Calabrese Massimiliano, De Stefano Nicola, Atzori Matteo, Bernardi Valentina, Mattisi Irene, Barachino Luigi, Rinaldi Luciano, Morra Aldo, McAuliffe Matthew M J, Perini Paola, Battistin Leontino, Gallo Paolo
The Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Dept. of Neurosciences, University Hospital of Padova, Via Giustiniani 5, 35128 Padova, Italy.
J Neurol. 2008 Apr;255(4):581-6. doi: 10.1007/s00415-008-0752-7. Epub 2008 Jan 31.
Epilepsy is three to six times more frequent in MS than in the general population. Previous studies based on conventional magnetic resonance (MR) imaging have suggested a possible correlation between cortical inflammatory pathology and epileptic seizures. However, pure intracortical lesions (ICLs) are unlikely to be demonstrated with conventional MR. We applied the double inversion recovery (DIR) sequence in relapsing remitting MS (RRMS) patients with or without epileptic seizures in order to clarify the relationship between ICLs and epilepsy in MS in vivo.
Twenty RRMS patients who had epileptic seizures (RRMS/E) during the course of the disease were studied for the presence of ICLs. A group of 80 RRMS patients with no history of seizures and matched for gender, age, disease duration, Expanded Disability Status Scale (EDSS) grading, and T2 lesion volume (T2-WMLV) was selected as reference population. ICLs were detected by applying the DIR sequence.
ICLs were observed in 18/20 (90%) RRMS/E and in 39/80 (48%) RRMS (p = 0.001). RRMS/E showed five times more ICLs (7.2 +/- 8.4) than RRMS (1.5 +/- 2.4; p = 0.015). The total ICLs volume was 6 times larger in RRMS/E than in RRMS (1.2 +/- 1.7 cm3 versus 0.2 +/- 0.2 cm3, p = 0.016). No significant difference was observed between RRMS and RRMS/E with regard to the number and volume of juxtacortical lesions and T2-WMLV.
Our findings indicate that RRMS/E have more extensive cortical inflammation than RRMS patients with no history of epilepsy. Inflammatory ICLs may be responsible for epilepsy in MS.
癫痫在多发性硬化症（MS）中的发病率比普通人群高3至6倍。以往基于传统磁共振（MR）成像的研究表明，皮质炎症病理与癫痫发作之间可能存在关联。然而，传统MR不太可能显示出单纯的皮质内病变（ICLs）。我们对复发缓解型MS（RRMS）患者应用双反转恢复（DIR）序列，这些患者有或无癫痫发作，以阐明体内MS中ICLs与癫痫之间的关系。
研究20例在疾病过程中出现癫痫发作的RRMS患者（RRMS/E），以确定是否存在ICLs。选择80例无癫痫发作史、性别、年龄、病程、扩展残疾状态量表（EDSS）分级和T2病变体积（T2-WMLV）相匹配的RRMS患者作为参照人群。通过应用DIR序列检测ICLs。
在18/20（90%）的RRMS/E患者和39/80（48%）的RRMS患者中观察到ICLs（p = 0.001）。RRMS/E患者的ICLs数量（7.2±8.4）比RRMS患者（1.5±2.4）多5倍（p = 0.015）。RRMS/E患者的ICLs总体积比RRMS患者大6倍（1.2±1.7 cm3对0.2±0.2 cm3，p = 0.016）。RRMS和RRMS/E在皮质旁病变数量和体积以及T2-WMLV方面未观察到显著差异。
我们的研究结果表明，RRMS/E患者的皮质炎症比无癫痫病史的RRMS患者更广泛。炎症性ICLs可能是MS中癫痫的病因。
