Rodríguez-Cruces Raúl, Velázquez-Pérez Leticia, Rodríguez-Leyva Ildefonso, Velasco Ana Luisa, Trejo-Martínez David, Barragán-Campos Héctor Manuel, Camacho-Téllez Vicente, Concha Luis
Instituto de Neurobiología, Universidad Nacional Autónoma de México, 3001, Boulevard Juriquilla, Querétaro, Querétaro 76230, Mexico.
Centro Estatal de Salud Mental, Servicios de Salud del Estado de Querétaro, 105, Av. 5 de Febrero Sur, Virreyes, Querétaro 76170, Mexico.
Epilepsy Behav. 2018 Feb;79:138-145. doi: 10.1016/j.yebeh.2017.11.040. Epub 2018 Jan 4.
The purpose of this study was to evaluate the relation between cognitive performance and white matter (WM) integrity in patients with temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS).
We included 26 patients with TLE (10 right, 16 left onset) as well as 24 healthy controls matched for age, gender, and years of education. In addition to quantitative hippocampal volume and transverse relaxation (T2) evaluation, whole-brain WM was analyzed using fractional anisotropy (FA) maps, derived from the diffusion tensor model. Average FA values were obtained from 38 regions of interest (ROI) of the main WM fascicles using an atlas-based approach. All subjects underwent extensive coFignitive assessments, Wechsler Adult Intelligence Scale (WAIS-IV) and Wechsler Memory Scale (WMS-IV). Fractional anisotropy was correlated with neuropsychological scores, and group effects were evaluated. Finally, patients were clustered based on their cognitive performance to evaluate if clinical and structural variables relate to specific cognitive profiles.
Patients had differential alterations in the integrity of the WM dependent on seizure laterality and presence of hippocampal sclerosis. Patients with TLE showed, on average, lower scores in most of the cognitive assessments. Correlations between cognition and WM followed specific trajectories per group with TLE, particularly in Left-TLE, in which we found a marked association between cognitive abilities and WM abnormalities. Cluster analysis of cognitive performance revealed three cognitive profiles, which were associated with the degree and spread of WM abnormalities.
White matter diffusion characteristics differ between patients, particularly in relation to seizure laterality and hippocampal damage. Moreover, WM abnormalities are associated with cognitive performance. The extent of WM alterations leads to disrupted cerebral intercommunication and therefore negatively affects cognition.
本研究旨在评估伴内侧颞叶硬化（MTS）的颞叶癫痫（TLE）患者的认知表现与白质（WM）完整性之间的关系。
我们纳入了26例TLE患者（10例右侧起病，16例左侧起病）以及24名年龄、性别和受教育年限相匹配的健康对照者。除了定量海马体积和横向弛豫（T2）评估外，还使用基于扩散张量模型得出的分数各向异性（FA）图对全脑白质进行分析。使用基于图谱的方法从主要白质束的38个感兴趣区域（ROI）获取平均FA值。所有受试者均接受了广泛的认知评估、韦氏成人智力量表（WAIS-IV）和韦氏记忆量表（WMS-IV）。将分数各向异性与神经心理学评分相关联，并评估组间效应。最后，根据患者的认知表现进行聚类，以评估临床和结构变量是否与特定的认知概况相关。
根据癫痫发作的侧别和海马硬化的存在情况，患者白质完整性存在不同改变。TLE患者在大多数认知评估中的得分平均较低。TLE组中，认知与白质之间的相关性遵循特定轨迹，特别是在左侧TLE患者中，我们发现认知能力与白质异常之间存在显著关联。对认知表现的聚类分析揭示了三种认知概况，它们与白质异常的程度和范围相关。
患者之间白质扩散特征存在差异，特别是与癫痫发作侧别和海马损伤有关。此外，白质异常与认知表现相关。白质改变的程度导致大脑内部沟通中断，因此对认知产生负面影响。
