Kim Seong Hoon, Lim Sung-Chul, Kim Woojun, Kwon Oh-Hun, Jeon Seun, Lee Jong-Min, Shon Young-Min
Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea; Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea.
Seizure. 2015 Aug;30:124-31. doi: 10.1016/j.seizure.2015.06.009. Epub 2015 Jun 29.
An increasing amount of evidence has demonstrated that juvenile myoclonic epilepsy (JME) is associated with structural abnormalities in not only the thalamofrontal system but its adjacent regions such as temporal or parieto-occipital areas. The goal of this study was to systematically characterize morphological changes and the subsequent pathophysiological implications in JME patients using the combined structural and diffusion tensor MRI analysis.
Comparisons of white matter (WM) water diffusivity and gray matter (GM) cortical thickness were analyzed with tract-based spatial statistics (TBSS) and a Constrained Laplacian-based Anatomic Segmentation with Proximity (CLASP) algorithm, respectively. Additionally, volumes of the bilateral thalami and hippocampi were obtained using manual volumetry (MV).
Compared with 22 normal controls, 18 patients with JME exhibited WM alterations in the antero-superior corona radiata, corpus callosum, both centro-parietal regions, and the left temporal lobe. JME patients also had reduced GM thickness (right paracentral lobule, precuneus, dorsolateral parietal and inferior temporal cortex; left dorsolateral frontal and anterior temporal areas). Furthermore, MV analyses revealed a significant volume reduction in the bilateral thalami and hippocampi.
In addition to structural changes in the thalamofrontal system, there was a conspicuous alteration of WM diffusivity in widespread extra-frontal areas and an associated decreased GM thickness in temporoparietal regions, including a significant reduction of hippocampal volume. These findings suggest that the pathophysiology of JME may be not confined to the thalamofrontal circuit but may also involve extensive areas of the extra-frontal network which encompasses temporo-parietal regions.
越来越多的证据表明，青少年肌阵挛性癫痫（JME）不仅与丘脑额叶系统的结构异常有关，还与其相邻区域如颞叶或顶枕叶区域的结构异常有关。本研究的目的是使用结构和扩散张量MRI联合分析，系统地表征JME患者的形态学变化及其后续的病理生理意义。
分别采用基于体素的空间统计学（TBSS）和基于约束拉普拉斯的近距离解剖分割（CLASP）算法，分析白质（WM）水扩散率和灰质（GM）皮质厚度。此外，使用手动容积测量法（MV）获得双侧丘脑和海马的体积。
与22名正常对照相比，18例JME患者在额上前放射冠、胼胝体、中央顶叶区域和左侧颞叶出现WM改变。JME患者的GM厚度也降低（右侧中央旁小叶、楔前叶、背外侧顶叶和颞下皮质；左侧背外侧额叶和颞前区）。此外，MV分析显示双侧丘脑和海马体积显著减小。
除了丘脑额叶系统的结构变化外，广泛的额外区域的WM扩散率也有明显改变，颞顶叶区域的GM厚度也相应降低，包括海马体积显著减小。这些发现表明，JME的病理生理学可能不仅局限于丘脑额叶回路，还可能涉及包括颞顶叶区域在内的额外网络的广泛区域。
