新诊断额叶癫痫认知神经网络的特征

Frontal lobe epilepsy (FLE) is a common type of epilepsy. It is reported as well as our previous researches suggest that: 1) cognitive disorder is frequently seen in epilepsy patients and can be reversed after medical intervention; 2) abnormal functional and white matter fibers connectivity have been observed in absence epilepsy as well as partial epilepsy. However it is still unclear about the features and the potential mechanism of cognitive neuronic networks in FLE. This study was designed to recruit newly diagnosed FLE to investigate the cognitive neuronic networks before and after medical intervention by using functional magnetic resonance (fMRI), diffusion tensor imaging (DTI), voxel based morphometry (VBM), positron emission tomography (PET), magnetic resonance spectroscopy (MRS) and neuropsychological tests. To be more specific, function, structure, metabolism (glucose and quantification of GABA) and clinical cognitive level will be evaluated. The present research aims at: 1) to prove the existence and to summarize the feature of the abnormal cognitive neuronic networks in FLE; 2)to study the relativity between the clinical factors and the abnormal cognitive neuronic networks;3)to investigate whether the abnormal networks can be reversed after medical intervention. It is believed that such research on cognitive neuronic networks of FLE not only contributes to the understanding of potential neuro- pathophysiological mechanism of cognitive function impairments in patients with FLE, but also contributes to improve cognitive function and life quality of epilepsy patients.

额叶癫痫（FLE）是常见的癫痫类型之一。国内外研究及我们的前期工作提示，1)癫痫容易伴发认知障碍且通过药物干预后认知障碍可被逆转；2)失神癫痫及局灶性癫痫存在神经功能连接异常及白质纤维改变。但有关额叶癫痫认知神经网络的特征及机制不清楚。为此，我们拟选择新诊断FLE为研究对象，采用功能核磁共振（fMRI）、弥散张量成像（DTI）和基于体素的形态测量（VBM）、正电子发射计算机断层显像（PET）和核磁共振波谱成像（MRS）定量测定GABA、神经心理学量表，分别从神经网络功能、结构、代谢及临床认知水平四个方面进行分析，并予以药物干预。旨在：1）证实FLE存在异常认知神经网络，并揭示其特征；2）探索异常认知神经网络的形成与临床特征的相关性；3）通过药物治疗，探讨异常认知神经网络是否可被逆转。本研究不仅有助于FLE认知神经功能损害的神经病理生理机制认识，而且可改善癫痫患者认知水平，提高生活质量。

有研究指出，脑白质损害与伴中央颞叶棘波的良性儿童癫痫（BECTS）患者的疾病进展有一定关联。我们拟通过研究BECTS患者的神经网络结构损害特点来为额叶癫痫的认知神经网络特征研究打下基础。我们通过弥散张量成像（DTI）来研究左侧或右侧放电的BECTS患者的脑白质损害模型，及其与癫痫持续时间，发作频率和优势半球等因素的关系。我们对28名BECTS患儿和8名健康对照组儿童进行了DTI检查。所得数据用TBSS及ROI软件分析。研究其临床特征例如年龄、发病年龄及发作频率等和所识别变异区域各向异性分数（FA）值之间的相关性。TBSS分析发现在同侧半球有中央沟区棘波的儿童脑白质损害更广泛。在棘波位于同侧半球的BECTS患者中胼胝体及胼胝体辐射线额部的FA值明显更低。癫痫发作频率与胼胝体、两侧扣带回及左侧钩状束的FA值明显相关。优势半球放电的BECTS患儿脑白质损害范围更大，可能原因是由于左半球对早期脑损害抵抗较差和痫性发作的影响。