Hao J R, Xu Q, Zhang Q R, Xie X Y, Weng Y F, Yang F, Sun K J, Lu G M, Zhang Z Q
Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
Zhonghua Yi Xue Za Zhi. 2020 Jul 21;100(27):2121-2125. doi: 10.3760/cma.j.cn112137-20200327-00144.
To investigate the effect of febrile convulsions on gray matter volume (GMV) in medial temporal lobe epilepsy (mTLE) and its correlation with disease duration. A retrospective study was conducted to collect 41 mTLE patients with a history of febrile convulsions (mTLE-FC), 42 mTLE patients with no initial precipitating injury (mTLE-noIPI), and 42 normal and age and sex matched normal controls. High-resolution T1-weighted (T(1)WI) whole brain MR scans were performed on all subjects. Voxel-based morphometry were used to obtain GMV brain maps, and the GMV differences between the three groups of subjects were compared (0.01, GRF corrected). Finally, Spearmen rank correlation analysis was used to explore the correlation between GMV changes and the course of disease. Compared with the normal control subjects, each mTLE group showed extensive GMV reduction, mainly in the affected hippocampus, thalamus, temporal lobe, and bilateral cerebellum. Further analysis found that mTLE-FC group had more significant reductions in GMV than the mTLE-noIPI group in the affected hippocampus, amygdala, inferior temporal gyrus, contralateral hippocampus, para hippocampus, and inner cingulate gyrus. At the same time, the affected amygdala and hippocampal GMV in the mTLE-FC group was significantly negatively related to the course of disease (-0.381, 0.014), while the mTLE-noIPI group had no downward trend (0.081, 0.611). The atrophic trend of the affected amygdala and hippocampus in patients with mTLE-FC was significantly greater than that in patients with mTLE-noIPI (0.029, permutation test). There is extensive damage to the gray matter structure of bilateral cerebral hemispheres, mainly in the hippocampus, in mTLE patients. The brain damage of mTLE patients with a history of juvenile fever convulsions is more extensive and serious, and the trend of progressive exacerbation with the course of the disease is more obvious, suggesting mTLE associated with juvenile fever convulsions may have different pathophysiological mechanisms.
探讨热性惊厥对内侧颞叶癫痫（mTLE）患者灰质体积（GMV）的影响及其与病程的相关性。进行一项回顾性研究，收集41例有热性惊厥病史的mTLE患者（mTLE-FC）、42例无初始诱发损伤的mTLE患者（mTLE-noIPI）以及42例年龄和性别匹配的正常对照者。对所有受试者进行高分辨率T1加权（T(1)WI）全脑磁共振扫描。采用基于体素的形态学测量方法获取GMV脑图谱，比较三组受试者之间的GMV差异（0.01，GRF校正）。最后，采用Spearman等级相关分析探讨GMV变化与病程之间的相关性。与正常对照受试者相比，各mTLE组均表现出广泛的GMV减少，主要位于患侧海马、丘脑、颞叶及双侧小脑。进一步分析发现，mTLE-FC组在患侧海马、杏仁核、颞下回、对侧海马、海马旁回及扣带回中部的GMV减少比mTLE-noIPI组更显著。同时，mTLE-FC组患侧杏仁核和海马的GMV与病程呈显著负相关（-0.381，0.014），而mTLE-noIPI组无下降趋势（0.081，0.611）。mTLE-FC患者患侧杏仁核和海马的萎缩趋势显著大于mTLE-noIPI患者（0.029，置换检验）。mTLE患者双侧大脑半球灰质结构存在广泛损伤，主要位于海马。有幼年发热惊厥病史的mTLE患者脑损伤更广泛、更严重，且随病程进展加重的趋势更明显，提示与幼年发热惊厥相关的mTLE可能具有不同的病理生理机制。
