Blood-brain barrier disruption in post-traumatic epilepsy
Blood-brain barrier disruption in post-traumatic epilepsy
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DOI：
10.1136/jnnp.2007.126425
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发表时间：
2008-07-01
影响因子：
11
通讯作者：
Friedman, A.
中科院分区：
文献类型：
--
作者：
Tomkins, O.;Shelef, I.;Friedman, A.
背景：创伤性脑损伤（TBI）是局灶性癫痫的重要原因。目的：探讨外伤后癫痫（PTE）患者血脑屏障（BBB）通透性增高的发生率、程度及功能相关性。患者接受脑MRI（bMRI），并使用一种新的半定量技术评估BBB破坏。使用脑电图（EEG）测量皮质功能障碍，并使用标准化的低分辨率脑电磁断层扫描（sLORETA）。结果：频谱EEG分析显示TBI患者的显着放缓，癫痫患者和那些没有显着差异。尽管bMRI显示PTE患者更有可能出现皮质内病变（p = 0.02），但两组之间的病变大小没有差异（p = 0.19）。在76.9%的PTE患者中发现BBB通透性增加，而无癫痫患者为33.3%（p = 0.047），并且可以在创伤后数年观察到。PTE患者BBB破坏的大脑皮质体积较大（p = 0.001）。在70%的患者中，缓慢（δ带）活动是共同定位的，sLORETA，与区域显示血脑屏障disruption.Conclusions：持久的血脑屏障病理是常见的轻度TBI患者，与增加的频率和程度被观察到PTE患者。破坏血脑屏障和异常的神经元活动之间的相关性建议。
Background: Traumatic brain injury (TBI) is an important cause of focal epilepsy. Animal experiments indicate that disruption of the blood-brain barrier (BBB) plays a critical role in the pathogenesis of post-traumatic epilepsy (PTE).Objective: To investigate the frequency, extent and functional correlates of increased BBB permeability in patient with PTE.Methods: 32 head trauma patients were included in the study, with 17 suffering from PTE. Patients underwent brain MRI (bMRI) and were evaluated for BBB disruption, using a novel semi-quantitative technique. Cortical dysfunction was measured using electroencephalography (EEG), and localised using standardised low-resolution brain electromagnetic tomography (sLORETA).Results: Spectral EEG analyses revealed significant slowing in patients with TBI, with no significant differences between patients with epilepsy and those without. Although bMRI revealed that patients with PTE were more likely to present with intracortical lesions (p = 0.02), no differences in the size of the lesion were found between the groups (p = 0.19). Increased BBB permeability was found in 76.9% of patients with PTE compared with 33.3% of patients without epilepsy (p = 0.047), and could be observed years following the trauma. Cerebral cortex volume with BBB disruption was larger in patients with PTE (p = 0.001). In 70% of patients, slow (delta band) activity was co-localised, by sLORETA, with regions showing BBB disruption.Conclusions: Lasting BBB pathology is common in patients with mild TBI, with increased frequency and extent being observed in patients with PTE. A correlation between disrupted BBB and abnormal neuronal activity is suggested.