Li Wei, Jiang Yuchao, Qin Yingjie, Zhou Baiwan, Lei Du, Luo Cheng, Zhang Heng, Gong Qiyong, Zhou Dong, An Dongmei
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, China.
Acta Neurol Scand. 2021 Mar;143(3):261-270. doi: 10.1111/ane.13361. Epub 2020 Nov 6.
To explore the dynamic changes of gray matter volume and intrinsic brain activity following anterior temporal lobectomy (ATL) in patients with unilateral mesial temporal lobe epilepsy (mTLE) who achieved seizure-free for 2 years.
High-resolution T1-weighted MRI and resting-state functional MRI data were obtained in ten mTLE patients at five serial timepoints: before surgery, 3, 6, 12, and 24 months after surgery. The gray matter volume (GMV) and amplitude of low-frequency fluctuations (ALFF) were compared among the five scans to depict the dynamic changes after ATL.
After successful ATL, GMV decreased in several ipsilateral brain regions: ipsilateral insula, thalamus, and putamen showed gradual gray matter atrophy from 3 to 24 months, while ipsilateral superior temporal gyrus, middle temporal gyrus, inferior temporal gyrus, middle occipital gyrus, inferior occipital gyrus, caudate nucleus, lingual gyrus, and fusiform gyrus showed significant GMV decrease at 3 months follow-up, without further changes. Ipsilateral insula showed gradual ALFF decrease from 3 to 24 months after surgery. Ipsilateral superior temporal gyrus showed ALFF decrease at 3 months follow-up, without further changes. Ipsilateral thalamus and cerebellar vermis showed obvious ALFF increase after surgery.
Surgical resection may lead to a short-term reduction of gray matter volume and intrinsic brain activity in neighboring regions, while the progressive gray matter atrophy may be due to possible intrinsic mechanism of mTLE. Dynamic ALFF changes provide evidence that disrupted focal spontaneous activities were reorganized after successful surgery.
探讨单侧内侧颞叶癫痫（mTLE）患者行前颞叶切除术（ATL）后癫痫发作控制2年时灰质体积和脑内在活动的动态变化。
对10例mTLE患者在5个连续时间点采集高分辨率T1加权MRI和静息态功能MRI数据：术前、术后3、6、12和24个月。比较5次扫描中的灰质体积（GMV）和低频波动幅度（ALFF），以描绘ATL后的动态变化。
ATL成功后，几个同侧脑区的GMV减小：同侧岛叶、丘脑和壳核在术后3至24个月显示灰质逐渐萎缩，而同侧颞上回、颞中回、颞下回、枕中回、枕下回、尾状核、舌回和梭状回在术后3个月随访时GMV显著减小，且无进一步变化。同侧岛叶在术后3至24个月显示ALFF逐渐降低。同侧颞上回在术后3个月随访时ALFF降低，且无进一步变化。同侧丘脑和小脑蚓部术后ALFF明显增加。
手术切除可能导致邻近区域灰质体积和脑内在活动短期内减少，而渐进性灰质萎缩可能归因于mTLE的潜在内在机制。ALFF的动态变化提供了证据，表明成功手术后局灶性自发活动紊乱得到了重新组织。
