibit epileptic activity.Part 3 Magnetic resonance research of cerebral gray matter volume change in childhood general tonic-clonic seizureObjective Use voxel-based optimized morphometry method (namely VBM) to analysis whole brain gray matter volume changes of childhood general tonic-clonic seizure patients.Methods We do whole brain MRI scans for 12 childhood general tonic-clonic seizure patients and 29 normal control children, obtain high-resolution T1-weighted structure image,and do data processing and statistical analysis, then obtain the brain of gray matter volume change.Results Compared with normal control group, the brain regions of decreased gray matter volume in epilepsy patient group are located in bilateral thalamus(mainly in the left side),right postcentral grus,left middle temporal gyrus,right inferior frontal gyrus,left caudate nucleus。Compared with normal control group, the brain regions of increased gray matter volume in epilepsy patient group have not been found.Conclusion The use of VBM analysis can show the brain regions of gray matter volume change in childhood general tonic-clonic epilepsy patients, so as to prompt the main parts of the lesion, and then provide basis for clinical treatment.Part 4 Review:Resting-state functional magnetic resonance imaging (rs-fMRI) in the applicational research progress of epilepsy diagnosis and treatmentFirst,the basic principle of resting state functional magnetic resonance imaging.Second, the process and analysis methods of the resting state functional magnetic resonance imaging data.Third,the application of resting state functional magnetic resonance imaging in epilepsy diagnosis and treatment.Fourth, prospect of resting state functional magnetic resonance imaging application. |
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