Widespread epileptic networks in focal epilepsies: EEG-fMRI study
Widespread epileptic networks in focal epilepsies: EEG-fMRI study
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DOI：
10.1111/j.1528-1167.2012.03533.x
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发表时间：
2012-09-01
期刊：
影响因子：
5.6
通讯作者：
Gotman, Jean
中科院分区：
文献类型：
--
作者：
Fahoum, Firas;Lopes, Renaud;Gotman, Jean
目的：为了评估局灶性癫痫活动期间大脑受累的程度，我们使用局灶性癫痫患者的同步脑电图和功能磁共振成像（EEG-fMRI）扫描进行分组分析，研究了与发作间期癫痫放电（IED）同时发生的皮质和皮质下代谢变化的模式。方法：我们从 3 Tesla EEG-fMRI 数据库中选择了颞叶癫痫 (TLE，n = 32)、额叶癫痫 (FLE，n = 14) 和后象限癫痫 (PQE，n = 20) 患者。我们对与局部简易爆炸装置相关的血氧水平依赖性（BOLD）反应进行了分组分析。主要发现：TLE 和 FLE 患者表现出激活和失活，而 PQE 患者仅发生失活。在 TLE 和 FLE 中，最大的激活位于双侧扣带中回。在 FLE 中，在同侧额叶盖、丘脑和内囊以及对侧小脑中也发现了激活，而在 TLE 中，我们在同侧内侧内侧和新皮质颞区、岛叶和小脑皮质中发现了额外的激活。所有三个组都在默认模式网络区域中表现出失活，最广泛的是 TLE 组，PQE 和 FLE 组中较少。意义：这些结果表明，不同的癫痫综合征导致与焦点简易爆炸装置相关的独特且广泛的网络。默认模式区域响应于具有综合症特定模式的所有三组中的局灶放电而被停用。我们得出的结论是，局灶性简易爆炸装置与广泛的代谢变化的特定网络有关，这些变化可能对大脑功能造成比从头皮脑电图放电的局灶性质中可能理解的更严重的干扰。
Purpose: To assess the extent of brain involvement during focal epileptic activity, we studied patterns of cortical and subcortical metabolic changes coinciding with interictal epileptic discharges (IEDs) using group analysis of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) scans in patients with focal epilepsy. Methods: We selected patients with temporal lobe epilepsy (TLE, n = 32), frontal lobe epilepsy (FLE, n = 14), and posterior quadrant epilepsy (PQE, n = 20) from our 3 Tesla EEG-fMRI database. We applied group analysis upon the blood oxygenlevel dependent (BOLD) response associated with focal IEDs. Key Findings: Patients with TLE and FLE showed activations and deactivations, whereas in PQE only deactivations occurred. In TLE and FLE, the largest activation was in the midcingulate gyri bilaterally. In FLE, activations were also found in the ipsilateral frontal operculum, thalamus, and internal capsule, and in the contralateral cerebellum, whereas in TLE, we found additional activations in the ipsilateral mesial and neocortical temporal regions, insula, and cerebellar cortex. All three groups showed deactivations in default mode network regions, the most widespread being in the TLE group, and less in PQE and FLE. Significance: These results indicate that different epileptic syndromes result in unique and widespread networks related to focal IEDs. Default mode regions are deactivated in response to focal discharges in all three groups with syndrome specific pattern. We conclude that focal IEDs are associated with specific networks of widespread metabolic changes that may cause more substantial disturbance to brain function than might be appreciated from the focal nature of the scalp EEG discharges.