Progressive neocortical damage in epilepsy
Progressive neocortical damage in epilepsy
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DOI：
10.1002/ana.10463
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发表时间：
2003-03-01
影响因子：
11.2
通讯作者：
Duncan, JS
中科院分区：
文献类型：
--
作者：
Liu, RSN;Lemieux, L;Duncan, JS
我们的目的是确定癫痫患者发生的全身性和局灶性新皮质萎缩的模式和程度以及与此类变化相关的因素。作为一项前瞻性纵向随访研究的一部分，该研究对 122 名慢性癫痫患者、68 名新诊断患者和 90 名对照者进行了连续 3.5 年的磁共振成像扫描。图像减法用于识别弥漫性和局灶性新皮质变化，这些变化通过区域脑图谱和全自动分割算法进行量化。 54% 的慢性癫痫患者、39% 的新诊断患者和 24% 的对照者发现新的局灶性或全身性新皮质体积损失。慢性癫痫患者比对照受试者更容易发生新皮质萎缩。癫痫脑萎缩的风险增加与记录的癫痫病史无关。新皮质萎缩的危险因素是年龄和多种抗癫痫药物暴露。局灶性和全身性新皮质萎缩通常发生在慢性癫痫中。我们对照组的四分之一在 3.5 年内观察到的新皮质变化可能反映了生理变化。我们的研究结果表明，持续的脑萎缩可能广泛存在，并且远离假定的癫痫病灶，这可能反映了皮质区域之间广泛的网络和互连。
Our objective was to determine the pattern and extent of generalized and focal neocortical atrophy that develops in patients with epilepsy and the factors associated with such changes. As part of a prospective, longitudinal follow-up study of 122 patients with chronic epilepsy, 68 newly diagnosed patients, and 90 controls, serial magnetic resonance imaging scans were obtained 3.5 years apart. Image subtraction was used to identify diffuse and focal neocortical change that was quantified with a regional brain atlas and a fully automated segmentation algorithm. New focal or generalized neocortical volume losses were identified in 54% of patients with chronic epilepsy, 39% of newly diagnosed patients and 24% of controls. Patients with chronic epilepsy were significantly more likely to develop neocortical atrophy than control subjects. The increased risk of cerebral atrophy in epilepsy was not related to a history of documented seizures. Risk factors for neocortical atrophy were age and multiple antiepileptic drug exposure. Focal and generalized neocortical atrophy commonly develops in chronic epilepsy. Neocortical changes seen in a quarter of our control group over 3.5 years were likely to reflect physiological changes. Our results show that ongoing cerebral atrophy may be widespread and remote from the putative epileptic focus, possibly reflecting extensive networks and interconnections between cortical regions.