Exercise for Memory Rehabilitation in Epilepsy

项目摘要/摘要 在美国340万癫痫(PWE)患者中，约有50%的人有认知障碍 最常报告的是记忆缺陷。记忆缺陷对个人和 PWE的职业结果，包括生活质量。虽然认知康复计划已经 用于帮助改善癫痫患者的记忆功能，其疗效尚不清楚。最近，记忆 在健康人群的随机对照试验中，正规运动训练的效果有所改善 个体，以及我们在PWE中参与监督联合耐力和抵抗的试点研究 训练。尽管有证据表明体育锻炼对记忆力和其他认知能力有好处，但临床试验 到目前为止，还没有将运动作为改善记忆的康复策略进行过。 此外，我们缺乏对运动引起的大脑变化及其在提高身体素质中的作用的了解 记忆功能以及运动对记忆和大脑变化的纵向影响。改善我们的 了解和改善癫痫、癫痫发作及其治疗的负面影响 癫痫作为医学界和科学界的重要研究热点。因此，运动训练是一种 有希望的康复策略，以减轻癫痫所经历的记忆缺陷。 这项研究的主要目标是确定成人特发性全面性癫痫(Ige)。 耐力与抵抗力相结合的6周监督结构化训练方案的疗效观察 记忆康复训练，研究运动相关记忆的可能作用机制 好处，并确定记忆好处和大脑变化是否在完成治疗6周后保留 运动干预。根据我们在成人癫痫患者中的试点运动数据，我们假设运动将 与非干预对照组相比，运动组的言语记忆功能明显改善 一群人。我们还假设，言语记忆的改善是通过休息时间的变化来调节的 海马体的功能连接状态，海马体是大脑中在记忆功能中起关键作用的区域。我们 提出一种运动诱导的海马区功能连通性改变的调节模型 探讨运动对癫痫患者记忆功能的改善作用，并利用因果法 一种方法，必须满足4个具有统计意义的条件才能确定是否存在调解。 采用随机延迟干预研究设计，我们将进行一项为期6周的临床试验 结合耐力和抵抗力训练的成人IGE运动计划，以测试我们的 假设。拟议研究的完成将对实地产生重大影响，因为它将奠定基础 在癫痫患者中使用运动进行记忆康复，其中对抗记忆损害的选择 是有限的。

Project Summary/Abstract Approximately 50% of the 3.4 million persons with epilepsy (PWE) in the U.S. have cognitive problems with memory deficits reported most commonly. Memory deficits negatively contribute to the personal and professional outcomes of PWE including quality of life. While cognitive rehabilitation programs have been utilized to help improve memory function in epilepsy, their efficacy remains unclear. Recently, memory improvements with formal exercise training have been shown in randomized controlled trials in healthy individuals, and in our pilot study in PWE who participated in supervised combined endurance and resistance training. Despite evidence of memory and other cognitive benefits derived from physical exercise, clinical trials of exercise as a rehabilitative strategy for memory improvement in PWE have not been conducted to date. Further, we lack understanding of the brain changes that occur with exercise and their role in improving memory function as well as the longitudinal effects of exercise on memory and brain changes. Improving our understanding and ameliorating the negative impact of epilepsy, seizures, and its treatment are recognized by the epilepsy, medical and scientific community as an important focus of research. Thus, exercise training is a promising rehabilitative strategy for mitigating the memory deficits experienced in epilepsy. The primary objectives of this study are to determine in adults with idiopathic generalized epilepsy (IGE) the efficacy of a 6-week supervised and structured exercise program combining endurance and resistance training for memory rehabilitation, investigate a putative mechanisms of action for exercise-related memory benefits, and determine if the memory benefits and brain changes are retained 6 weeks after completing the exercise intervention. Based on our pilot exercise data in adults with epilepsy, we hypothesize that exercise will significantly improve verbal memory function in the exercise group compared to the no-intervention control group. We also hypothesize that the verbal memory improvements are mediated by the changes in resting state functional connectivity of the hippocampus, a brain region that plays a vital role in memory function. We propose a mediation model in which exercise-induced changes in the hippocampus functional connectivity is mediating the beneficial effect of exercise on memory function in epilepsy, and we will utilize the causal-steps approach in which 4 conditions of statistical significance must be met to determine if mediation is present. Using a randomized delayed intervention study design, we will conduct a clinical trial of the 6-week supervised exercise program combining endurance and resistance training in adults with IGE in order to test our hypotheses. Completion of the proposed study will significantly impact the field in that it will lay the groundwork for the use of exercise for memory rehabilitation in epilepsy, in which option for combatting memory impairment are limited.