From the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.).
Radiology (F.X.), Xiangya Hospital, Central South University, Changsha, China.
AJNR Am J Neuroradiol. 2019 Feb;40(2):245-252. doi: 10.3174/ajnr.A5944. Epub 2019 Jan 24.
Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations.
Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures ( = 18), primary generalized tonic-clonic seizures ( = 19), and secondary generalized tonic-clonic seizures ( = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed.
Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios ( < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios ( < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups ( > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus ( < .05).
Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.
先前的研究表明，意识受损的癫痫患者的丘脑和上脑干存在灌注异常。我们假设这些与意识相关的区域也会出现代谢异常。然而，尚未用多体素 H-MRS 对这些区域的代谢异常进行特征描述。在本研究中，我们研究了这些脑区的代谢改变，并评估了发作特征与代谢改变之间的相关性。
57 例癫痫患者和 24 例对照组接受了常规磁共振成像和 3D 多体素 H-MRS 检查。患者分为 3 个亚组：局灶性意识障碍发作（ = 18）、原发性全面强直阵挛发作（ = 19）和继发性全面强直阵挛发作（ = 20）。比较了患者组和对照组之间与意识网络相关的脑区 NAA/Cr、NAA/（Cr+Cho）和 Cho/Cr 比值的测量代谢改变。ROI 放置在双侧额下回、缘上回、扣带回、楔前叶、丘脑和上脑干。分析了临床参数（癫痫持续时间和发作频率）与代谢改变之间的相关性。
所有实验组双侧丘脑和上脑干的 NAA/Cr 和 NAA/（Cho+Cr）比值显著降低（ <.05 和 <.01，分别），右侧丘脑的 Cho/Cr 比值显著升高（ <.05）。在局灶性意识障碍发作组中。3 个患者组之间的代谢比值无显著差异（ >.05）。继发性全面强直阵挛发作组双侧丘脑的 NAA/（Cr+Cho）比值与癫痫持续时间呈负相关（ <.05）。
意识受损的癫痫患者的脑干和丘脑存在代谢改变。
