应用静息态fMRI对右侧颞叶癫痫患者执行功能脑网络的研究

Executive dysfunction is often presented in right temporal lobe epilepsy (rTLE) patients. Few studies，however, are reported on the functional connectivity and structural connectivity of resting state networks related to it and the regulatory within and between networks. Our previous studies showed that executive function of healthy subjects activated cerebral regions with right asymmetry, and the areas with decreased intensity in TLE groups localized in right hemisphere compared with controls. In addition, the integrity of uncinate fasciculus was damage in TLE. Thus we propose a hypothesis that the recurrent epileptiform discharges would affecting the functional connectivity and structural connectivity of the executive control network (ECN) and the regulation of intra-network or inter-network, leading to the decline in executive functions,and the reconstruction and compensatory of ECN will occur with the passage of time, For verifying this assumption, rTLE patients and healthy controls are included in the current study and undergo a resting-state fMRI scanning and behavior tests of executive function, longitudinal comparison. The data are analysis with the SPM8, REST, GIFT,FNC, et al. We investigate the integrity, functional connectivity and structural connectivity of ECN , the regulatory mechanism of executive function on the brain network level, the reconstruction and compensatory of ECN. With these works we aim to reveal the foundation of brain function and structure, the regulatory of networks and brain plastic mechanism of executive function in rTLE. And provide helpfulness to the prevention and therapy to the executive dysfunction in rTLE patients.

右侧颞叶癫痫（rTLE）患者存在执行功能缺陷,但其静息态下执行功能脑网络与结构基础及网络调控研究鲜有报道。我们前期研究显示，正常执行功能脑区为右偏侧激活，TLE患者激活下降多位于右半球；其钩束的微结构完整性受到损害。我们推测：反复痫性放电可能导致rTLE患者执行控制网络（ECN）相关功能与结构及网络调控改变，患者执行功能下降，并随时间的推移，ECN发生重构和代偿。为验证此假设,本项目对rTLE患者和正常对照者行静息fMRI、DTI扫描和执行功能行为学测试，并追踪其影像学与行为学；采用SPM8、REST、GIFT、FNC等软件分析数据。研究rTLE患者ECN的完整性、执行脑区的功能与结构连接；探讨执行功能脑网络的调控机制；研究执行脑功能的重构和代偿；为揭示rTLE患者执行脑功能与结构基础、网络调节及脑功能的可塑性机制提供理论依据,并为rTLE患者执行功能损害的防治提供帮助。

颞叶癫痫(TLE)患者存在多种认知功能损害，执行功能是其中之一，执行功能存在着右半球偏侧优势。静息态功能磁共振（rs-fMRI）在认知功能领域方面的研究具有独特优势。本项目运用rs-fMRI、DTI及执行功能测试研究右侧颞叶癫痫（rTLE）患者执行功能脑网络的完整性、相关脑区的功能与结构连接的特征、执行功能的损害及其网络重构代偿机制。发现：⑴ TLE患者执行功能损害，执行网络平均反应时间（RT）延长，rTLE患者较左侧颞叶癫痫（lTLE）患者执行功能损害更重，多元线性回归分析表明痫性放电和起病年龄与执行网络效率有关；⑵rTLE患者执行控制网络广泛涉及前额叶、额叶、顶叶、扣带回、默认模式网络（DMN）、小脑功能网络、尾状核等脑区及结构； ⑶相关性分析发现执行功能网络的调控和代偿重构通过右侧额叶、楔前叶、DMN、小脑功能网络、尾状核等发挥作用；⑷通过2年的rs-fMRI跟踪研究揭示TLE患者出现局部自发活动异常分布及功能连接改变，显示其可能存在不同程度的脑功能重组。综上所述，本研究进一步证实TLE患者执行功能的偏侧性，发现执行功能损害的可能相关因素，并识别出rTLE患者执行控制网络及其调控、重构相关脑区，为更好地认识rTLE患者执行脑功能网络的损害、代偿和可塑性机制提供相关的理论依据, 并为rTLE患者执行功能损害的防治提供新思路。