人类颞叶癫痫伴海马硬化患者发作间期氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）代谢与发作期单光子发射计算机断层扫描（SPECT）灌注变化的相关性
Correlations of interictal FDG-PET metabolism and ictal SPECT perfusion changes in human temporal lobe epilepsy with hippocampal sclerosis.
作者信息
Nelissen N, Van Paesschen W, Baete K, Van Laere K, Palmini A, Van Billoen H, Dupont P
机构信息
Department of Neurology, University Hospital Gasthuisberg, 49 Herestraat, 3000 Leuven, Belgium.
出版信息
Neuroimage. 2006 Aug 15;32(2):684-95. doi: 10.1016/j.neuroimage.2006.04.185. Epub 2006 Jun 9.
BACKGROUND
The pathophysiological role of the extensive interictal cerebral hypometabolism in complex partial seizures (CPS) in refractory mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) is poorly understood. Our aim was to study ictal-interictal SPECT perfusion versus interictal fluorodeoxyglucose (FDG)-PET metabolic patterns.
METHODS
Eleven adults with refractory unilateral mTLE-HS, who were rendered seizure free after epilepsy surgery, were included. All had an interictal FDG-PET and an interictal and ictal perfusion SPECT scan. FDG-PET data were reconstructed using an anatomy-based reconstruction algorithm, which corrected for partial volume effects, and analyzed semi-quantitatively after normalization to white matter activity. Using Statistical Parametric Mapping (SPM), we compared interictal metabolism of the patient group with a control group. We correlated metabolic with ictal perfusion changes in the patient group.
RESULTS
Global cerebral grey matter glucose metabolism in patients was decreased 10-25% compared with control subjects. Interictal PET hypometabolism and ictal SPECT hypoperfusion were maximal in the ipsilateral frontal lobe. Ictal frontal lobe hypoperfusion was associated with crossed cerebellar diaschisis. The ipsilateral temporal lobe showed maximal ictal hyperperfusion and interictal hypometabolism, which was relatively mild compared with the degree of hypometabolism affecting the frontal lobes.
CONCLUSION
Interictal hypometabolism in mTLE-HS was greatest in the ipsilateral frontal lobe and represented a seizure-related dynamic process in view of further ictal decreases. Crossed cerebellar diaschisis suggested that there is a strong ipsilateral frontal lobe inhibition during CPS. We speculate that surround inhibition in the frontal lobe is a dynamic defense mechanism against seizure propagation, and may be responsible for functional deficits observed in mTLE.
背景
广泛的发作间期大脑代谢减低在伴有海马硬化的难治性内侧颞叶癫痫（mTLE-HS）的复杂部分性发作（CPS）中的病理生理作用尚不清楚。我们的目的是研究发作期-发作间期单光子发射计算机断层扫描（SPECT）灌注与发作间期氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）代谢模式。
方法
纳入11例难治性单侧mTLE-HS的成年患者，这些患者在癫痫手术后无癫痫发作。所有患者均进行了发作间期FDG-PET以及发作间期和发作期灌注SPECT扫描。FDG-PET数据使用基于解剖结构的重建算法进行重建，该算法校正了部分容积效应，并在归一化至白质活性后进行半定量分析。使用统计参数映射（SPM），我们将患者组的发作间期代谢与对照组进行比较。我们将患者组的代谢与发作期灌注变化进行相关性分析。
结果
与对照组相比，患者的全脑灰质葡萄糖代谢降低了10%-25%。发作间期PET代谢减低和发作期SPECT灌注减低在同侧额叶最为明显。发作期额叶灌注减低与交叉性小脑失联络有关。同侧颞叶在发作期显示最大灌注增加和发作间期代谢减低，与影响额叶的代谢减低程度相比相对较轻。
结论
mTLE-HS发作间期代谢减低在同侧额叶最为明显，鉴于发作期进一步降低，这代表了一个与癫痫发作相关的动态过程。交叉性小脑失联络提示在CPS期间同侧额叶存在强烈抑制。我们推测额叶的周围抑制是一种防止癫痫发作传播的动态防御机制，可能是mTLE中观察到的功能缺陷的原因。
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