Study Of The Cognition In Patients With Benign Epilepsy Of Childhood With Centrotemporal Spikes By Using The ReHo?ALFF?fALFF Of RS-fMRI

Objective The ReHo?ALFF?fALFF of resting-state functional magnetic resonance imaging(RS-fMRI)technology were used to study the influencing factors and neural mechanism of cognitive dysfunction in patients with benign epilepsy of childhood with centrotemporal spikes(BECT).Methods fourteen patients were recruited(from April 2015 to March 2018)from epilepsy specialist outpatients and functional department of neurosurgery of Tianjin Medical University General Hospital.According to the inclusion and exclusion criteria,fourteen patients were enrolled at last.They underwent the long term VEEG monitoring(one sleep cycle was included at least),the Wechsler Intelligence Scale China Revised,the head MRI and RS-fMRI examinations.Spike-wave index(SWI),FIQ,VIQ,PIQ scores were calculated.According to full-scale IQ(FIQ),they were divided into two groups: FIQ?90(scores were between 90 and 126,the average score was 116.6±12.9,8 cases)and FIQ<90(scores were between 70 and 89,the average score was 78.3±8.9,6 cases).SPSS21.0 statistical software was used to compare the general clinical data and SWI of the two groups,and the correlation between clinical factors and the evaluation results of wechsler intelligence scale was analyzed.The RS-fMRI images were preprocessed by SPM8 analysis software under the MATLAB(2013a)and the further data were analysed by single sample t-test and two independent samples t-test under the whole brain of regional homogeneity(ReHo),amplitude of low frequency fluctuation(ALFF)and fractional of ALFF(fALFF)methods in the REST software.The differences of brain activation regions in RS-fMRI between the two groups were observed,and the results of general clinical data,SWI and cognitive function test were compared and analyzed comprehensively.Results There were no statistically significant in age,sex,years of education,age of onset,course of disease,total number of seizures(P>0.05).The differences of SWI were statistically significant(P<0.05): FIQ?90 group were lower than FIQ<90 group.The FIQ,VIQ and PIQ of BECT patients were negatively correlated with SWI(P<0.05).And the FIQ and PIQ were negatively correlated with the total number of seizures(P<0.05),while the VIQ had no correlation with the total number ofseizures(P>0.05).The FIQ,VIQ,PIQ had also no correlation with the age,years of education,age of onset and course of disease(P>0.05).Single sample t-test based on whole level ReHo,ALFF,fALFF methods showed that in FIQ?90 group,the brain regions with abnormal activation were mainly in the cerebral cortex,and those were less in the subcortical structure.And in FIQ<90 group,in addition to the abnormal activation regions of cortex,those of subcortical structures were more apparent.Namely compared with FIQ?90 group,the abnormal activation regions of cortical and subcortical structures were more distributed in FIQ<90 group.Compared with FIQ?90 group by two sample t-test based on whole level ReHo,ALFF,fALFF methods,deactivation of brain regions of FIQ<90 group include bilateral precuneus,posterior cingulate and occipital lobe,and enhanced activation of brain regions include left prefrontal cortex,bilateral superior frontal gyrus medial and right precentral gyrus,supplementary motor area,angular gyrus,supramarginal gyrus,middle temporal gyrus,and bilateral insular lobe,subcortical gray matter structures such as putamen,globus pallidus,the caudate nucleus.Conclusions1.Frequent epileptic discharge during slow ware sleep and recurrent clinical episodes were risk factors for cognitive impairment in BECT patients.2.Compared with BECT patients with normal intelligence and above,those with below normal intelligence had abnormal activation of brain regions,including left prefrontal cortex including language related brain regions,subcortical gray matter structures and default mode network.This provided a new way for us to understand the cognitive impairment of BECT patients,and suggested that in clinical it was very important to control clinical episodes and abnormal discharge in EEG to protect the cognitive function of BECT patients.