心因性非痫性发作额顶功能的脑磁电生理研究

The patients with psychogenic non-epileptic seizures (PNES) are common in epilepsy centers, but the accurate diagnosis of PNES is difficult partly because of the obscure pathophysiological mechanisms. The delay of diagnosis and treatment may result in poor outcomes in patients, and economic burdens in families and the whole society. However, the underlying neurophysiological mechanism of PNES is still unclear and the relative studies are limited. Based on our prior study of scalp EEG in PNES patients, we put a hypothesis that the functions of frontal and parietal areas are abnormal. But there is problem in resolving the location of brain targets, the direction of the information flows and the interaction between frontal and parietal areas by EEG or MRI. This project will study magnetoencephalography (MEG) and directed transferring function (DTF) in PNES patients to reveal the accurate abnormal targets of the fronto-parietal areas, the direction of the communication; at the same time, the project will explore the interaction between frontal and parietal areas by transcranial magnetic stimulation-electroencephalography (TMS-EEG) and wavelet analysis, to find the neurophysiological mechanisms of PNES, to elucidate the nature of the disease to some extent and to provide an important theoretical basis for neuromodulation therapy for PNES.

心因性非痫性发作（PNES）患者在癫痫中心患者中的比例很高，但其病理生理机制不明确，且缺乏确诊的手段，长期的误诊误治给患者、家庭、社会都造成不良后果和严重的负担。目前对PNES神经病理机制的研究较少，且以磁共振研究为主。我们根据本课题组前期的头皮脑电研究，提出假说：心因性非痫性发作的患者额顶功能存在异常。而用脑电图或磁共振较难于解决PNES患者精确的异常脑区定位、信息传递方向和脑区间交互作用的科学问题。本项目将通过脑磁图（MEG）技术结合脑磁共振成像进行皮层电流密度成像，试图定位PNES患者额顶的关键异常脑区，进一步用方向性传递函数（DTF）的方法计算出脑区间连接的方向性；并利用经颅磁刺激同步脑电（TMS-EEG）和小波分析方法研究PNES患者额顶关键脑区间的交互影响，试图发现心因性发作患者的神经病理生理机制，以期在一定程度上揭示疾病的本质，为临床开展神经调控治疗提供重要的理论依据。

心因性非痫性发作（PNES）患者在癫痫中心患者中的比例很高，但其病理生理机制不明确，且缺乏确诊的手段，目前对PNES神经病理机制的研究较少，且以磁共振研究为主。本课题首先提出假说：心因性非痫性发作的患者额顶功能存在异常。本课题通过脑磁图（MEG）技术结合脑磁共振成像进行皮层电流密度成像，发现了心因性非痫性发作患者相对于正常对照来说，额内侧的功能减低，连接减弱。并且运用经颅磁刺激扰动态脑电监测（TMS-EEG）发现，心因性非痫性发作患者刺激右额之后，右前额、左前额、枕区出现信息输出过度，提示了右额对神经环路抑制能力下降，而且患者较正常对照的左额、左额极的信息输出显著不足。本研究的关键脑区靶点可以作为PNES疾病治疗的切入点，为临床开展神经调控治疗提供了重要的理论依据。