Functional MRI of the pre-ictal state
Functional MRI of the pre-ictal state
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DOI：
10.1093/brain/awh533
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发表时间：
2005-08-01
期刊：
影响因子：
14.5
通讯作者：
Jackson, GD
中科院分区：
文献类型：
--
作者：
Federico, P;Abbott, DF;Jackson, GD
从间隔期状态到间隔期状态转变的机制尚不清楚。对脑电图频率成分的非线性数学分析证实了局灶性癫痫的前兆状态的存在。我们报告了三例难治性局灶性癫痫患者的孕前状态的功能MRI （fMRI）分析。每个受试者在扫描仪中都有典型的部分癫痫发作，同时获得连续血氧水平依赖（BOLD）功能磁共振成像图像。首先通过统计比较两个1分钟区块的BOLD信号来分析孕前的BOLD变化。然后对全日制课程进行进一步的考试。每位患者均表现出高度显著的局灶性BOLD信号改变。在患者1中，在补充癫痫调查中发现的癫痫发作焦点区域出现了显著的孕前BOLD信号增加。未观察到明显的BOLD信号降低。患者2在假定的癫痫病灶对侧显示广泛的牙周前BOLD升高，以及在假定的癫痫病灶附近出现局灶性BOLD降低。在患者3中，峰前BOLD增加与峰前单光子发射计算机断层扫描（SPECT）显示的高灌注部位共定位。然而，这是基于癫痫症状的癫痫病灶定位的对侧。BOLD未见明显下降。每个患者的时间过程数据显示，在癫痫发作前几分钟，BOLD信号发生了变化。高度显著的BOLD fMRI信号变化发生在癫痫发作前，支持癫痫发作前状态的存在。这些变化可能局限于假定的癫痫发作病灶，也可能局限于其他大脑区域，这表明癫痫发作前的BOLD信号变化及其潜在机制是复杂的。
The mechanisms underlying the transition from interictal to ictal states are poorly understood. Non-linear mathematical analysis of EEG frequency components has confirmed the presence of a pre-ictal state in focal epilepsy. We report on functional MRI (fMRI) analysis of the pre-ictal state in three patients with intractable focal epilepsy. Each subject had a typical partial seizure in the scanner while continuous blood oxygen level dependent (BOLD) fMRI images were acquired. The pre-ictal BOLD changes were first analysed by statistically comparing BOLD signals of two one-minute blocks. Further examination of the full time course was then performed. Each patient showed highly significant, focal BOLD signal changes. In Patient 1, a striking pre-ictal BOLD signal increase was seen over the region of the seizure focus identified on complementary epilepsy investigations. No significant BOLD signal decreases were observed. Patient 2 showed widespread pre-ictal BOLD increase contralateral to the presumed seizure focus, as well as a focal BOLD decrease near the presumed seizure focus. In Patient 3, pre-ictal BOLD increase was co-localized with the site of hyperperfusion seen on ictal single photon emission computed tomography (SPECT). However, this was contralateral to the seizure focus localization based on seizure symptomatology. No significant BOLD decreases were seen. The time course data in each patient studied showed change of the BOLD signal several minutes before the onset of the seizure. Highly significant BOLD fMRI signal changes occur before the onset of seizures, supporting the presence of a pre-ictal state. These changes can be localized to the site of the presumed seizure focus, as well as to other brain regions, suggesting that the pre-ictal BOLD signal changes and their underlying mechanisms are complex.