CAJ | 학술논문

目的：探讨间期痫样发放对内侧颞叶癫痫患者脑静息态网络的影响，揭示间期癫痫活动发放对全脑功能的损害机制。材料与方法从45例行同步脑电fMRI数据采集单侧颞叶癫痫患者中，挑选35例(左侧颞叶癫痫患者18例、右侧颞叶癫痫患者17例)，以同步脑电图监测，每一患者均采集间期痫样发放及无痫样发放状态静息态fMRI数据。采用独立成分分析方法，分别提取患者两种状态的核心网络、背侧注意网络、执行控制网络、默认网络及感觉运动网络等7套内在连接网络。采用配对t检验比较痫样发放及无痫样发放状态mTLE患者脑内在连接网络的差异。结果相比未发放状态，发放状态下颞叶癫痫患者核心网络的前扣带回功能连接增强，听觉网络的脑岛及颞上回功能连接减低。此外，背侧注意网络的顶上小叶在左侧颞叶癫痫患者表现为功能连接增强，而在右侧表现为连接减弱。前默认网络的额中回在右侧表现为功能连接减弱，而后默认网络颞中回及后扣带回在右侧表现为功能连接增强。执行控制网络的中扣带回和视觉网络枕叶皮层在左侧表现为功能连接增强。相关分析结果显示，左侧组视觉网络及右侧组听觉网络内连接强度的变化与发放状态下IEDs发放次数呈正相关。结论内侧颞叶癫痫发作间期痫样发放对脑高级认知网络及感知觉网络均产生了广泛影响，尤其是对参与脑高级认知功能网络的损害，这有助于进一步了解海马硬化这一特异性内侧颞叶癫痫在发作间期脑功能受损机制。
목적：탐토간기간양발방대내측섭협전간환자뇌정식태망락적영향，게시간기전간활동발방대전뇌공능적손해궤제。재료여방법종45례행동보뇌전fMRI수거채집단측섭협전간환자중，도선35례(좌측섭협전간환자18례、우측섭협전간환자17례)，이동보뇌전도감측，매일환자균채집간기간양발방급무간양발방상태정식태fMRI수거。채용독립성분분석방법，분별제취환자량충상태적핵심망락、배측주의망락、집행공제망락、묵인망락급감각운동망락등7투내재련접망락。채용배대t검험비교간양발방급무간양발방상태mTLE환자뇌내재련접망락적차이。결과상비미발방상태，발방상태하섭협전간환자핵심망락적전구대회공능련접증강，은각망락적뇌도급섭상회공능련접감저。차외，배측주의망락적정상소협재좌측섭협전간환자표현위공능련접증강，이재우측표현위련접감약。전묵인망락적액중회재우측표현위공능련접감약，이후묵인망락섭중회급후구대회재우측표현위공능련접증강。집행공제망락적중구대회화시각망락침협피층재좌측표현위공능련접증강。상관분석결과현시，좌측조시각망락급우측조은각망락내련접강도적변화여발방상태하IEDs발방차수정정상관。결론내측섭협전간발작간기간양발방대뇌고급인지망락급감지각망락균산생료엄범영향，우기시대삼여뇌고급인지공능망락적손해，저유조우진일보료해해마경화저일특이성내측섭협전간재발작간기뇌공능수손궤제。
Objective:To comprehensively assess the alterations of resting-state brain networks affected by interictal epileptic discharges (IEDs) in mesial temporal lobe epilepsy (mTLE), and to reveal the mechanism of brain function damages caused by IEDs in mTLE. Materials and Methods: Forty-five patients with bilateral mTLE underwent continuous EEG-fMRI during rest. Finally 35 fMRI sessions (left mTLE, n=18) with IEDs and individually paired non-IEDs sessions were acquired. Independent component analysis was used to investigate the alterations in different states of seven resting-state networks including the core network, dorsal attention network, executive control network, anterior and posterior default mode network, auditory network, visual network and sensorimotor network. Results:Paired t-test results showed, compared with non-IEDs state, the anterior cingulum cortex in core network showed increased coherence of brain activity and the auditory network showed decreased activity in both groups of mTLE. Apart from this, superior parietal gyrus in dorsal attention network showed reverse performance when the epileptic focus located in different sides of the brain. While it increased in left mTLE, but decreased in right mTLE. The middle temporal gyrus and post cingulum in posterior default mode network showed increased activity, while the middle frontal gyrus in anterior default mode network showed decreased activity in IEDs state in right mTLE. The middle cingulum in executive control network and middle occipital gyrus in visual network showed increased coherence of brain activity in left mTLE. And the changed mean connectivity strength in visual network of left mTLE and auditory network of right mTLE were positively correlated with the number of IEDs. Conclusions:This study revealed IEDs in mTLE have an extensive impact in the resting-state brain networks, especially for the networks damage involved in higher cognitive functions of the brain. This study was expected to contribute to further understanding of the mechanism of brain functional injury in mTLE.