多模态神经成像技术在特发性全面性癫痫中的应用研究
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摘要
癫痫是以大脑神经元反复出现过度放电导致的中枢神经系统功能失常为特征的慢性脑部疾病。作为神经系统的一个典型疾病,从微观到宏观的各个层次的癫痫机制研究一直受到高度重视。本工作着眼于神经成像技术所能触及到的神经元群及其网络层次上的问题,采用新近发展起来的多模态神经成像技术,综合应用多种数据处理方法,对特发性全面性癫痫(Idiopathic Generalized Epilepsy, IGE)的脑机制,从病灶定位方法、功能网络特征和结构参数改变几个方面,进行了比较深入的研究。主要内容包括以下三个方面:
1,发展了一种基于同步EEG-fMRI提高癫痫灶定位效果的方法。该方法采用独立成分分析(Independent Component Analysis,ICA)和相关分析相结合的办法对癫痫放电进行分类,然后将分类后的放电信息用于fMRI(functional Magnetic Resonance Imaging)的成像计算。将该方法应用于临床采集的实际EEG-fMRI数据,发现在常规方法处理结果为阴性的一些情况,该方法也能成像出与癫痫放电有关,且与临床现象一致的区域。说明该方法可提高EEG-fMRI对癫痫灶的检出敏感性,具有一定的为临床意义。
2,针对IGE的全面性棘慢波放电(generalized Spike and Wave Discharges,SWDs)的起源、播散及其对大脑基本功能的影响,我们利用静息态fMRI脑功能网络分析方法,研究了皮层-丘脑网络(Cortico-Thalamus Network,CTN)、基底节网络(Basal Ganglia Network,BGN)和“默认模式”网络(Default Mode Network,DMN)。这些研究都基于EEG-fMRI技术,以区分或者排除SWDs对这些脑静息态网络的干扰。在对于SWDs的起源和传播密切相关的皮层-丘脑网络的研究中发现,在具有典型失神发作的IGE患者中,在排除SWDs的影响后,存在丘脑和前扣带回间的功能失连接,推测这个失连接可能在IGE患者SWDs的起源、传播中起到极其重要的作用;在对基底节网络的研究中发现,静息态BGN在IGE患者中显示出显著增强的功能连接,IGE患者在有SWDs时功能连接更强,而且增强的连接性与SWDs的数目正相关,由此推测BGN可能作为一个SWDs的调节器在IGE中扮演了一个重要角色;在对“默认模式”网络的研究中发现,没有SWDs情况下的DMN在IGE患者中表现为显著的连接降低,这个结果可能反映了慢性长期的SWDs导致了DMN功能的异常集成,这可能源自解剖方面的异常或者功能方面的重组;这些改变有可能导致IGE患者中的认知心理损害以及癫痫发作时的意识丧失。这些结果表明,IGE对脑功能造成了多方面的影响,总体上表现为皮层相关连接减低,皮层下结构内连接增强,进一步说明,IGE的脑机制是分布式的,需要从脑网络角度深入研究。
3,利用高分辨MRI结构像和弥散张量成像,从结构水平上研究了具有失神发作的IGE患者的皮层下结构(丘脑和基底节神经核团)的体积和弥散参数。结果发现IGE患者皮层下结构水分子的弥散特性和体积都存在异常;它证实了在长期受到癫痫放电影响的皮层下结构中存在微结构变化,而且这种变化在早发患者中比在晚发患者中更加严重。这些发现也为上面功能网络研究中发现的,基底节和丘脑参与了SWDs的传播和调节的推测,提供了来自结构方面的证据。所有这些来自结构和功能方面的规律性的变化,有可能是具有典型失神发作IGE患者的特征指标,值得进一步进行临床应用研究。
Epilepsy is a chronic neurologic condition characterized by recurrent unprovoked seizures, which caused by the excessive, synchronized and disorderly discharges of a set of cerebral neurons. Hence, it is of great importance to study the mechanism of epilepsy from both micro level and macro level. In the current study, we focus on the neural mass level action in epilepsy with a new emerging non-invasive technique, i.e., multimodel neuroimagings including simultaneous electroenphalogram and functional magnetic resonance imaging (EEG-fMRI), diffusion tensor imaging (DTI)as well as high resolution anatomical MRI. Using these methods, the brain mechanism of idiopathic generalized epilepsy (IGE) was studied, achieving three lines of breakthroughs: method of epileptic focus localization, features of functional network and variation of structural parameters.
1, We developed a new scheme based on simultaneous EEG-fMRI to promote the detectability of epileptic focus. With this new scheme, we classified interictal epileptic discharge (IED) by a combination of an independent component analysis (ICA) and a temporal correlation analysis. The discharge information after classification of IED was used for blood oxygenation-level-dependent (BOLD) imaging. The proposed scheme was effective to identify the regions of BOLD action consistent with clinico-electron localization, where no BOLD change related to IED was found by routine method in patients with complex epileptic discharges. Therefore, the scheme was of clinical meaning in providing more detailed information of the foci.
2, Using the resting-state fMRI, a set of important functional networks in IGE were analyzed in-depth, including cortico-thalamus network, basal ganglia network (BGN) and default mode network (DMN), which were related to the generation and propagation of SWDs or influence of brain resting function by SWDs. Because SWDs might affect these functional networks, the simultaneous EEG during fMRI acquisition was recorded to classify whether the BOLD signal was hybrided by SWDs or not. For the cortico-thalamus network, which was important to the generation and propagation of SWDs, the functional connectivity between thalamus and anterior cingulated cortex (ACC) was significantly decreased in IGE with absence seizures during the non-discharge period (NDP). This finding, avoided effects from SWDs, might reflect a permanent abnormality between thalamus and ACC in IGE. The abnormality might play important role in the generation and propagation of SWDs in IGE. For the BGN, the functional connectivity of BGN in IGE patients demonstrated more integration within the network during NDP and WDP (the period with discharge). Furthermore, it increased more evidently during WDP compared with that in NDP, and it showed a positive relationship with the number of SWDs in WDP. These findings provided an evidence confirming the role of the BGN as an important modulator of SWDs in IGE. For the DMN, the decreased functional connectivity within DMN in IGE patients with absence seizures was found during NDP. These results indicated abnormal functional integration in DMN, which was derived from anatomic abnormality or functional reorganization. Such changes could lead to the cognitive mental impairment and unconsciousness during absence seizure. These findings on the three networks suggested that IGE could result in complex impairment of brain function, namely, decreased connectivity in the cortex and increased connectivity within subcortical nuclei. Such findings also supported that the abnormality of brain function in IGE presented a characteristic of decentralization.
3, Based on the brain structural imagings (DTI and high resolution anatomical MRI), the diffusion properties and volume of subcortical nuclei, were evaluated in IGE patients with absence seizure. Abnormality in both of them was found, which provide preliminary evidence demonstrating microstructural changes of subcortical structures related to the chronic abnormal epileptic activity. It also found to be more severe in patients with early age of onset than those with later age of onset. This structural disturbance provided anatomical evidence for the functional network and derived presumption that thalamus and basal ganglia were involved in propagation and modulation of SWDs in IGE. These consistant alterations from anatomical and functional abnormality might be a characteristic for IGE patients with absence seizures, which deserves further study in clinical application.
1,发展了一种基于同步EEG-fMRI提高癫痫灶定位效果的方法。该方法采用独立成分分析(Independent Component Analysis,ICA)和相关分析相结合的办法对癫痫放电进行分类,然后将分类后的放电信息用于fMRI(functional Magnetic Resonance Imaging)的成像计算。将该方法应用于临床采集的实际EEG-fMRI数据,发现在常规方法处理结果为阴性的一些情况,该方法也能成像出与癫痫放电有关,且与临床现象一致的区域。说明该方法可提高EEG-fMRI对癫痫灶的检出敏感性,具有一定的为临床意义。
2,针对IGE的全面性棘慢波放电(generalized Spike and Wave Discharges,SWDs)的起源、播散及其对大脑基本功能的影响,我们利用静息态fMRI脑功能网络分析方法,研究了皮层-丘脑网络(Cortico-Thalamus Network,CTN)、基底节网络(Basal Ganglia Network,BGN)和“默认模式”网络(Default Mode Network,DMN)。这些研究都基于EEG-fMRI技术,以区分或者排除SWDs对这些脑静息态网络的干扰。在对于SWDs的起源和传播密切相关的皮层-丘脑网络的研究中发现,在具有典型失神发作的IGE患者中,在排除SWDs的影响后,存在丘脑和前扣带回间的功能失连接,推测这个失连接可能在IGE患者SWDs的起源、传播中起到极其重要的作用;在对基底节网络的研究中发现,静息态BGN在IGE患者中显示出显著增强的功能连接,IGE患者在有SWDs时功能连接更强,而且增强的连接性与SWDs的数目正相关,由此推测BGN可能作为一个SWDs的调节器在IGE中扮演了一个重要角色;在对“默认模式”网络的研究中发现,没有SWDs情况下的DMN在IGE患者中表现为显著的连接降低,这个结果可能反映了慢性长期的SWDs导致了DMN功能的异常集成,这可能源自解剖方面的异常或者功能方面的重组;这些改变有可能导致IGE患者中的认知心理损害以及癫痫发作时的意识丧失。这些结果表明,IGE对脑功能造成了多方面的影响,总体上表现为皮层相关连接减低,皮层下结构内连接增强,进一步说明,IGE的脑机制是分布式的,需要从脑网络角度深入研究。
3,利用高分辨MRI结构像和弥散张量成像,从结构水平上研究了具有失神发作的IGE患者的皮层下结构(丘脑和基底节神经核团)的体积和弥散参数。结果发现IGE患者皮层下结构水分子的弥散特性和体积都存在异常;它证实了在长期受到癫痫放电影响的皮层下结构中存在微结构变化,而且这种变化在早发患者中比在晚发患者中更加严重。这些发现也为上面功能网络研究中发现的,基底节和丘脑参与了SWDs的传播和调节的推测,提供了来自结构方面的证据。所有这些来自结构和功能方面的规律性的变化,有可能是具有典型失神发作IGE患者的特征指标,值得进一步进行临床应用研究。
Epilepsy is a chronic neurologic condition characterized by recurrent unprovoked seizures, which caused by the excessive, synchronized and disorderly discharges of a set of cerebral neurons. Hence, it is of great importance to study the mechanism of epilepsy from both micro level and macro level. In the current study, we focus on the neural mass level action in epilepsy with a new emerging non-invasive technique, i.e., multimodel neuroimagings including simultaneous electroenphalogram and functional magnetic resonance imaging (EEG-fMRI), diffusion tensor imaging (DTI)as well as high resolution anatomical MRI. Using these methods, the brain mechanism of idiopathic generalized epilepsy (IGE) was studied, achieving three lines of breakthroughs: method of epileptic focus localization, features of functional network and variation of structural parameters.
1, We developed a new scheme based on simultaneous EEG-fMRI to promote the detectability of epileptic focus. With this new scheme, we classified interictal epileptic discharge (IED) by a combination of an independent component analysis (ICA) and a temporal correlation analysis. The discharge information after classification of IED was used for blood oxygenation-level-dependent (BOLD) imaging. The proposed scheme was effective to identify the regions of BOLD action consistent with clinico-electron localization, where no BOLD change related to IED was found by routine method in patients with complex epileptic discharges. Therefore, the scheme was of clinical meaning in providing more detailed information of the foci.
2, Using the resting-state fMRI, a set of important functional networks in IGE were analyzed in-depth, including cortico-thalamus network, basal ganglia network (BGN) and default mode network (DMN), which were related to the generation and propagation of SWDs or influence of brain resting function by SWDs. Because SWDs might affect these functional networks, the simultaneous EEG during fMRI acquisition was recorded to classify whether the BOLD signal was hybrided by SWDs or not. For the cortico-thalamus network, which was important to the generation and propagation of SWDs, the functional connectivity between thalamus and anterior cingulated cortex (ACC) was significantly decreased in IGE with absence seizures during the non-discharge period (NDP). This finding, avoided effects from SWDs, might reflect a permanent abnormality between thalamus and ACC in IGE. The abnormality might play important role in the generation and propagation of SWDs in IGE. For the BGN, the functional connectivity of BGN in IGE patients demonstrated more integration within the network during NDP and WDP (the period with discharge). Furthermore, it increased more evidently during WDP compared with that in NDP, and it showed a positive relationship with the number of SWDs in WDP. These findings provided an evidence confirming the role of the BGN as an important modulator of SWDs in IGE. For the DMN, the decreased functional connectivity within DMN in IGE patients with absence seizures was found during NDP. These results indicated abnormal functional integration in DMN, which was derived from anatomic abnormality or functional reorganization. Such changes could lead to the cognitive mental impairment and unconsciousness during absence seizure. These findings on the three networks suggested that IGE could result in complex impairment of brain function, namely, decreased connectivity in the cortex and increased connectivity within subcortical nuclei. Such findings also supported that the abnormality of brain function in IGE presented a characteristic of decentralization.
3, Based on the brain structural imagings (DTI and high resolution anatomical MRI), the diffusion properties and volume of subcortical nuclei, were evaluated in IGE patients with absence seizure. Abnormality in both of them was found, which provide preliminary evidence demonstrating microstructural changes of subcortical structures related to the chronic abnormal epileptic activity. It also found to be more severe in patients with early age of onset than those with later age of onset. This structural disturbance provided anatomical evidence for the functional network and derived presumption that thalamus and basal ganglia were involved in propagation and modulation of SWDs in IGE. These consistant alterations from anatomical and functional abnormality might be a characteristic for IGE patients with absence seizures, which deserves further study in clinical application.
引文
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