局灶性癫痫患者的过度换气：电磁断层扫描、功能连接和图论——癫痫诊断的一种可能工具？
Hyperventilation in Patients With Focal Epilepsy: Electromagnetic Tomography, Functional Connectivity and Graph Theory - A Possible Tool in Epilepsy Diagnosis?
作者信息
Mazzucchi Edoardo, Vollono Catello, Losurdo Anna, Testani Elisa, Gnoni Valentina, Di Blasi Chiara, Giannantoni Nadia M, Lapenta Leonardo, Brunetti Valerio, Della Marca Giacomo
机构信息
*Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy; †Department of Geriatrics, Neuroscience and Orthopedics, Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy; ‡Institute of Neurology, Istituto Auxologico Italiano, Milan, Italy; §Clinica Luganese, Lugano, Switzerland; and ‖Child and Adolescent Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Università degli Studi Aldo Moro, Bari, Italy.
出版信息
J Clin Neurophysiol. 2017 Jan;34(1):92-99. doi: 10.1097/WNP.0000000000000329.
PURPOSE
Hyperventilation (HV) is a commonly used electroencephalogram activation method.
METHODS
We analyzed EEG recordings in 22 normal subjects and 22 patients with focal epilepsy of unknown cause. We selected segments before (PRE), during (HYPER), and 5 minutes after (POST) HV. To analyze the neural generators of EEG signal, we used standard low-resolution electromagnetic tomography (sLORETA software). We then computed EEG lagged coherence, an index of functional connectivity, between 19 regions of interest. A weighted graph was built for each band in every subject, and characteristic path length (L) and clustering coefficient (C) have been computed. Statistical comparisons were performed by means of analysis of variance (Group X Condition X Band) for mean lagged coherence, L and C.
RESULTS
Hyperventilation significantly increases EEG neural generators (P < 0.001); the effect is particularly evident in cingulate cortex. Functional connectivity was increased by HV in delta, theta, alpha, and beta bands in the Epileptic group (P < 0.01) and only in theta band in Control group. Intergroup analysis of mean lagged coherence, C and L, showed significant differences for Group (P < 0.001), Condition (P < 0.001), and Band (P < 0.001). Analysis of variance for L also showed significant interactions: Group X Condition (P = 0.003) and Group X Band (P < 0.001).
CONCLUSIONS
In our relatively small group of epileptic patients, HV is associated with activation of cingulate cortex; moreover, it modifies brain connectivity. The significant differences in mean lagged coherence, path length, and clustering coefficient permit to hypothesize that this activation method leads to different brain connectivity patterns in patients with epilepsy when compared with normal subjects. If confirmed by other studies involving larger populations, this analysis could become a diagnostic tool in epilepsy.
目的
过度换气（HV）是一种常用的脑电图激活方法。
方法
我们分析了22名正常受试者和22名病因不明的局灶性癫痫患者的脑电图记录。我们选择了过度换气前（PRE）、期间（HYPER）和之后5分钟（POST）的片段。为了分析脑电图信号的神经发生器，我们使用了标准低分辨率电磁断层扫描（sLORETA软件）。然后，我们计算了19个感兴趣区域之间的脑电图滞后相干性，这是一种功能连接指标。为每个受试者的每个频段构建了一个加权图，并计算了特征路径长度（L）和聚类系数（C）。通过方差分析（组X条件X频段）对平均滞后相干性、L和C进行统计比较。
结果
过度换气显著增加脑电图神经发生器（P < 0.001）；这种效应在扣带回皮层尤为明显。癫痫组的δ、θ、α和β频段中，过度换气增加了功能连接（P < 0.01），而对照组仅在θ频段增加。平均滞后相干性、C和L的组间分析显示，组（P < 0.001）、条件（P < 0.001）和频段（P < 0.001）存在显著差异。L的方差分析也显示出显著的交互作用：组X条件（P = 0.003）和组X频段（P < 0.001）。
结论
在我们相对较小的癫痫患者群体中，过度换气与扣带回皮层的激活有关；此外，它还改变了脑连接性。平均滞后相干性、路径长度和聚类系数的显著差异使我们推测，与正常受试者相比，这种激活方法会导致癫痫患者出现不同的脑连接模式。如果其他涉及更大人群的研究证实了这一点，这种分析可能会成为癫痫的一种诊断工具。
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