本文選題：兒童良性癲癇伴中央顳區(qū)棘波　切入點：長時程視頻腦電圖　出處：《天津醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的應(yīng)用長程視頻腦電(VEEG)及靜息態(tài)功能磁共振成像(RS-fMRI)技術(shù),研究兒童良性癲癇伴中央顳區(qū)棘波(BECTS)患者認知功能障礙的影響因素及腦功能網(wǎng)絡(luò)的改變,探討其認知功能損害的神經(jīng)網(wǎng)絡(luò)機制。方法收集于2015年4月至2017年3月就診于天津醫(yī)科大學總醫(yī)院癲癇門診及功能神經(jīng)外科病區(qū)符合國際抗癲癇聯(lián)盟(ILAE)2010年所制定的癲癇和癲癇綜合征分類中有關(guān)BECTS診斷標準的25例患者,均為右利手且能配合整個檢查過程。根據(jù)納入及排除標準,最終入組22例患者,均行長程VEEG監(jiān)測(至少包括一個完整睡眠周期),計算出慢波睡眠期棘慢波放電指數(shù)(SWI)并將其按SWI高低分為兩組:SWI50%組(10例)及SWI≥50%組(12例),其中SWI50%組男6名,女4名,平均年齡(11.3±4.3)歲;SWI≥50%組男7名,女5名,平均年齡(9.9±3.0)歲。所有入組患者均行中國修訂版韋氏智力量表評估及頭顱MRI、RS-fMRI檢查。應(yīng)用MATLAB(2013a)平臺下SPM8分析軟件對RS-fMRI數(shù)據(jù)進行預處理及預處理后數(shù)據(jù)采用REST軟件從局部一致性(ReHo)、低頻振幅(ALFF)、低頻振幅分數(shù)(fALFF)三種分析方法分別進行全腦水平單樣本t檢驗和兩獨立樣本t檢驗,并結(jié)合其臨床資料、腦電圖及認知功能測評結(jié)果進行綜合對比分析。結(jié)果兩組患者的年齡、性別、首發(fā)年齡、病程、總發(fā)作次數(shù)、受教育程度比較差異無統(tǒng)計學意義(P0.05)。SWI≥50%組患者的總智商(FIQ)、語言智商(VIQ)、操作智商(PIQ)均低于SWI50%組患者,比較差異有統(tǒng)計學意義(P0.05)。其中,VIQ子項目測試中的算術(shù)、詞匯評分差異更明顯,PIQ子項目測試中的填圖、積木、圖形拼湊評分差異更明顯(P0.05)。FIQ、VIQ、PIQ分別與SWI呈負相關(guān)(P0.05),而與年齡、首發(fā)年齡、病程、總發(fā)作次數(shù)、受教育程度之間無相關(guān)性(P0.05)。從ReHo、ALFF、fALFF三種分析方法基于全腦水平單樣本t檢驗結(jié)果顯示SWI≥50%組腦激活區(qū)明顯多于SWI50%組,除皮層激活增多外,中線結(jié)構(gòu)激活突出;兩獨立樣本t檢驗結(jié)果顯示SWI≥50%組較SWI50%組異常激活增強的腦區(qū)包括雙側(cè)中央前回、運動前區(qū)及其皮質(zhì)下結(jié)構(gòu),雙側(cè)前額葉,雙側(cè)顳葉前部,雙側(cè)島葉,前扣帶回(P0.05),激活減弱的腦區(qū)包括后扣帶回、雙側(cè)顳下回后部、雙側(cè)枕葉、雙側(cè)小腦(P0.05)。結(jié)論1、BECTS患者慢波睡眠期頻繁的異常放電是造成其語言、操作等認知功能受損的主要危險因素;2、BECTS患者在靜息狀態(tài)下,慢波睡眠期SWI高的其fMRI異常激活增強或減弱的腦區(qū)尚包括Rolandic區(qū)以外的區(qū)域,如前額葉、枕葉、島葉、小腦、扣帶回及基底神經(jīng)核,提示慢波睡眠期頻繁異常放電可導致腦局部神經(jīng)元的異�；顒�,影響正常腦網(wǎng)絡(luò)的形成并導致信息傳遞功能受損,這為我們理解并進一步研究BECTS患者合并高級神經(jīng)功能包括認知、情緒、行為等活動障礙,提供了一個新的思路和研究方向,并為我們早期發(fā)現(xiàn)BECTS患者高級神經(jīng)功能受損,早期給予輔導或藥物治療,預防及減輕腦損傷,提高BECTS患者生活質(zhì)量提供了理論基礎(chǔ)。3、BECTS患者除皮層功能受損外,尚發(fā)現(xiàn)皮層下結(jié)構(gòu)如丘腦、殼核、尾狀核等靜息狀態(tài)下的異常活動,其可能在癲癇發(fā)病及合并認知功能障礙上發(fā)揮著一定的作用,提示我們在今后的研究中,不應(yīng)只關(guān)注皮層結(jié)構(gòu)的異常,還應(yīng)同時關(guān)注皮層下結(jié)構(gòu)在癲癇發(fā)病及合并認知功能障礙中的作用。
[Abstract]:Objective to use long-term video EEG (VEEG) and resting state functional magnetic resonance imaging (RS-fMRI) technology, the research of benign childhood epilepsy with centrotemporal spikes (BECTS) change factors and brain functional network effects in patients with cognitive impairment, to explore the cognitive impairment of neural network mechanism. Methods from April 2015 to March 2017 in General Hospital Affiliated to Tianjin Medical University from epilepsy clinic department of Neurosurgery Ward and function in line with the International League Against Epilepsy (ILAE) of 25 patients developed epilepsy and epilepsy in 2010 about the diagnostic criteria of BECTS syndrome in the classification, were right-handed and can cooperate with the whole inspection process. According to the inclusion and exclusion criteria, 22 patients were enrolled in the final, both President VEEG monitoring (including at least one complete sleep cycle), calculated during slow wave sleep spike wave discharge index (SWI) and its SWI level divided into two groups: group SWI50% (10 cases SWI = 50%) and group (12 cases), SWI50% group male 6, female 4, average age (11.3 + 4.3); SWI = 50% group male 7, female 5, average age (9.9 + 3) years old. All patients underwent Chinese revised Wechsler Intelligence Scale the assessment form and head MRI, RS-fMRI examination. The application of MATLAB (2013a) platform SPM8 analysis software of pretreatment and pretreatment on RS-fMRI data using REST software from the local consistency (ReHo), low frequency amplitude (ALFF), fractional amplitude of low frequency (fALFF) three methods were all brain levels of single sample t test and two independent samples t test, and combined with the clinical data, analysis of EEG and cognitive function evaluation results were compared. Results of the two groups in age, gender, age of onset, course of disease, the total number of attacks, there was no significant difference between the level of Education (P0.05) total IQ.SWI more than 50% groups (FIQ), verbal IQ (VIQ), performance IQ (PIQ) were lower than SWI50% group, the difference was statistically significant (P0.05). Among them, the VIQ project in the test arithmetic, lexical score difference is more obvious, the PIQ project in the test blocks, mapping, graphics together score more obvious differences (P0.05).FIQ, VIQ, PIQ were negatively correlated with SWI (P0.05), and with age, age of onset, course of disease, the total number of attacks, there is no correlation between the level of Education (P0.05). From ReHo, ALFF, fALFF three kinds of analysis method of whole brain level based on a single sample t test showed that SWI = 50% group of activated brain regions were more than those in group SWI50% in addition, increased cortical activation, activation of midline prominent; two independent sample t test showed that SWI = 50% group than in SWI50% group of abnormal brain activation enhanced bilateral precentral gyrus, the premotor cortex and subcortical structures, prefrontal cortex, bilateral anterior temporal lobe, bilateral insula, anterior cingulate (P0 .05), including the activated brain region decreases the posterior cingulate, bilateral temporal gyrus, bilateral occipital lobe, bilateral cerebellum (P0.05). Conclusion: 1 BECTS patients with abnormal discharge, slow wave sleep stage frequently is the language, the main risk factors such as impaired cognitive function operation; 2 patients in the resting state, BECTS next, the slow wave sleep stage SWI high fMRI abnormal brain activation is increased or decreased including Rolandic area outside the region, such as the prefrontal cortex, occipital lobe, insula, cingulate gyrus and cerebellum, basal ganglia, suggesting that during slow wave sleep frequent abnormal discharge can lead to abnormal brain activity local neurons, influence normal brain network formation and cause the information transfer function is damaged, this is our understanding and further study of BECTS in patients with advanced neural function including cognition, emotion, behavior disorder and other activities, provides a new idea and research direction, and it is found that the BEC for our early TS patients with advanced nerve function damage, early counselling or medical treatment, prevention and mitigation of brain injury, and provide a theoretical basis to improve the quality of life of patients with.3, BECTS, BECTS in patients with cortical dysfunction, it is found that the subcortical structures such as the thalamus, putamen, caudate nucleus and other abnormal activity in resting state, which may play a certain the role in the pathogenesis of epilepsy and combined with cognitive dysfunction, we suggest that in the future, should not only pay attention to abnormal cortical structures, but also pay attention to role of subcortical structures in the pathogenesis of epilepsy and cognitive dysfunction in the merger.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.1

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