【摘要】 目的应用基于局部一致性(ReHo)、低频振幅(ALFF)、低频振幅分数(fALFF)的静息态功能磁共振成像(Resting-state functional magnetic resonance imaging,RS-fMRI)技术,探索伴中央颞区棘波的儿童良性癫痫(Benign epilepsy of childhood with centrotemporal spikes,BECT)患儿认知功能受损的影响因素及神经机制。方法纳入2015年4月-2018年3月就诊于天津医科大学总医院的BECT患儿14例,均行韦氏智力量表评估、长时程视频脑电图(VEEG)监测及头颅核磁共振(MRI)、RS-fMRI检查,计算慢波睡眠期棘慢波放电指数(SWI)、总智商(FIQ)、言语智商(VIQ)、操作智商(PIQ)。按FIQ分为两组:FIQ <90组[70～89分,平均(78.3±8.9)分,6例]和FIQ≥90组[90～126分,平均(116.6±12.9)分,8例],将两组进行对比,并分析临床因素与智力评估结果的相关性;从ReHo、ALFF、fALFF三种方法对两组进行全脑水平两独立样本t检验,观察脑激活区的差异;结合临床因素、认知测评结果进行综合对比分析。结果 FIQ <90组的SWI高于FIQ≥90组,差异具有统计学意义(P<0.05)。FIQ、VIQ、PIQ均与SWI呈负相关(P<0.05);FIQ、PIQ均与总发作次数呈负相关(P<0.05)。FIQ <90组与FIQ≥90组相比较,激活减弱的脑区包括双侧楔前叶、后扣带回及枕叶,增强的脑区包括左侧前额叶,双侧额上回内侧,右侧中央前回、补充运动区、角回、缘上回及颞中回,双侧岛叶及皮层下灰质结构。结论慢波睡眠期频繁痫样放电及反复临床发作是BECT认知受损的危险因素,两者可引起与认知相关的局部脑区及默认网络的功能异常,从而导致其认知受损。更多还原

【Abstract】 Objective The ReHo, ALFF, fALFF of resting-state functional magnetic resonance imaging(RSfMRI) 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 enrolled (from April 2015 to March 2018) from epilepsy specialist outpatients and Functional Department of Neurosurgery of Tianjin Medical University General Hospital. 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 range from 70 to 89, the average score was 78.3±8.9, 6 cases) and FIQ≥90(scores range from 90 to 126, the average score was 116.6±12.9, 8 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 and the further data were analysed by 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. 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 The differences of SWI were statistically significant (P<0.05): FIQ<90 group were greater than FIQ≥90 group.The FIQ, VIQ and PIQ of two groups 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). 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, bilateral insular lobe and subcortical gray matter structures. Conclusions Frequent epileptic discharges during slow wave sleep and recurrent clinical episodes were risk factors for cognitive impairment in BECT patients.Repeated clinical seizures and frequent subclinical discharges could cause dysfunction of local brain areas associated with cognition and the default network, resulting in patients with impaired cognitive function.更多还原