本文選題：伴中央顳區(qū)棘波兒童良性癲癇 + 靜息態(tài)功能磁共振�。� 參考：《浙江大學(xué)》2014年博士論文

【摘要】：伴中央顳區(qū)棘波良性兒童癲癇(Benign epilepsy with centrotemporal spikes, BECTS),是臨床上最為常見(jiàn)的兒童癲癇綜合征之一。傳統(tǒng)的觀點(diǎn)認(rèn)為,BECTS有著良好的預(yù)后,故也被稱為兒童“良性”癲癇。但是,現(xiàn)代神經(jīng)影像學(xué)的發(fā)展,尤其是功能性磁共振(Functional Magnetic Resonance Imaging, fMRI)技術(shù)為癲癇研究提供了無(wú)創(chuàng)的高空間分辨率的工具,已經(jīng)有越來(lái)越多的結(jié)果表明有相當(dāng)一部分患兒存在不同程度的認(rèn)知及腦功能損傷。 近年興起的靜息態(tài)功能磁共振(Resting-state fMRI, rs-fMRI)技術(shù),有別于傳統(tǒng)的基于外在任務(wù)刺激的功能磁共振范式,它以探究腦內(nèi)在自發(fā)活動(dòng)。靜息態(tài)功能磁共振技術(shù)具有無(wú)創(chuàng)、高分辨和簡(jiǎn)便易行的優(yōu)點(diǎn),為研究癲癇,特別是兒童癲癇的特征性腦自發(fā)活動(dòng)提供了獨(dú)特的機(jī)遇。 在本研究中,我們采用基于局部特征研究的功能磁共振數(shù)據(jù)分析方法對(duì)伴中央顳區(qū)棘波良性兒童癲癇患兒的癲癇活動(dòng)進(jìn)行描繪。首先,基于癲癇活動(dòng)表現(xiàn)為局部神經(jīng)活動(dòng)同步性異常增高的電生理特性,我們采用局域一致性分析方法,觀察癲癇活動(dòng)引起的血氧水平代謝信號(hào)局部一致性的改變；其次,基于癲癇活動(dòng)異常的高波幅腦電發(fā)放的特性,我們采用低頻振幅分析的方法觀察間期癲癇活動(dòng)引起的血氧水平代謝信號(hào)振幅的改變。最后,利用血氧水平代謝信號(hào)改變的局部特征期望達(dá)到癲癇活動(dòng)的檢測(cè)。本研究希望促進(jìn)靜息態(tài)功能磁共振成像在癲癇臨床方面的應(yīng)用,以及加深對(duì)癲癇病理生理機(jī)制的認(rèn)識(shí)。本論文共分三部分。第一部分伴中央顳區(qū)棘波兒童良性癲癇的靜息態(tài)功能磁共振局部一致性研究 目的： 基于癲癇活動(dòng)表現(xiàn)為局部神經(jīng)元活動(dòng)同步性增高的電生理特征,我們嘗試采用局域一致性分析的靜息態(tài)功能磁共振成像技術(shù),對(duì)伴中央顳區(qū)棘波兒童良性癲癇患兒癲癇活動(dòng)相關(guān)的血氧水平信號(hào)的局域一致性改變進(jìn)行觀察。方法： 30例伴中央顳區(qū)棘波兒童良性癲癇患兒參與了本研究,在3.0特斯拉的磁共振儀下進(jìn)行了靜息態(tài)功能磁共振數(shù)據(jù)采集。采用局域一致性分析的方法對(duì)這些功能磁共振成像數(shù)據(jù)進(jìn)行分析,通過(guò)與20例健康兒童做對(duì)照分析,檢測(cè)血氧水平代謝信號(hào)局域一致性改變的腦區(qū)。結(jié)果： 組間比較發(fā)現(xiàn),BECTS患兒在雙側(cè)中央前回,右側(cè)中央后回,右側(cè)緣上回,左側(cè)額上回,左側(cè)額下回和頂上回的局域一致性值顯著高于正常對(duì)照組；而在雙側(cè)顳葉,雙側(cè)眶額區(qū)和殼核的局域一致性值顯著低于正常對(duì)照組。并且左側(cè)額上回局域一致性值與病程成顯著正相關(guān)關(guān)系。 結(jié)論： 本研究利用靜息態(tài)fMRI信號(hào)的局域一致性,發(fā)現(xiàn)BECTS患者在中央?yún)^(qū)和前額區(qū)的ReHo值顯著提高；而患兒在邊緣系統(tǒng)的局域一致性值顯著降低,暗示著患者的感覺(jué)整合功能受損。本研究對(duì)理解BECTS病患的神經(jīng)生理學(xué)機(jī)制提供新的解釋。 第二部分伴中央顳區(qū)棘波兒童良性癲癇的腦自發(fā)活動(dòng)靜息態(tài)功能磁共振研究 目的： 基于癲癇活動(dòng)異常的高波幅腦電發(fā)放的特性,并可引起血氧水平依賴信號(hào)的改變的生理基礎(chǔ),本研究嘗試采用基于低頻振幅(ALFF)分析的靜息態(tài)功能磁共振成像技術(shù),對(duì)這些癲癇相關(guān)的血氧水平信號(hào)振幅改變進(jìn)行觀察。 方法： 30例伴中央顳區(qū)棘波兒童良性癲癇患兒參與了本研究,在3.0特斯拉的磁共振儀下進(jìn)行了靜息態(tài)功能磁共振數(shù)據(jù)采集。采用低頻振幅的方法對(duì)這些功能磁共振成像數(shù)據(jù)進(jìn)行分析,通過(guò)與20例健康兒童做對(duì)照分析,檢測(cè)血氧水平代謝信號(hào)局域一致性改變的腦區(qū)。 結(jié)果： 組間比較發(fā)現(xiàn),BECTS患者在雙側(cè)中央前回,右側(cè)中央后回,右側(cè)緣上回,右側(cè)額葉和右側(cè)蒼白球的ALFF值顯著高于正常對(duì)照組；而在左側(cè)小腦,右側(cè)顳下回,右側(cè)額下回,左側(cè)直回,左側(cè)頂上回和左側(cè)枕中回的ALFF值顯著低于正常對(duì)照組。 結(jié)論： 本研究利用靜息態(tài)fMRI低頻振幅方法,探測(cè)BECTS患者BECTS病人自發(fā)神經(jīng)活動(dòng)異常的腦區(qū)。我們的結(jié)果表明顯著低頻振幅值增高的腦區(qū)主要集中在中央?yún)^(qū)。而且中央?yún)^(qū)的低頻振幅值與總智商和操作智商和病程有關(guān)。這些發(fā)現(xiàn)暗示發(fā)作間期癲癇放電導(dǎo)致BECTS病人自發(fā)神經(jīng)活動(dòng)改變,右側(cè)中央前回與弱的操作能力有關(guān)。 第三部分伴中央顳區(qū)棘波兒童良性癲癇患者的致癲灶個(gè)體靜息態(tài) fMRI定位研究 目的： 基于癲癇活動(dòng)異常的高波幅腦電發(fā)放的特性,并可引起血氧水平依賴信號(hào)的改變的生理基礎(chǔ),針對(duì)未檢測(cè)到患兒癲癇樣放電,本研究嘗試采用低頻振幅(ALFF)1對(duì)多分析技術(shù),并達(dá)到伴中央顳區(qū)棘波兒童良性癲癇活動(dòng)的個(gè)體檢測(cè)。 方法： 30例伴中央顳區(qū)棘波兒童良性癲癇患兒參與了本研究,在3.0特斯拉的磁共振儀下進(jìn)行了靜息態(tài)功能磁共振數(shù)據(jù)采集。采用低頻振幅的方法對(duì)這些功能磁共振成像數(shù)據(jù)進(jìn)行1對(duì)多(20例健康兒童)的個(gè)例分析,以評(píng)價(jià)低頻振幅對(duì)癲癇活動(dòng)的臨床癲癇活動(dòng)定側(cè)能力。 結(jié)果： 組間比較發(fā)現(xiàn),傳統(tǒng)廣義線性模型(GLM)方法等定位43%的癲癇樣放電患者,而采用ALFF一對(duì)多的方法也能定位43%患者。但是,ALFF方法能定位53%的未檢出癲癇樣放電的患者。 結(jié)論： 本研究利用ALFF采用1對(duì)多參數(shù)檢驗(yàn)統(tǒng)計(jì)方法來(lái)定位個(gè)體BECTS病人的腦自發(fā)活動(dòng)異常腦區(qū)。結(jié)果顯示,ALFF定位方法效果和傳統(tǒng)GLM方法一致,此外,它還能能定位數(shù)據(jù)采集過(guò)程中沒(méi)發(fā)生放電的癲癇患者。本研究為癲癇定位提供了新的補(bǔ)充手段。
[Abstract]:It is one of the most common children ' s epilepsy syndrome in clinic . The traditional point of view is that there is a good prognosis for the children , which is called " benign " epilepsy . However , the development of modern neuroimaging , especially the functional magnetic resonance imaging ( MRI ) , has provided a noninvasive high spatial resolution tool for epilepsy research , and there are more and more results showing that there are quite a few children with different degrees of cognition and brain function damage .

In recent years , the technique of resting state functional magnetic resonance ( rs - fmri ) is different from the traditional functional magnetic resonance paradigm based on external task stimulation . It has the advantages of non - invasive , high resolution and simple and easy operation , and provides unique opportunity for studying the characteristic brain spontaneous activity of epilepsy , especially children ' s epilepsy .

In this study , we used the functional magnetic resonance data analysis method based on local features to describe the seizure activity in children with benign epilepsy in the central temporal region . First , based on the electrophysiological characteristics of the abnormal increase of local neural activity , the local consistency analysis method was used to observe the changes of local consistency of blood oxygen level metabolic signals caused by seizure activity .
Secondly , based on the characteristics of high - amplitude EEG distribution , we use low - frequency amplitude analysis to observe the changes of the amplitude of blood - oxygen level metabolic signal caused by interval seizure activity . Finally , we hope to promote the application of resting - state functional magnetic resonance imaging in the clinical aspect of epilepsy and to deepen the understanding of the physiological mechanism of epilepsy .

Purpose :

Based on the electrophysiological characteristics of the increased synchronization of local neuronal activity in epileptic activity , we attempted to observe the local coherence of the blood oxygen level signal related to the seizure activity in children with benign epilepsy in children with central temporal region , using the static state functional magnetic resonance imaging technique of local consistency analysis .

Thirty patients with benign epilepsy with central temporal spikes participated in the study . The magnetic resonance data were collected under the magnetic resonance instrument of 3.0 Tesla . These functional magnetic resonance imaging data were analyzed by local coherence analysis .

Compared with the control group , the local consistency between the two groups was significantly higher than that in the normal control group .
The local consistency values of bilateral temporal lobe , bilateral orbital frontal area and shell nucleus were significantly lower than those of the normal control group .

Conclusion :

In this study , we found that the ReHo values in the central and forehead regions were significantly improved by using the local consistency of the resting - state MRI signals .
This study provides a new explanation for understanding the neurophysiology mechanism of patients with BECDs .

A study of the resting state function of the brain spontaneous activity in the second part with benign epilepsy in the central temporal region of the temporal region

Purpose :

Based on the characteristics of high amplitude brain electrical distribution in epileptic activity , and can cause the physiological basis of the change of blood oxygen level dependent signal , this study attempts to observe the change of blood oxygen level signal amplitude related to these epilepsy by using the static state functional magnetic resonance imaging technique based on low frequency amplitude ( ALFF ) analysis .

Method :

Thirty patients with benign epilepsy with central temporal spikes participated in the study . The magnetic resonance imaging data were collected under the magnetic resonance instrument of 3.0 Tesla . These functional magnetic resonance imaging data were analyzed by the method of low frequency amplitude . By contrast analysis with 20 healthy children , the brain regions with changes of local coherence of blood oxygen level were detected .

Results :

Compared with the control group , the ALFF values of the right frontal lobe and the right side were significantly higher than those of the normal control group .
The ALFF value was significantly lower in the left cerebellum , the right temporal gyrus , the right frontal gyrus , the left straight back , the left parietal gyrus , and the left occipital gyrus .

Conclusion :

The results showed that the low - frequency amplitude in the central region was mainly concentrated in the central region , and the low - frequency amplitude of the central region was related to the total IQ and the course of the course .

The third part is accompanied by the resting state of epileptic foci in patients with benign epilepsy in the central temporal region of the temporal region .

A Study on the Localization of MRI

Purpose :

Based on the characteristics of high amplitude brain electrical distribution in epileptic activity , and the physiological basis of the change of blood oxygen level dependent signal , this study attempted to use low frequency amplitude ( ALFF ) 1 to analyze multi - analysis technique and achieve the individual detection of benign epilepsy activity of children with central temporal region .

Method :

Thirty patients with benign epilepsy with central temporal spikes were involved in the study . Magnetic resonance data were collected under the magnetic resonance instrument of 3.0 Tesla . Individual analysis of these functional magnetic resonance imaging data was carried out by using low frequency amplitude method .

Results :

It was found that the traditional generalized linear model ( GLM ) method was used to locate 43 % of patients with epilepsy , while the ALFF method could be used to locate 43 % of patients . However , the ALFF method could position 53 % of patients with no epilepsy - like discharges .

Conclusion :

The results showed that ALFF was consistent with the traditional GLM method . In addition , it was able to locate epileptic patients with no discharge during data acquisition . This study provides new supplementary means for the localization of epilepsy .

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.1

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本文編號(hào)：1876120