与癫痫发作起始相关的神经网络：应用 EEG-fMRI 和 MEG 研究阅读性癫痫病例。
Networks involved in seizure initiation. A reading epilepsy case studied with EEG-fMRI and MEG.
机构信息
Department of Neurological Sciences, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
出版信息
Neurology. 2012 Jul 17;79(3):249-53. doi: 10.1212/WNL.0b013e31825fdf3a. Epub 2012 Jul 3.
Abstract
OBJECTIVE
To define the ictal cortical/subcortical network of reading-induced seizures.
METHODS
We analyzed ictal magnetoencephalography (MEG) and EEG-correlated fMRI (EEG-fMRI) data in a unique patient with reading epilepsy (RE) affected by frequent perioral reflex myocloni triggered by reading silently.
RESULTS
Ictal MEG corroborated EEG localization and revealed activity extending precentrally into Brodmann area (BA) 6. fMRI blood oxygen level-dependent (BOLD) signal changes in the left deep piriform cortex (PFC) and left BA6 preceded seizures and occurred before BOLD changes were observed in thalamus and right inferior frontal gyrus (BA44). Dynamic causal modeling provided evidence of a causal link between hemodynamic changes in the left PFC and reading-evoked seizures.
CONCLUSION
Our findings support the important role of deep cortical and subcortical structures, in particular the frontal PFC, as key regions in initiating and modulating seizure activity. In our patient with RE, BA6 appeared to be the area linking cognitive activation and seizure activity.
摘要
目的
定义阅读诱发癫痫发作的发作期皮质/皮质下网络。
方法
我们分析了一位患有阅读性癫痫（RE）的独特患者的发作期脑磁图（MEG）和与 EEG 相关的 fMRI（EEG-fMRI）数据，该患者受到默读时引发的频繁口周反射性肌阵挛的影响。
结果
发作期 MEG 证实了 EEG 的定位，并显示活动向额前中央区（BA）6 扩展。左深梨状皮质（PFC）和左 BA6 的 fMRI 血氧水平依赖性（BOLD）信号变化在癫痫发作之前发生，并在丘脑和右额下回（BA44）出现 BOLD 变化之前发生。动态因果建模提供了证据，表明左 PFC 的血流动力学变化与阅读诱发的癫痫之间存在因果关系。
结论
我们的发现支持深部皮质和皮质下结构，特别是额前 PFC，作为启动和调节癫痫发作活动的关键区域的重要作用。在我们的 RE 患者中，BA6 似乎是连接认知激活和癫痫发作活动的区域。
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