本文選題：伏隔核 + 顳葉癲癇　； 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 伏隔核是額顳葉連接中一個重要結(jié)構(gòu),并且參與顳葉癲癇活動的傳導(dǎo)。我院神經(jīng)外科于2012年創(chuàng)新地將立體定向雙側(cè)伏隔核毀損術(shù)運用于治療雙側(cè)顳葉起源的難治性癲癇,并開展20余例手術(shù),對患者術(shù)后隨訪資料進(jìn)行評估,證實毀損雙側(cè)伏隔核對于雙側(cè)顳葉癲癇控制有顯著效果。然而伏隔核在癲癇發(fā)生及傳導(dǎo)中的作用,尚未十分明確。目前腦功能研究中缺乏關(guān)于伏隔核對顳葉癲癇網(wǎng)絡(luò)影響的報道。 本研究試圖通過靜息態(tài)fmri的方法,以伴海馬硬化的單側(cè)內(nèi)側(cè)顳葉癲癇(mTLE)作為研究對象,探索內(nèi)側(cè)顳葉癲癇患者雙側(cè)伏隔核與全腦功能連接改變情況,驗證其在顳葉癲癇致癇網(wǎng)絡(luò)中的作用；并進(jìn)一步研究這些改變的功能連接強度與顳葉癲癇患者的病程、發(fā)病年齡、精神癥狀之間有無相關(guān)性。 材料與方法 研究被試包括：24名內(nèi)側(cè)顳葉癲癇患者(其中右側(cè)顳葉癲癇患者組13人,平均年齡25.36±8.23歲,男性10名,女性3名；左側(cè)顳葉癲癇患者組11人,平均年齡22.24±6.38歲,男性8名,女性3名)及24名健康志愿者(17-35歲,平均年齡25.67±2.58歲,男性15名,女性9名)。內(nèi)側(cè)顳葉癲癇組入組標(biāo)準(zhǔn)為：1.癲癇的臨床癥狀與發(fā)作類型符合2010年國際抗癲聯(lián)盟的診斷標(biāo)準(zhǔn)與分類標(biāo)準(zhǔn)；2.連續(xù)兩次長程視頻腦電圖結(jié)果提示異常腦電起源于單側(cè)顳部,且異常腦電的偏側(cè)和發(fā)作特點無矛盾；3.FDG-PET/CT提示的發(fā)作間期低代謝區(qū)與腦電圖檢查相符；4.高分辨率MR檢查顯示無明顯異常,或存在與腦電圖結(jié)果偏側(cè)性一致的單側(cè)海馬硬化。5.滿足顳葉癲癇手術(shù)治療的適應(yīng)癥,擬行前顳葉切除術(shù),且術(shù)后病理證實切除海馬組織符合海馬硬化；6.漢族中國人,右利手(中國人利手分類標(biāo)準(zhǔn))。排除標(biāo)準(zhǔn)：1.MRI檢查除海馬硬化外,還存在其他腦部結(jié)構(gòu)異常(如皮層發(fā)育不良、軟化灶、腫瘤、寄生蟲、血管畸形等)；2.合并其他神經(jīng)、精神類疾��；3.有長期酗酒和藥物濫用史；4.患者存在嚴(yán)重認(rèn)知障礙或精神異常,合作不良者。正常對照組選取與顳葉癲癇組性別、年齡、教育程度相匹配的24例作為對照；所有正常被試：1.無任何系統(tǒng)性疾病及神經(jīng)系統(tǒng)癥狀體征；2.無本人及家族性精神疾病病史；3.無藥物(包括酒精)濫用史；4.頭部MRI檢查正常；5.漢族中國人,右利手。 所有受試者均完成橫斷位T2WI掃描、靜息狀態(tài)下功能磁共振(fMRI)掃描及矢狀位3D-T1WI掃描。使用Matlab2010、SPM8、DPARSFA V2.1等軟件對數(shù)據(jù)進(jìn)行預(yù)處理,包括：①將原始圖像的DICOM格式轉(zhuǎn)化為用于數(shù)據(jù)分析的NIFTI格式；②去除前十個時間點的掃描圖像；③時間序列校正；④頭動校正(realignment);⑤空間標(biāo)準(zhǔn)化(Normalization)處理；⑥進(jìn)行去線性飄移(lineardetrends)與低頻濾過(temporally filterd)處理；⑦協(xié)變量(covariates)的去除。預(yù)處理之后的時間序列信號用于進(jìn)一步的功能連接分析。采用FSL軟件提供的圖集Harvard-Oxford cortical and subcortical structural atlases,分別選取雙側(cè)伏隔核作為感興趣區(qū)(ROD。利用統(tǒng)計參數(shù)圖譜(SPM8)進(jìn)行數(shù)據(jù)處理。根據(jù)感興趣區(qū)NAc MASK文件提供的坐標(biāo)信息計算出每個被試感興趣區(qū)(ROI)內(nèi)的平均時間序列作為參照時間序列,對感興趣區(qū)的平均信號變化和全腦逐體素時間序列進(jìn)行相關(guān)分析。左、右側(cè)顳葉癲癇組和健康對照組的雙側(cè)伏隔核功能連接采用基于體素的單樣本t檢驗,左、右側(cè)顳葉癲癇組與正常對照組之間伏隔核功能連接異常的比較利用兩樣本t檢驗,設(shè)顯著水平為p=0.01,使用AlphaSim校正,設(shè)定連接準(zhǔn)則rmm=5(邊連接),高斯平滑核4mm,利用單樣本t檢驗顯著區(qū)所做MASK設(shè)定聚類的最小體素個數(shù)為15,最終獲得組間功能連接差異圖。用matlab自帶的corr腳本,在癲癇組,將與伏隔核有差異的功能連接與其病程、起病年齡及SAS、SDS量表作Pearson相關(guān)分析(MASK為上一步兩樣本t檢驗所得顯著差異的功能連接),計算線性相關(guān)系數(shù)r以及p值,統(tǒng)計閾值設(shè)置p=0.05,得出癲癇患者與病程、起病年齡及SAS、SDS量表評分呈線性相關(guān)的功能連接。 結(jié)果 1.左、右側(cè)癲癇患者組與健康對照組三組被試之間年齡(F=1.747,p=0.186),受教育程度(F=2.792,p=0.072),起病年齡(t=0.892,p=0.382)、病程(t=0.113,p=0.911)及性別構(gòu)成(χ2=0.922,p=0.631)無明顯統(tǒng)計學(xué)差異。 2.功能連接分析 ①左側(cè)顳葉癲癇組與健康對照組基于左、右側(cè)伏隔核功能連接的差異以左側(cè)伏隔核(L-NAc)為感興趣區(qū),左側(cè)顳葉癲癇組與健康對照組相比,與其功能連接減低的腦區(qū)主要有：雙側(cè)丘腦(左側(cè)為著)、右側(cè)殼核、楔前葉、后扣帶回等；無明顯功能連接增強的腦區(qū)。以右側(cè)伏隔核(R-NAc)為感興趣區(qū),左側(cè)顳葉癲癇組與健康對照組相比,與其功能連接減低的腦區(qū)主要有：小腦蚓部、楔前葉、扣帶回、雙側(cè)角回、左側(cè)額中回、左側(cè)輔助運動區(qū)、中央旁小葉及中央前回等；無明顯功能連接增強的腦區(qū)。 ②右側(cè)顳葉癲癇組與健康對照組基于左、右側(cè)伏隔核功能連接的差異以左側(cè)伏隔核(L-NAc)為感興趣區(qū),右側(cè)顳葉癲癇組與健康對照組相比,與其功能連接減低的腦區(qū)主要有：小腦蚓部、右側(cè)小腦扁桃體、左側(cè)小腦半球(齒狀核)、右側(cè)海馬旁回、右側(cè)額下回眶部、雙側(cè)丘腦(右側(cè)為著)、左側(cè)額中回等；無明顯功能連接增強的腦區(qū)。以右側(cè)伏隔核(R-NAc)為感興趣區(qū),右側(cè)顳葉癲癇組與健康對照組相比,與其功能連接減低的腦區(qū)主要有：小腦蚓部、右側(cè)小腦扁桃體、左側(cè)小腦半球(齒狀核)、左側(cè)直回、腦干左側(cè)、雙側(cè)角回、左側(cè)額上回內(nèi)側(cè)及額內(nèi)側(cè)回等；無明顯功能連接增強的腦區(qū)。 3.顳葉癲癇患者個體水平分析 左、右側(cè)顳葉癲癇患者組的左側(cè)伏隔核的異常功能連接均未表現(xiàn)出與病程、發(fā)病年齡、SAS、SDS評分之間的相關(guān)性； 右側(cè)顳葉癲癇患者組：右側(cè)伏隔核-腦干左側(cè)功能連接與病程之間呈正性相關(guān),相關(guān)系數(shù)R=0.6394,P=0.02517；左側(cè)顳葉癲癇患者組右側(cè)伏隔核-左側(cè)額中回功能連接強度與SAS評分呈負(fù)性相關(guān),相關(guān)系數(shù)R=-0.7953,P=0.0325。 結(jié)論 1.本研究通過對伏隔核靜息態(tài)功能連接分析發(fā)現(xiàn)左、右側(cè)顳葉癲癇患者伏隔核全腦功能連接均全面減低,減低的區(qū)域涉及雙側(cè)丘腦、海馬旁回、額下回等癲癇網(wǎng)絡(luò)結(jié)構(gòu),楔前葉、扣帶回等默認(rèn)網(wǎng)絡(luò)結(jié)構(gòu),以及輔助運動區(qū)、中央前回等運動網(wǎng)絡(luò)結(jié)構(gòu),提示伏隔核可能是顳葉癲癇傳導(dǎo)通路中的一個重要中繼站,在顳葉癲癇網(wǎng)絡(luò)中具有重要意義。 2.右側(cè)顳葉癲癇患者右側(cè)伏隔核-腦干左側(cè)功能連接與病程之間呈正性相關(guān),提示癲癇網(wǎng)絡(luò)可能隨發(fā)病時間延長而出現(xiàn)功能重塑； 3.左側(cè)顳葉癲癇癲癇患者右側(cè)伏隔核-左側(cè)額中回功能連接強度與SAS評分呈負(fù)性相關(guān),猜測該功能連接受損可能是顳葉癲癇患者焦慮癥狀的神經(jīng)機制。
[Abstract]:Purpose

Neurosurgery in our hospital , which is an important structure in frontal temporal lobe connection , is involved in the conduction of temporal lobe epilepsy . In 2012 , neurosurgeons in our hospital successfully applied stereotactic bilateral nuclear disrepair to the treatment of intractable epilepsy of bilateral temporal lobe origin , and carried out more than 20 procedures , which confirmed the remarkable effect on bilateral temporal lobe epilepsy control .

The purpose of this study was to investigate the changes of bilateral nuclear and whole brain function in patients with medial temporal lobe epilepsy and to verify its role in the epileptic network of temporal lobe epilepsy through the method of resting state fmri , with the unilateral medial temporal lobe epilepsy ( mTLE ) with hippocampus sclerosis as the subject .
The correlation between the functional connection intensity of these changes and the course , age and mental symptoms of patients with temporal lobe epilepsy was further studied .

Materials and Methods

The study was conducted in 24 patients with medial temporal lobe epilepsy ( 13 in the right temporal lobe epilepsy group , average age of 25.36 鹵 8.23 years , male 10 , female 3 ) .
There were 11 patients in the left temporal lobe epilepsy group ( mean age : 22.24 鹵 6.38 years , male 8 , female 3 ) and 24 healthy volunteers ( 17 - 35 years , mean age : 25.67 鹵 2.58 years , male 15 , female 9 ) . The standard of seizure group of medial temporal lobe epilepsy group was 1 . The clinical symptoms and seizure types of epilepsy conformed to the diagnostic criteria and classification criteria of the 2010 international anti - epilepsy coalition ;
2 . The results suggested that abnormal EEG originated from unilateral temporal part , and the abnormal EEG was not in contradiction with the characteristic of attack .
3 . The low metabolic region of FDG - PET / CT was consistent with EEG examination .
4 . High - resolution MR examination showed no obvious abnormality , or there was unilateral hippocampus sclerosis which was consistent with the results of EEG .
6 . Han Chinese , right Lishi ( Chinese Lishi Classification Standard ) . Exclusion criteria : 1 . MRI examination besides the sclerosis of hippocampus , there are other abnormal brain structures ( such as cortical dysplasia , softening range , tumor , parasite , vascular malformation , etc . ) ;
2 . Concomitant other neurological and psychiatric disorders ;
3 . Long - term history of alcohol and drug abuse ;
4 . The patients had severe cognitive impairment or mental disorder and poor cooperation . The normal control group selected 24 cases with sex , age and education degree in temporal lobe epilepsy group as control ;
All normal subjects : 1 . No systemic disease and signs of neurological symptoms ;
2 . No personal and familial mental illness history ;
3 . Drug - free ( including alcohol ) abuse history ;
4 . MRI of the head was normal ;
5 . Han Chinese , right - hand .

All subjects completed the scan of T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ T _ 1WI , functional magnetic resonance ( MRI ) scan and sagittal plane 3D - 1WI scan in resting state . The data were preprocessed by software such as Matlab2010 , SPM8 and DPARSFA V2.1 , including : ( 1 ) converting the DICOM format of the original image into NIFTI format for data analysis ;
( 2 ) removing the scanned image of the first ten time points ;
( 3 ) time series correction ;
( 4 ) head moveout correction ; ( 5 ) spatial standardization ;
( 6 ) carrying out linear detrends and low - frequency filtering ;
Based on the coordinate information provided by FSL software , the average time series in each region of interest ( ROI ) was used as reference time series , the average signal change of each region of interest ( ROI ) was calculated by using statistical parameter map ( SPM8 ) .

Results

1 . The age ( F = 1.747 , p = 0.186 ) , the degree of education ( F = 2.792 , p = 0.072 ) , the age of onset ( t = 0.892 , p = 0.382 ) , the course of disease ( t = 0.113 , p = 0.911 ) and sex ( 蠂 2 = 0.922 , p = 0.631 ) were not statistically significant .

2 . Functional connection analysis

In the left temporal lobe epilepsy group and the healthy control group , the left temporal lobe epilepsy group and the healthy control group were the regions of interest , and the left temporal lobe epilepsy group and the healthy control group were mainly composed of bilateral thalamus ( left side ) , right side shell nucleus , wedge anterior leaflet , posterior buckle and so on .
Compared with the healthy control group , the left temporal lobe epilepsy group and the healthy control group mainly include the cerebellar vermis part , the wedge anterior lobe , the buckle back , the bilateral angle gyrus , the left frontal gyrus , the left auxiliary motion area , the central parlobule and the central anterior gyrus , etc .
No obvious functional connection enhances the brain area .

In the right temporal lobe epilepsy group and the healthy control group , the difference of the function connection between the right temporal lobe epilepsy group and the healthy control group was mainly in the region of interest , the right temporal lobe epilepsy group , the left cerebellar hemisphere ( dentate nucleus ) , the right hippocampus side gyrus , the right frontal inferior orbital portion , the bilateral thalamus ( right side ) , the left frontal gyrus , and the like ;
Compared with the healthy control group , the brain regions of the right temporal lobe epilepsy group and the healthy control group mainly include the cerebellar vermis part , the right cerebellar tonsilic body , the left cerebellar hemisphere ( dentate nucleus ) , the left straight back , the left side of the brain stem , the bilateral angle gyrus , the left frontal gyrus and the medial frontal gyrus , etc . ;
No obvious functional connection enhances the brain area .

3 . Analysis of individual level in patients with temporal lobe epilepsy

The abnormal functional connections of left and right temporal lobe epilepsy patients showed no correlation with history , age , SAS and SDS scores .


Right temporal lobe epilepsy group : positive correlation between right - sided nucleus - brain stem left functional connection and course , correlation coefficient R = 0.6394 , P = 0.02517 ;
In the left temporal lobe epilepsy group , the left frontal septum nuclear - left frontal gyrus function connection strength was negatively correlated with the SAS score , the correlation coefficient R = - 0.7953 , P = 0.0325 .

Conclusion

1 . In this study , we found that all the functional connections in the left and right temporal lobe epilepsy patients were all decreased , and the decreased area involved the network structures such as bilateral thalamus , parahippocampal gyrus , frontal gyrus and the like , the default network structure such as wedge anterior and posterior gyrus , and the movement network structure of the auxiliary sports area and the central gyrus . It suggested that the nucleus accule nucleus may be an important relay station in the temporal lobe epilepsy conduction path , and it is of great significance in the temporal lobe epilepsy network .

2 . There was a positive correlation between the left functional connection and the course of left ventricular nucleus - brain stem in right temporal lobe epilepsy .


3 . In the left temporal lobe epilepsy , the connection strength of the right - sided nucleus - left frontal gyrus function was negatively correlated with the SAS score , and it was speculated that the impairment of the functional connection could be a neurological mechanism of anxiety symptoms in temporal lobe epilepsy .

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R742.1;R445.2

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相關(guān)期刊論文 前1條

1 何維為;王鐵民;魏孝琴;;人腦伏核的應(yīng)用解剖學(xué)研究[J];中國醫(yī)科大學(xué)學(xué)報;2007年01期

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本文編號：1827872