Study Of Brain Function Changes In Patients With BECT After Long-term Antiepileptic Drug Treatment By FMRI Combined With Long-term VEEG

Objective Resting state functional magnetic resonance imaging(RS-f MRI)technology based on regional homogeneity,amplitude of low-frequency fluctuation and fractional ALFF combined with long-term video electroencephalogram(VEEG)and cognitive function evaluation,was applied to study the changes of brain function in BECT patients after long-term application of antiepileptic drugs.Methods Patients with BECT who were followed up for more than 2 years after concurrent RS-f MRI,long-term VEEG,and cognitive function assessment in the epilepsy clinic and functional neurosurgery of Tianjin Medical University General Hospital from April 2015 to January 2019 were selected at last.After screening according to inclusion and exclusion criteria,4 patients were finally enrolled.All patients underwent head MRI,RS-f MRI,long-term video EEG monitoring(including at least one complete sleep Period)and cognitive function evaluation(C-WISC or WAIS-RC)at the time of the first examination and the second examination.The spike-wave index(SWI)in slow wave sleep period was calculated according to electroencephalogram,and verbal intelligence quotient(VIQ),operational intelligence quotient(PIQ)and total intelligence quotient(FIQ)were calculated according to cognitive function evaluation results.Statistical software SPSS21.0 was used to make comparative analysis on SWI,VIQ,PIQ and FIQ of BECT patients at the time of the first examination and the time of the second examination.Firstly,the RS-f MRI raw data is preprocessed by using software package SPM8,and then the paired samples T test based on whole brain level is carried out by using software package REST with three analysis methods of Re Ho,ALFF and f ALFF respectively.To observe the changes of brain activation in BECT patients during the first examination and the second examination,and make a comprehensive analysis based on the patients' basic data,clinical control,SWI and cognitive assessment results.Results 1.At the time of reexamination,1 of the 4 patients had no seizure(noseizure from the first examination to the reexamination),2 patients were effective(seizure frequency decreased ?50% compared with before),and 1 patient had nochange(seizure frequency decreased <50%).2.At the time of reexamination,the average SWI of 4 patients was lower than before.The average SWI of 4 patients at the time of reexamination was 41%,and the average SWI of 4 patients at the time of reexamination was 15.5%.3.The IQ of BECT patients at the time of reexamination was higher than that before.The difference between PIQ and FIQ was statistically significant(P<0.05),but the difference between VIQ and PIQ was not statistically significant(P>0.05).4.Re Ho analysis results showed that the brain regions with enhanced activation during reexamination mainly include the left temporal lobe,parietal lobe and occipital lobe,mainly located in the left temporal-parietal-occipital junction region.The brain regions with reduced activation mainly include bilateral frontal lobe,left temporal lobe,left insular lobe,bilateral ACC,bilateral limbic lobe,bilateral thalamus,right lenticular stone,right caudate stone,etc.ALFF analysis results showed that the brain regions with enhanced activation during the reexamination mainly included the left limbic lobe,bilateral thalamus,left brainstem,bilateral cerebellum,etc.The brain regions with reduced activation are mainly located in the left frontal lobe.FALFF analysis results showed that the brain regions with enhanced activation were mainly located in bilateral occipital lobe.There are no brain regions with obvious activation weakening.Conclusions 1.The frequent epileptiform discharges in NREM phase and recurrent clinical attacks of BECT patients are better than before when they were reexamined,suggesting that antiepileptic drugs are effective.2.The VIQ,PIQ and FIQ of BECT patients were higher than before,suggesting that reasonable application of AEDs to control epileptic seizure and improve abnormal discharge of electroencephalogram are beneficial to cognitive function of BECT patients.3.The comparison of RS-f MRI imaging between the two examinations shows that the decrease of bilateral frontal lobe activation and the enhancement of left(dominant)temporal parieto-occipital junction activation after long-term antiepileptic drug treatment may be related to the reduction of epileptic seizure frequency and epileptic discharge and improvement of cognitive function in BECT patients,which provides us with new ideas and methods for further evaluating the overall efficacy of BECT patients.