| Part I:A structural MRI study:gray matter changes in mesial temporal lobe epilepsy patients with different seizure typesObjective:To observe the damage of gray matter structure and evaluate the mechanism of structural damage in mesial temporal lobe epilepsy patients with different symptoms by voxel-based morphometry.Methods:A total of 40 patients with mTLE,including 20 with partial seizures(mTLE-PS group)and 20 with secondarily generalized seizures(mTLE-sGS group),and 20 sex-and age-matched healthy volunteers(control group)were recruited.T1-three-dimensional magnetization prepared rapid gradient echo(3D-MPRAGE)was scanned for voxel-based morphometry(VBM).Bilateral frontal lobes and thalami were selected as regions of interest(ROIs)to compare gray matter volume of brain regions among 3 groups.Spearman rank correlation analysis was used to evaluate the correlations between gray matter volumes of brain regions and duration of epilepsy.Results:There were significant differences in gray matter volume in bilateral superior frontal gyri,right middle frontal gyrus,right medial frontal gyrus,right angular gyrus,right middle temproral gyrus,right hippocampus,bilateral thalami and bilateral cerebellar hemispheres among 3 groups(P<0.01,for all).Compared with control group,gray matter volumes in bilateral superior frontal gyri,bilateral cerebellar hemispheres,right middle temproral gyrus,right hippocampus and right thalamus in mTLE-PS group were significantly decreased(P<0.01,for all).Compared with control group,gray matter volumes in bilateral superior frontal gyri,bilateral thalami,bilateral cerebellar hemispheres,right angular gyrus,right middle temporal gyrus and right hippocampus in mTLE-sGS group were significantly decreased(P<0.01,for all).Compared with mTLE-PS group,gray matter volumes in bilateral superior frontal gyri,bilateral thalami,right meial frontal gyrus and right gyrus rectus in mTLE-sGS group were significantly decreased(P<0.01,for all).Gray matter volumes in left superior frontal gyrus(rs=-0.611,P=0.004)and right middle frontal gyrus(rs=-0.562,P=0.010)were negatively correlated with duration in mTLE-sGS group.Conclusions:mTLE patients with different seizure types have revealed multiple gray matter damages in bilateral frontal lobes,thalemi and cerebellar hemispheres,and right hippocampus and temporal lobe,but there is a difference in the injured brain region.The thalami and frontal lobes atrophy in mTLE patients with secondarily generalized seizures show that thalamocortical circuit plays an important role in the generalied seizures of mTLE.Part II:A applied study using resting-state functional magnetic resonance in medial temporal lobe epilepsyObjective:Through analyze the lateralization and hippocampal activation in medial temporal lobe epilepsy using resting-state functional magnetic resonance,to explore the usefulness of different resting-state functional indicators in disease detection.Methods:A total of 150 patients with unilateral medial temporal lobe epilepsy(79 patients on the left focus and 71 patients on the right focus)and 192 normal controls matched by gender and age was scaned blood oxygenation level dependent functional magnetic resonance imaging(BOLD-fMRI)and functional indicators was calculated,including ALFF,fALFF,ReHo,GFCD,LFCD,Complexity.The differences of functional indicators between the patient group and the normal control group were compared,and the individual maps of each functional indicators of each patient were obtained by comparing each functional inicators between the patient group and the normal control group,consequently carry out individualized analysis of localization and hippocampal activation.Results:The results between the patient group and the normal group on different functional indicators were as follows,1.ALFF:Positive activation was observed in bilateral hippocampus,temporal lobe,cerebellar hemispheres,frontal lobe and occipital middle gyrus in affected side in the patient group.2.fALFF:The occipital lobe of the affected side was positively activated and bilateral temporal pole and superior frontal gyrus showed negative activation in the patients group 3.GFCD:The parietal gyrus and precuneus of the affected side were positively activated.The contralateral side insula,hippocampus,amygdala,cerebellum,middle temporal gyrus and pallidus were negatively activated In the patients group.4.LFCD:Bilateral cerebellar hemispheres,inferior temporal gyrus and parietal gyrus of the affected side were positively activated.The cerebellar hemisphere of the contralateral side and the legume nucleus of the affected side showed negative activation in the patients group.5.ReHo:the superior frontal gyrus,middle frontal gyrus,superior marginal gyrus and temporal pole of the affected side were negatively activated in the patients group.6.Complexity Hurst index:The medial occipital gyrus,cerebellar hemisphere,inferior temporal gyrus of the affected side,angular gyrus of the contralateral side and middle temporal gyrus were positively activated.Bilateral temporal lobes showed negative activation.Results of individualized analysis:ALFF is the best functional indicator about activation accuracy of hippocampus,and its activation rate is 50.00%.GFCD is the best functional indicator about lateralization,and its lateralization accuracy rate is 75.53%,Sensitivity is 78.40%,specificity is 76.89%.Conclusions:Among many functional indicators,GFCD has the best hippocampal activation and focal-specific lateral efficacy for medial temporal lobe epilepsy.ALFF has good hippocampal activation and reho has good focal localization.These three functional indicators can better detect abnormal neural activities in the brain on the medial temporal lobe epilepsy,and play a certain role in the localization of epileptic foci and the construction of epileptic network... |
PDF Full Text Request