Dreifuss S, Vingerhoets F J, Lazeyras F, Andino S G, Spinelli L, Delavelle J, Seeck M
Laboratory of Presurgical Epilepsy Evaluation, University Hospital Lausanne, Switzerland.
Neurology. 2001 Nov 13;57(9):1636-41. doi: 10.1212/wnl.57.9.1636.
To determine the volumes of subcortical nuclei in patients with chronic epilepsy.
Animal and human data suggest a crucial role for subcortical structures in the modulation of seizure activity, mostly as seizure-suppressing relays. Although cortical epileptogenic foci can vary in localization and extent, it nevertheless appears that these structures subsequently influence seizure propagation in a universal fashion. There is, however, little knowledge about the size of implicated subcortical structures in patients with epilepsy.
Using high-resolution MRI, the volumes of selected subcortical nuclei, such as the thalamus, caudate nucleus, putamen, and pallidum, were measured in both hemispheres of 27 patients with temporal lobe epilepsy. Fourteen healthy volunteers served as controls. Statistical analysis was done for both normalized volumes (by total brain volume) and unnormalized volumes.
Overall, the patient group had smaller thalamic and striatal volumes in both hemispheres, mostly ipsilateral to the epileptic focus. No significant correlations were noted between volume measurements and age, age at onset, duration of epilepsy, or total seizure frequency, including frequency of generalized seizures. The putamen and thalamus seemed to be affected predominantly in patients with a history of febrile convulsions, whereas patients without febrile convulsions had smaller caudate nuclei bilaterally.
Volumetric measurements of subcortical nuclei reveal atrophy of distinct subcortical nuclei in the patient group, predominantly ipsilateral to the focus. This finding probably reflects persistent abnormalities and not secondary change. In addition, the structural differences between patients with and patients without previous febrile convulsions suggest that these conditions may have different causes.
确定慢性癫痫患者皮质下核团的体积。
动物和人体数据表明，皮质下结构在癫痫活动的调节中起关键作用，主要作为癫痫抑制中继站。尽管皮质癫痫病灶在定位和范围上可能有所不同，但这些结构似乎随后以一种普遍的方式影响癫痫传播。然而，对于癫痫患者中受累皮质下结构的大小知之甚少。
使用高分辨率MRI，测量27例颞叶癫痫患者双侧半球中选定的皮质下核团，如丘脑、尾状核、壳核和苍白球的体积。14名健康志愿者作为对照。对标准化体积（按全脑体积）和未标准化体积均进行了统计分析。
总体而言，患者组双侧半球的丘脑和纹状体体积较小，主要在癫痫病灶同侧。体积测量与年龄、发病年龄、癫痫持续时间或总癫痫发作频率（包括全身性发作频率）之间未发现显著相关性。有高热惊厥病史的患者中，壳核和丘脑似乎受影响更明显，而无高热惊厥病史的患者双侧尾状核较小。
皮质下核团的体积测量显示患者组中不同皮质下核团萎缩，主要在病灶同侧。这一发现可能反映了持续性异常而非继发性改变。此外，有和无既往高热惊厥病史患者之间的结构差异表明，这些情况可能有不同的病因。
