Brainstem network disruption: A pathway to sudden unexplained death in epilepsy?
Brainstem network disruption: A pathway to sudden unexplained death in epilepsy?
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DOI：
10.1002/hbm.24325
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发表时间：
2018-12
影响因子：
4.8
通讯作者：
Goldman AM
中科院分区：
文献类型：
--
作者：
Mueller SG;Nei M;Bateman LM;Knowlton R;Laxer KD;Friedman D;Devinsky O;Goldman AM
对癫痫性猝死 (SUDEP) 的观察表明，中枢自主控制的致命性崩溃可能在 SUDEP 中发挥重要作用。之前的一项 MR 研究发现，两名患者的局灶性癫痫中脑容量损失更为严重，并延伸至下脑干，这些患者后来死于 SUDEP。本研究的目的是证明 (1) 脑干体积损失与自主控制受损（心率变异性 [HRV] 降低）之间存在关联； (2) 脑干损伤与后来死于 SUDEP 的患者进行 SUDEP 的时间之间的关系。研究了两个人群：(1) 采用 HRV 测量和标准化 3 T MR 检查的自主系统功能人群（ASF、18 名局灶性癫痫患者、11 名对照）。 (2) SUDEP 人群（26 名 SUDEP 癫痫患者）在 SUDEP 前 1-10 年进行临床 MRI 检查。基于变形的脑干形态测量用于从所得雅可比行列式图生成轮廓相似性图，并通过图形分析进一步表征，以识别过度扩张的区域，表明显着的体积损失或萎缩。 ASF 过度扩张的区域总数与 HRV 呈负相关（r = −.37，p = .03），导水管周围灰质/延髓自主核的过度体积损失解释了大部分 HRV 相关变异（r/r2 = −.82/.67，p < .001）。 SUDEP 过度扩张的区域总数与 SUDEP 时间呈负相关 (r = −.39, p = .03)，obex 水平中缝/延髓过度体积损失解释了 MRI 至 SUDEP 之间时间变化的大部分 (r/r2 = −.60/.35, p = .001)。癫痫与脑干萎缩有关，脑干萎缩会损害自主控制，如果扩展到中脑，会增加 SUDEP 的风险。
Observations in witnessed Sudden Unexpected Death in Epilepsy (SUDEP) suggest that a fatal breakdown of the central autonomic control could play a major role in SUDEP. A previous MR study found volume losses in the mesencephalon in focal epilepsy that were more severe and extended into the lower brainstem in two patients who later died of SUDEP. The aims of this study were to demonstrate an association (1) between brainstem volume loss and impaired autonomic control (reduced heart rate variability [HRV]); (2) between brainstem damage and time to SUDEP in patients who later died of SUDEP. Two populations were studied: (1) Autonomic system function population (ASF, 18 patients with focal epilepsy, 11 controls) with HRV measurements and standardized 3 T MR exams. (2) SUDEP population (26 SUDEP epilepsy patients) with clinical MRI 1–10 years before SUDEP. Deformation-based morphometry of the brainstem was used to generate profile similarity maps from the resulting Jacobian determinant maps that were further characterized by graph analysis to identify regions with excessive expansion indicating significant volume loss or atrophy. The total number of regions with excessive expansion in ASF was negatively correlated with HRV (r = −.37, p = .03), excessive volume loss in periaqueductal gray/medulla oblongata autonomic nuclei explained most of the HRV associated variation (r/r2 = −.82/.67, p < .001). The total number of regions with excessive expansion in SUDEP was negatively correlated with time to SUDEP (r = −.39, p = .03), excessive volume loss in the raphe/medulla oblongata at the obex level explained most of the variation of the time between MRI to SUDEP (r/r2 = −.60/.35, p = .001). Epilepsy is associated with brainstem atrophy that impairs autonomic control and can increase the risk for SUDEP if it expands into the mesencephalon.
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影响因子：
5.6
作者：
Furman M;Zhan Q;McCafferty C;Lerner BA;Motelow JE;Meng J;Ma C;Buchanan GF;Witten IB;Deisseroth K;Cardin JA;Blumenfeld H
通讯作者：
Blumenfeld H
影响因子：
4.2
作者：
Lambert, Christian;Lutti, Antoine;Helms, Gunther;Frackowiak, Richard;Ashburner, John
通讯作者：
Ashburner, John
影响因子：
5.7
作者：
Ashburner J;Friston KJ
通讯作者：
Friston KJ
影响因子：
5.3
作者：
Dlouhy, Brian J.;Gehlbach, Brian K.;Richerson, George B.
通讯作者：
Richerson, George B.
影响因子：
2.2
作者：
Kommajosyula, Srinivasa P.;Randall, Marcus E.;Faingold, Carl L.
通讯作者：
Faingold, Carl L.