癫痫性痉挛发作脑网络特征及其靶向经颅直流电刺激调控的研究

Epileptic spasms (ES) is a common type of epileptic seizures. Currently, the physiopathologic mechanism of ES hasn’t been illustrated yet, and the disease is still hard to treat (due to great side effect and pharmacoresistance), so it will be of great clinical significance to do breakthrough research into its pathogenesis and treatment. Some studies have found that some specific brain regions may play a key role in the pathogenesis of ES. Our previous small sample study suggested that noninvasive transcranial direct current stimulation (tDCS) can regulate brain function. Therefore, we propose a hypothesis: ES has a characteristic brain network with hub regions, and tDCS can regulate the network. This program intends to combine a variety of neuroimaging techniques to exert their respective advantages. We hope to picture characteristic brain network of ES, from the aspects of electrophysiology (EEG and MEG), brain function (fMRI) and brain structure (VBM). Then, multi-modality fusion analysis will be performed and the result will be compared with healthy people to identify the hubs of ES brain network. tDCS, as a noninvasive, effective and safe neuromodulation technology, will be performed at hub regions of ES to modulate cortical excitability and connection strength. We will also evaluate changes in brain networks and clinical symptoms before and after treatment, and assess whether the ES brain network has "normalized" trends. This program will provide a new research idea for studying the pathogenesis and treatment of ES disease and provides a theoretical basis for neuromodulation treatment.

癫痫性痉挛发作（ES）是常见的癫痫发作类型，发病机制不清，治疗存在困境（药物难治且副作用大），因此对其发病机制及治疗的突破性研究有重大意义。有研究发现某些特定脑区可能在ES发病中起关键作用，课题组前期小样本研究提示经颅直流电刺激（tDCS）能调节脑功能。因此我们提出假说：ES具有特征性的脑网络，存在核心节点脑区，且tDCS能够调节该网络。我们拟联合多种神经影像技术，分别从脑电生理（EEG和MEG技术）、脑功能（fMRI技术）、脑结构（VBM技术）多角度刻画ES特征性脑网络；进行多模态融合分析并对比健康人群，找到ES脑网络核心节点，作为调控靶点；应用无创、有效、安全的神经调控技术tDCS刺激靶点，调节皮层兴奋性和连接强度，观察脑网络及临床症状的改变，评估ES脑网络是否具有“正常化”趋势，进一步验证假说。本课题为研究ES的发病机制和治疗提供新型的研究思路，为神经调控治疗提供理论依据。

癫痫性痉挛发作（ES）是常见的癫痫发作类型，发病机制不清，治疗存在困境（药物难治且副作用大），亟待对其发病机制及治疗的突破性研究。本课题组首先提出假说：ES具有特征性的脑网络，存在核心节点脑区，且tDCS能够调节该网络。我们联合多种神经影像技术，分别从脑电生理（EEG技术）、脑功能（fMRI技术）、脑结构（VBM技术）多角度刻画ES特征性脑网络；通过分析对比健康人群，个体化确定ES脑网络核心节点，包括额、顶、颞、中央等脑区作为调控靶点；应用神经调控技术tDCS进行调节，评价临床疗效。研究发现靶点位于顶叶时，患者癫痫发作明显减少，疗效最佳；靶点位于其他脑区则疗效不佳；推测顶叶在癫痫性痉挛中起着关键核心节点作用。此外，tDCS不但调节了功能脑网络，可能还改变了结构脑网络。本课题为研究ES的发病机制和治疗提供新型的研究思路，为神经调控治疗提供理论依据。