Keller S S, Wieshmann U C, Mackay C E, Denby C E, Webb J, Roberts N
The Magnetic Resonance and Image Analysis Research Centre (MARIARC), Pembroke Place, University of Liverpool, Liverpool, UK.
J Neurol Neurosurg Psychiatry. 2002 Dec;73(6):648-55. doi: 10.1136/jnnp.73.6.648.
To investigate the use of whole brain voxel based morphometry (VBM) and stereological analysis to study brain morphology in patients with medically intractable temporal lobe epilepsy; and to determine the relation between side, duration, and age of onset of temporal lobe epilepsy, history of childhood febrile convulsions, and grey matter structure.
Three dimensional magnetic resonance images were obtained from 58 patients with left sided seizure onset (LSSO) and 58 patients with right sided seizure onset (RSSO), defined using EEG and foramen ovale recordings in the course of presurgical evaluation for temporal lobectomy. Fifty eight normal controls formed a comparison group. VBM was used to characterise whole brain grey matter concentration, while the Cavalieri method of modern design stereology in conjunction with point counting was used to estimate hippocampal and amygdala volume. Age and sex were used as confounding covariates in analyses.
LSSO and RSSO patients showed significant reductions in volume (using stereology) and grey matter concentration (using VBM) of the hippocampus, but not of the amygdala, in the presumed epileptogenic zone when compared with controls, but hippocampal (and amygdala) volume and grey matter concentration were not related to duration or age of onset of epilepsy. LSSO and RSSO patients with a history of childhood febrile convulsions had reduced hippocampal volumes in the presumed epileptogenic zone compared with patients without such a history. Left amygdala volume was also reduced in LSSO patients with a history of childhood convulsions. VBM results indicated bilateral thalamic, prefrontal, and cerebellar GMC reduction in patients, which correlated with duration and age of onset of epilepsy.
Hippocampal sclerosis is not necessarily the consequence of recurrent temporal lobe seizures. A major cause of hippocampal sclerosis appears to be an early aberrant neurological insult, such as childhood febrile seizures. Secondary brain abnormalities exist in regions outside the presumed epileptogenic zone and may result from recurrent seizures.
研究采用基于体素的全脑形态测量法（VBM）和体视学分析来研究药物难治性颞叶癫痫患者的脑形态；并确定颞叶癫痫的发作侧、病程、发病年龄、儿童热性惊厥史与灰质结构之间的关系。
对58例左侧发作性癫痫（LSSO）患者和58例右侧发作性癫痫（RSSO）患者进行三维磁共振成像检查，这些患者在颞叶切除术的术前评估过程中通过脑电图和卵圆孔记录进行定义。58名正常对照者组成对照组。VBM用于表征全脑灰质浓度，同时采用现代设计体视学的卡瓦列里方法结合点计数法来估计海马体和杏仁核体积。年龄和性别在分析中用作混杂协变量。
与对照组相比，LSSO和RSSO患者在假定的致痫区域内，海马体的体积（采用体视学方法）和灰质浓度（采用VBM）显著降低，但杏仁核未出现这种情况，不过海马体（和杏仁核）的体积和灰质浓度与癫痫的病程或发病年龄无关。有儿童热性惊厥史的LSSO和RSSO患者与无此类病史的患者相比，在假定的致痫区域内海马体体积减小。有儿童惊厥史的LSSO患者左侧杏仁核体积也减小。VBM结果表明患者双侧丘脑、前额叶和小脑的灰质浓度降低，这与癫痫的病程和发病年龄相关。
海马硬化不一定是颞叶反复癫痫发作的结果。海马硬化的一个主要原因似乎是早期异常的神经损伤，如儿童热性惊厥。继发性脑异常存在于假定的致痫区域之外，可能是反复癫痫发作所致。
