本文選題：全面強(qiáng)直陣攣發(fā)作 + 顳葉內(nèi)側(cè)面癲癇�。� 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:伴海馬硬化的顳葉內(nèi)側(cè)面癲癇(temporal lobe epilepsy with hippocampal sclerosis,TLE-HS)是常見的耐藥性局灶性癲癇,而繼發(fā)性全面強(qiáng)直陣攣發(fā)作(secondary generalized tonic-clonic seizures,sGTCS)嚴(yán)重威脅著癲癇患者的人身安全和生活質(zhì)量。本文旨在比較TLE-HS患者中伴和不伴sGTCS兩組間的大腦皮層和皮層下結(jié)構(gòu)的灰質(zhì)體積差異,以探究TLE-HS患者發(fā)生sGTCS的潛在機(jī)制。方法:本文連續(xù)性納入2014年4月至2016年6月在我院神經(jīng)內(nèi)科癲癇門診就診的單側(cè)TLE-HS患者作為研究對(duì)象。利用統(tǒng)計(jì)參數(shù)成像8軟件(Statistical Parametric Mapping 8,SPM8)對(duì)患者的3DT1圖像進(jìn)行大腦皮層的基于體素的形態(tài)學(xué)分析(voxel-based morphometric analysis,VBM),利用 FSL 軟件對(duì)患者的 3DT1 圖像進(jìn)行皮層下結(jié)構(gòu)(丘腦和基底節(jié))的基于頂點(diǎn)的形態(tài)分析(vertex-wise shape analysis)。在本研究中,我們先比較單側(cè)TLE-HS患者中伴或不伴有sGTCS兩組間的皮層和皮層下灰質(zhì)結(jié)構(gòu)差異,再比較藥物可治性sGTCS組與藥物難治性sGTCS組兩個(gè)亞組間的皮層和皮層下灰質(zhì)結(jié)構(gòu)差異。結(jié)果:本研究共收集到39例單側(cè)TLE-HS患者,平均年齡為31.2±9.7歲,平均病程為15.6±10.4年,其中21例(53.8%)伴有sGTCS。相較于無sGTCS組,sGTCS組在同側(cè)的腹側(cè)蒼白球(團(tuán)塊體素大小450 mm3,p校正=0.047)、內(nèi)側(cè)丘腦(團(tuán)塊體素大小1128 mm3,p校正=0.049)、額中回(團(tuán)塊體素大小60mm3,p校正0.05)及對(duì)側(cè)的后扣帶回(團(tuán)塊體素大小130 mm3,p校正0.05)有區(qū)域性的萎縮。相較于藥物可治性sGTCS組,藥物難治性sGTCS組在同側(cè)的內(nèi)側(cè)丘腦(團(tuán)塊體素大小1240mm3,p校正=0.014)有更明顯的區(qū)域性萎縮。結(jié)論:在TLE-HS患者中,丘腦和蒼白球在sGTCS產(chǎn)生的病理生理機(jī)制中發(fā)揮了重要作用。
[Abstract]:Objective: temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) with hippocampal sclerosis (TLE-HS) is a common drug-resistant focal epilepsy, and secondary comprehensive tonic clonic seizures (secondary generalized tonic-clonic seizures, sGTCS) threatened personal safety and quality of life in epileptic patients. This article is aimed at this article. To compare the gray matter volume difference between the cerebral cortex and subcortical structures of the TLE-HS patients with and without sGTCS two in order to explore the potential mechanism of sGTCS in TLE-HS patients. Methods: the continuity of this article was included in the unilateral TLE-HS patients in the epilepsy clinic of the neurology department of our hospital from April 2014 to June 2016. The digital imaging 8 software (Statistical Parametric Mapping 8, SPM8) carries out a voxel based morphological analysis of the cerebral cortex (voxel-based morphometric analysis, VBM) of the patient's 3DT1 image (voxel-based morphometric analysis, VBM). The morphological analysis of the subcortical structure (the thalamus and base floor) of the patient's 3DT1 image is analyzed by FSL software (vertex-wise) Analysis. In this study, we compared the cortical and subcortical gray matter structure differences between the two groups of the unilateral TLE-HS patients with or without sGTCS two, and then compared the cortical and subcortical gray matter structure differences between the drug treatable sGTCS group and the two subgroups of the drug refractory sGTCS group. The average age was 31.2 + 9.7 years, and the average course of disease was 15.6 + 10.4 years, of which 21 cases (53.8%) were compared with sGTCS. without sGTCS. Group sGTCS was on the same side of the ventral pallidus (mass size 450 mm3, P corrected =0.047), medial thalamus (lump volume 1128 mm3, P correction = 0.049), middle frontal gyrus (lump volume 60mm3, P correction 0.05) and contralateral rear. The cingulate gyrus (mass 130 mm3, P correction 0.05) had regional atrophy. Compared to the drug treatable sGTCS group, the drug refractory sGTCS group had a more obvious regional atrophy in the ipsilateral medial thalamus (mass 1240mm3, P corrected =0.014). Conclusion: in TLE-HS patients, the thalamus and globus pallidus were produced in the pathophysiology machine of sGTCS. The system plays an important role.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.1
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本文編號(hào)：2037175