Altered Amygdala Volumes and Microstructure in Focal Epilepsy Patients with Tonic-Clonic Seizures, Ictal and Post-Ictal Central Apnea
Altered Amygdala Volumes and Microstructure in Focal Epilepsy Patients with Tonic-Clonic Seizures, Ictal and Post-Ictal Central Apnea
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伴有强直阵挛发作、发作期和发作后中枢性呼吸暂停的局灶性癫痫患者杏仁核体积和微观结构的改变
DOI：
10.1101/2023.03.16.23287369
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Zeicu C
中科院分区：
文献类型：
--
作者：
Zeicu C
目的癫痫猝死（SUDEP）是癫痫患者死亡的主要原因；然而，病理生理学仍不清楚。局灶性至双侧强直阵挛发作 (FBTCS) 是一个主要危险因素，中枢介导的呼吸抑制可能会进一步增加风险。在这里，我们确定了杏仁核的体积和微观结构，杏仁核是局灶性癫痫患者中可能引发呼吸暂停的关键结构，根据是否存在 FBTCS、发作性中枢性呼吸暂停 (ICA) 和发作后中枢性呼吸暂停 (PICA) 进行分层。方法在术前调查期间前瞻性招募了 73 名仅局灶性癫痫发作的患者和 30 名在视频脑电图 (VEEG) 和呼吸监测期间记录到 FBTCS 的患者。我们获取了所有癫痫患者和 69 名健康对照者的高分辨率 T1 加权解剖和多壳扩散图像，并计算了神经突方向分散和密度成像 (NODDI) 指标。比较健康受试者和仅局灶性癫痫发作或 FBTCS 患者之间的杏仁核体积和微观结构变化。FBTCS 组根据 ICA 和 PICA 的存在进一步细分，并经 VEEG 验证。结果与健康对照和局灶性队列相比，FBTCS 队列的双侧杏仁核体积显着增加。 FBTCS 队列中记录有 PICA 的患者双侧杏仁核体积增加最多。与健康对照组相比，局灶组和 FBTCS 组的杏仁核神经突密度指数 (NDI) 值均显着降低，其中 FBTCS 组的值是两者中最低的。与非呼吸暂停 FBTCS 组相比，PICA 的存在与显着较低的 NDI 值相关 (p=0.004)。 显着性 患有 FBTCS 和 PICA 的个体显示出双侧杏仁核体积显着增加和结构破坏，左侧变化更大。 NODDI 反映的结构改变和体积差异可能与杏仁核介导的不适当的心肺模式有关，特别是在 FBTCS 之后。确定杏仁核体积和结构的变化可能有助于识别处于危险中的个体。
ObjectivesSudden unexpected death in epilepsy (SUDEP) is a leading cause of death for patients with epilepsy; however, the pathophysiology remains unclear. Focal-to-bilateral tonic-clonic seizures (FBTCS) are a major risk factor, and centrally-mediated respiratory depression may increase the risk further. Here, we determined volume and microstructure of the amygdala, a key structure that can trigger apnea in people with focal epilepsy, stratified by presence or absence of FBTCS, ictal central apnea (ICA) and post-ictal central apnea (PICA).Methods73 patients with only-focal seizures and 30 with FBTCS recorded during video EEG (VEEG) with respiratory monitoring were recruited prospectively during presurgical investigations. We acquired high-resolution T1-weighted anatomical and multi-shell diffusion images, and computed neurite orientation dispersion and density imaging (NODDI) metrics in all epilepsy patients and 69 healthy controls. Amygdala volumetric and microstructure alterations were compared between healthy subjects, and patients with only-focal seizures or FBTCS The FBTCS group was further subdivided by presence of ICA and PICA, verified by VEEG.ResultsBilateral amygdala volumes were significantly increased in the FBTCS cohort compared to healthy controls and the focal cohort. Patients with recorded PICA had the highest increase in bilateral amygdala volume of the FBTCS cohort. Amygdala neurite density index (NDI) values were significantly decreased in both the focal and FBTCS groups relative to healthy controls, with values in the FBTCS group being the lowest of the two. The presence of PICA was associated with significantly lower NDI values vs the non-apnea FBTCS group (p=0.004).SignificanceIndividuals with FBTCS and PICA show significantly increased amygdala volumes and disrupted architecture bilaterally, with greater changes on the left side. The structural alterations reflected by NODDI and volume differences may be associated with inappropriate cardiorespiratory patterns mediated by the amygdala, particularly after FBTCS. Determination of amygdala volumetric and architectural changes may assist identification of individuals at risk.
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影响因子：
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