Study Of The Cognition In Patients With Benign Epilepsy Of Childhood With Centrotemporal Spikes By Using The VEEG And RS-fMRI

Objective The long term video electroencephalogram(EEG)and resting-state functional magnetic resonance imaging(RS-f MRI)technology were used to study the influencing factors of cognitive dysfunction and the change of brain network in patients with benign epilepsy of childhood with centrotemporal spikes(BECTS)and then explored the neural network mechanism of cognitive impariment.Methods Twenty five patients were recruited(from April 2015 to March 2017)from epilepsy specialist outpatients and functional department of neurosurgery of Tianjin Medical University General Hospital.They were eligible for the diagnostic criterion about BECTS published in 2001 by the International League Against Epilepsy(ILAE).They were with right-handed and could be able to complete the whole experiment.According to the inclusion and exclusion criteria,twenty two patients were enrolled at last.They underwent the long term VEEG monitoring(one sleep cycle was included at least).According to spike-wave index(SWI)during slow ware sleep,they were divided into two groups: SWI<50%(10 cases)and SWI?50%(12 cases).The SWI<50% group had 6 males and 4 females and the average age was(11.3±4.3)years.The SWI?50% group had 7 males and 5 females and the average age was(9.9±3.0)years.The two groups of patients administered the Wechsler Intelligence Scale China Revised.They also underwent the head MRI and RS-f MRI examinations.The RS-f MRI images were preprocessed by SPM8 analysis software under the MATLAB(2013a)and the further date were analysed by single sample t-test and two independent samples t-test under the whole brain of regional homogeneity(Re Ho),amplitude of low frequency fluctuation(ALFF)and fractional of ALFF(f ALFF)methods in the REST software.Then the results of clinical date,EEG and cognitive functional test were comparatively analysed.Results There were no statistically significant in sex,age,age of onset,disease course,total number of seizures and years of education(P>0.05).The FIQ,VIQ and PIQ of SWI?50% group were lower than SWI<50% group and the differences were statistically significant(P<0.05).The arithmetic,vocabulary of VIQ and the picture completion,block design,object assembly of PIQ in SWI?50% group were more poorer than SWI<50% group.There was a negative correlation between the FIQ,VIQ,PIQ and the SWI.The FIQ,VIQ and PIQ had no correlation with the age,age of onset,disease course,total number of seizures and years of education(P>0.05).Single sample t-test based on whole level Re Ho,ALFF,f ALFF methods showed more brain regions were activated in SWI?50% group than SWI<50% group,and the middle line structures were more prominent.Compared with SWI<50% group by two sample t-test based on whole level Re Ho,ALFF,f ALFF methods showed that SWI?50% group had a strong activate in the bilateral precentral gyrus,premotor area and subcortical structure,bilateral prefrontal lobe,bilateral pretemporal lobe,bilateral insular lobe and anterior cingulate gyrus(P<0.05);while they showed negative activate in the posterior cingulate gyrus,bilateral posterior inferior temporal lobe,bilateral occipital lobe and bilateral cerebellum(P<0.05).Conclusions 1.The frequency abnormal discharge during slow ware sleep in patients with BECTS was the main risk factor that leading to cognitive impariment,such as language and performance.2.The abnormal enhanced or weakened activated brain regions still included areas outside the rolandic focus in patients with BECTS who had a higher SWI during slow ware sleep,such as prefrontal cortex,island leaves,occipital lobe,cerebellum,posterior cingulate gyrus and basal ganglia,suggesting that sustained abnormal discharge during slow wave sleep leading to abnormal activity of local neurons in patients,affecting the formation of normal brain network and impairing the transmission of information.It provided a new way to understand the impairment of advanced neurological functions including cognitive,emotional,behavioral and other activities in patients with BECTS.And it might provide a theoretical basis for the early detection of advanced neurological impairment,so that we could give an early counseling or drug therapy,preventing and reducing brain injury and improving the quality of life in patients with BECTS.3.Except the cortical function impaired,we also found the abnormal activities of subcortical structures such as thalamus,cranial nucleus and caudate nucleus which might be play a certain role in epilepsy and cognitive dysfunction combined,suggesting that we should not only focus on the abnormal cortical structure,should also be concerned on the subcortical structure in the pathogenesis of epilepsy and the role of cognitive dysfunction in the future.