新诊断夜发性额叶癫痫异常GABA网络机制的1H-MRS定量研究

Nocturnal frontal lobe epilepsy (NFLE) predominantly occurs during sleep with the origin of frontal lobe. The clinical semiologies of NFLE are generally variable without detectable lesions in routine imaging, which lead to the difficulty of early diagnosis. Previous studies indicated that the GABAergic neuronal network of frontal lobe was involved in NFLE, but the underlining mechanism of epileptogenesis and development are still unclear. Our previous study has already successfully applied quantitative measurment by 1H MRS into Coriaria Lactone-induced rhesus monkey model, which found the fluctuation of GABA concentration in thalamus and the continuous decrease afterwards related to the chronic epilepsy. Based on these findings, the hypothesis of the association between the dysfunctional GABAergic neuronal network and the mechanism of epileptogenesis in early phase of NFLE, as well as the prognosis has been proposed. Thus, this study aims to investigate the quantitative level of GABA dynamically in frontal lobe among 40 patients with newly diagnosed NFLE by mature techniques of 1H MRS, in order to find out the correlation in GABAergic network and the epileptogenesis of NFLE, explore the characters of abnormal GABAergic network and its evolvement, deepen the understanding of underling mechanism, search the imaging index for early warning prediction，and provide the theoretical evidence for further treatment in NFLE.

夜发性额叶癫痫(nocturnal frontal lobe epilepsy, NFLE)起源于额叶且与睡眠相关，临床表现多样，普通影像学技术难以发现异常，早期诊断困难。研究发现NFLE在额叶存在γ-氨基丁酸(GABA)网络代谢和功能的异常，但其起源及衍变的机制不清。我们的前期研究已经成功应用1H-MRS技术，在恒河猴癫痫模型的基础上，定量检测出丘脑区域GABA浓度的变化，并发现GABA浓度波动后持续性降低与其发展成为慢性癫痫相关，据此假设NFLE早期亦存在GABA网络代谢及功能异常，且与预后相关。因此，我们拟应用1H- MRS技术，动态跟踪研究40例新诊断的NFLE患者脑区的GABA水平并进行定量测定，研究GABA网络与NFLE发生发展的相关关系，探讨NFLE中GABA网络异常发生及衍变特征，深入对NFLE发生机制的认识，寻找早期分子影像学预警指标，为定量动态监测和调控治疗提供理论依据

夜发性额叶癫痫(nocturnal frontal lobe epilepsy) 额叶区域，包括双侧前额叶背外侧皮质中的各代谢产物进行了定量的分析。研究纳入了38例夜发性额叶癫痫的患者，和32例对照正常人。采用 SVS的频谱编辑，标准的1H-MRS扫描采用单体素点分辨波谱（PRESS）序列（TR/TE=2000ms/30ms，带宽1200Hz）扫描序列。采集了NAA, Cho，Cr，Ins和定量的GABA 数据，使用LCModel(Version 6.3-1H)分析方法。所得原始数据导出为rda文件，然后通过LCModel软件进行后处理。研究发现癫痫患者同侧DLPFC中的NAA显著降低。与对照组比较，双侧的DLPFC区的Ins均有显著降低。癫痫患者较正常对照，双侧DLPFC的GABA 均有降低，没有统计学差异。在癫痫患者组内左右侧对比，致痫灶同侧DLPFC区的GABA较对侧有所降低，同样没有统计学差异。夜发性额叶癫痫患者，由于癫痫的反复发作，造成了脑内代谢改变，同时也影响到了病灶区以外的脑区。