Physiologic and cortical response to acute psychosocial stress in left temporal lobe epilepsy - A pilot cross-sectional fMRI study
Physiologic and cortical response to acute psychosocial stress in left temporal lobe epilepsy - A pilot cross-sectional fMRI study
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DOI：
10.1016/j.yebeh.2014.05.003
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发表时间：
2014-07-01
影响因子：
2.6
通讯作者：
Szaflarski, Jerzy P.
中科院分区：
文献类型：
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作者：
Allendorfer, Jane B.;Heyse, Heidi;Szaflarski, Jerzy P.
应激通常被报道为癫痫发作控制不佳的个体的癫痫诱因，包括颞叶癫痫。本研究旨在探讨左颞叶癫痫(LTLE)患者功能性磁共振成像(FMRI)中心理社会应激反应的神经和生理相关性及其与癫痫发作的关系。我们招募了23名LTLE患者和23名年龄和性别匹配的健康对照组(HCS)；所有人都接受了带有对照数学任务(CMT)和压力数学任务(SMT)的功能磁共振成像，并在功能磁共振成像前后进行唾液皮质醇分析(急性应激反应计算为从应激后到恢复基线的百分比减少；DCort)。采用Beck抑郁量表(BDI-II)和领悟压力量表(PSS-10)进行测评。对运动能力和皮质醇变量进行t检验。对控制不良的LTLE患者进行对CMT正反馈和SMT负反馈的fMRI反应的处理和单对象建模、组比较以及发作发生和fMRI反应的全脑相关性。LTLE患者和健康对照组在人口统计学、数学成绩、心率和PSS-10得分方面相似(均为p>；0.05)。与HCS相比，LTLE患者表现出更大的DCort(p=0.048)和更低的BDI-II评分(p=0.016)。LTLE控制不良患者发作频率与DCort呈正相关(r=0.73，p=0.016)。功能磁共振对反馈的激活在不同组之间是相似的，包括额中区、颞区、顶区和枕区。回归分析显示，LTLE患者对正反馈的激活在左侧小脑/枕中回/梭状回、左侧海马区/副海马区、双侧额内侧/扣带回/额上回、右侧中央后回/顶下小叶、右侧脑岛/中央后回的激活程度低于HCS组(p<；0.05，校正后)。控制不良的LTLE患者的发作频率与双侧膝下前扣带回的激活呈负相关(p<；0.05，更正)。本研究首次对急性心理应激的皮层和生理反应进行了表征，并揭示了LTLE的癫痫控制与下丘脑-垂体-肾上腺轴和fMRI信号对急性心理应激的反应性之间的显著关系。这些发现加深了我们对应激、生理应激标记物和癫痫发作之间复杂相互作用的理解。(C)2014 Elsevier Inc.保留所有权利。
Stress is commonly reported as a seizure precipitant in individuals with poorly controlled seizures including temporal lobe epilepsy. The aim of the study was to assess the neural and physiologic correlates of psychosocial stress response during functional magnetic resonance imaging (fMRI) and their relationship with seizure occurrence in patients with left temporal lobe epilepsy (LTLE). We enrolled 23 patients with LTLE and 23 age- and sex-matched healthy controls (HCs); all underwent fMRI with control math task (CMT) and stress math task (SMT) and pre-/ post-fMRI salivary cortisol analysis (acute stress reactivity calculated as % reduction from post-stress to recovery baseline; dCORT). The Beck Depression Inventory-H (BDI-II) and Perceived Stress Scale (PSS-10) were administered. T-tests of performance and cortisol variables were performed. Processing and single-subject modeling of fMRI response to CMT positive feedback and SMT negative feedback, group comparisons, and whole-brain correlation of seizure occurrence and fMRI response in patients with poorly controlled LTLE were performed. Patients with LTLE and healthy controls were similar in demographics, math performance, heart rate, and PSS-10 scores (all p > 0.05). Patients with LTLE exhibited greater dCORT (p = 0.048) and lower BDI-II scores (p = 0.016) compared with HCs. Patients with poorly controlled LTLE showed a positive association between seizure frequency and dCORT (r = 0.73, p = 0.016). Functional MRI activation to feedback was similar between groups, including midfrontal, temporal, parietal, and occipital regions. Regression analyses revealed no group differences to positive feedback, but, compared with HCs, patients with LTLE showed decreased activation to negative feedback in the left cerebellum/middle occipital/fusiform gyri, left hippocampus/parahippocampus, bilateral medial frontal/cingulate/superior frontal gyri, right postcentral gyrus/inferior parietal lobule, and right insula/postcentral gyms (p < 0.05, corrected). Patients with poorly controlled LTLE showed negative association between seizure frequency and activation in the bilateral subgenual anterior cingulate (p < 0.05, corrected). This study is the first to characterize the cortical and physiologic responses to acute psychosocial stress and to show a significant relationship between seizure control in LTLE and both the hypothalamic-pituitary-adrenal axis and fMRI signal reactivity to acute psychosocial stress. These findings extend our understanding of the complex interplay between stress, physiologic stress markers, and seizures/epilepsy. (C) 2014 Elsevier Inc. All rights reserved.