| Objective To investigate the changes of cerebral blood flow and its clinical application value of functional near infrared spectroscopy(fNIRS) in focal epilepsy.Methods Select 42 cases of patients with focal epilepsy in Department of Neurosurgery and Neurology of General Hospital Affiliated to Tianjin Medical University. The diagnosis of all patients was in accordance with the International League Against Epilepsy(ILAE) in 2014 on the diagnosis of focal epilepsy criteria.All patients were admitted to the assessment process and selected the appropriate treatment plan. All patients were examined by video electroencephalogram(VEEG),MRI, PET-CT, neuropsychological examinations, ictal SPECT(if necessary), which were preliminarily to assess the focal discharges and abnormal blood flow changes in the brain areas.All patients weared EEG-fNIRS the special cap used for synchronous measurement, installed EEG scalp electrode and the spectrometer(SHIMADZU LABNIRS), respectively monitoring the frontal area, temporal area, the parietal area,occipital area. The E-prime software marks the beginning of the record synchronization, monitoring time 60~100 minutes. Patients can have a rest for about10 minutes, who can choose a comfortable position and keep quiet, during the process of monitoring. After the monitoring, we would locate the near infrared three-dimensional channel information. through the 3D positioning device and the locating rod. Filtered ECG artifact, the EEG results were analyzed respectively by two experienced EEG doctors.We chosed the typical epilepsy discharges which were recognized by the two doctors and marked the the main parts on the EEG, recording the interictal discharges time. After the record,we need to analyzed the regulation of the blood flow on the channels and the cerebral area of the channels location by MATLAB software. Analysis the relationship between the blood flow and epilepsy.Comparison of PET metabolism, blood flow changes and the onset of SPECT.Results 39 cases were found with abnormal cerebral blood flow changes, the sensitivity, the detection rate was 97.5%. One case may be due to a deeper location,beyond the depth of fNIRS detection. 25 cases were focal epilepsy, 15 cases mesial temporal lobe epilepsy. Region of interest(ROI) areas indicate blood flow changes in21 cases(84%), the adjacent brain regions 7 cases(25%), the mirror brain areas 8cases(32%) and distant brain regions 8 cases(32%) among the 25 cases of focal cortical epilepsy. 15 patients with temporal lobe epilepsy were not detected the blood flow changes in the interesting area,while 13 cases appeared blood flow change in other brain regions(86.7%), 2 cases did not appear blood flow changes(13.3%) in the other areas. 10 cases appear blood flow changed in contralateral brain areas(66.7%) and 8 cases appeared blood rheological in ipsilateral cerebral areas(53.3%).The level deoxyhemoglobin(HbR) baseline was higher than oxygen synthetic high hemoglobin(HbO) and total hemoglobin(HbT) in the abnormal brain regions during the interictal epileptiform discharges while the level of HbR baseline was lower than that of HbO and HbT. When the epileptiform discharges appeaderd,corresponding channels appeared vertical shape increased in HbO, HbT and then slowly decreased to the baseline level. At the same time the level of HbR decreased then slowly increased to baseline levels.Conlusion fNIRS is a non-invasive, safe, portable, reasonably priced method to reflect the brain activity. In the detection of cerebral blood flow changes, it is a sensitive and accurate functional imaging technology, which can explore the level of HbR, HbO and HbT, indirectly reflect the cerebral blood flow perfusion. Combined with EEG, fNIRS can dynamically monitor the changes of cortical blood flow during interictal discharges, which can not only detect the abnormal changes of blood flow in the local area, but also can catch the abnormal blood flow in the adjacent, the contralateral and the remote areas. It also accompany the deficiency of the PET and the SPECT in the examination of cerebral perfusion during epileptic seizures and epileptic discharge. With the technology developing, it is expected to be used in epilepsy surgery to assist the localization of epilepsy. |
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