应用多模态核磁共振对颞叶癫痫患者警觉脑功能和结构的研究

The impairment on the attention network is observed in the patients with temporal lobe epilepsy (TLE). Alertness, a fundamental component of attention, is also evidenced to be deficit. However, fewer studies are reported concerning about the alterations in the resting-state functional connectivity (RSFC) and cerebral structure of alertness, as well as the relationship between them. Our previous researches applying the task-based fMRI demonstrated that the alertness correlated brain activation is smaller in spatial distribution and lower in intensity when comparing the TLE patients with healthy controls. Base on such findings, we proposed a hypothesis that during rest, the human brain might has an alertness network functionally connected; the functional connectivity within alertness network and the correlated fiber structure in TLE patients are altered and can be reorganized as time goes by. To verify this hypothesis, the TLE patients group and the normal controls will be administered by the attentional networks test and secondly undergo rfMRI，task-based fMRI, and DTI session. Data analysis will be processed utilizing SPM8, REST, DTI STUDIO and SPSS. Additionally we also trace the radiological changes in different disease periods. The objective of our study is to investigate the alertness related RSFC and the correlated structure, find out the relationship between them, explore the underlying mechanism of compensatory and the potential influential factors in the TLE patients. With the above works, we might lay the foundation for revealing the principle of the alertness RSFC and structural alteration and the mechanism of plasticity, providing helpfulness to the prevention and therapy to the alertness function in TLE patients.

颞叶癫痫（TLE）患者存在注意网络损害，警觉是注意网络的重要组成部分，但TLE患者警觉脑功能连接和相关结构改变及相互关系鲜有报道。我们前期利用task-based fMRI研究发现，TLE患者警觉脑激活区较正常人范围小强度弱。据此提出假设：在静息态下，存在着警觉脑功能连接网络，TLE患者警觉脑功能连接和结构发生改变，并随时间的推移，警觉脑功能连接网络及相关结构发生变化。为验证这一假设，拟对TLE患者行注意网络测试，继后进行rfMRI、task-based fMRI、DTI扫描，并追踪其影像学，采用SPM8、REST、DTI STUDIO、SPSS等软件对数据处理分析。探讨患者警觉脑功能连接和结构特点，阐明两者间的关系；研究患者警觉脑功能及结构的代偿机制；探讨患者警觉脑功能连接的影响因素。为揭示TLE患者警觉脑功能连接和结构以及脑可塑性机制奠定基础，并为防治TLE患者警觉功能损害提供帮助。

颞叶癫痫(TLE)是一种局灶性癫痫，长期反复的癫痫发作可对警觉功能造成损害。影像学检查作为研究脑结构和功能的重要手段，在神经系统疾病诊断和机制研究等方面发挥着重要的作用。本项目通过运用多模态磁共振(MRI)及注意网络测试（ANT）分别研究TLE患者警觉相关脑功能和结构的改变、警觉功能的损害以及影像学改变和警觉功能之间的相关性。该研究发现：（1）ANT测试结果显示，患者警觉功能损害，固有警觉、位相性警觉平均反应时间延长；（2）颞叶癫痫患者脑内结构变化不仅仅局限于癫痫灶的起病部位，还广泛涉及丘脑、海马旁回、后扣带回以及白质纤维等结构；（3）警觉功能网络的损害通过增强颞上回、颞中回、顶上小叶、楔叶等脑区的功能发挥代偿作用；（4）相关性分析发现丘脑、楔叶和后扣带回等的结构损害、功能改变之间存在相关关系；（5）多因素回归分析示警觉功能的损害与发作类型及是否存在痫性放电有关。本项目的研究结果将进一步阐释说明颞叶癫痫患者警觉脑结构和功能损害的基础，提取出与警觉功能损害和代偿相关的脑区，揭示颞叶癫痫患者警觉功能损害的相关因素，更好的认识了解警觉功能损害的病理生理机制及相关的代偿机能，为癫痫警觉功能损害机制的研究、警觉功能损害影响因素的早期预警和干预以及长期康复治疗提供了重要的理论依据。