儿童内侧颞叶癫痫伴海马硬化的皮质厚度异常。
Abnormalities of Cortical Thickness in Pediatric Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis.
机构信息
Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
Shenzhen Children's Hospital, Shenzhen, China.
出版信息
Curr Med Imaging. 2020;16(9):1095-1104. doi: 10.2174/1573405616666200116161335.
OBJECTIVE
Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most common intractable seizure type of pediatric epilepsy, with alterations in the cortex across the whole brain. The aim of this study is to investigate the abnormalities of cortical thickness in pediatric MTLE-HS.
METHODS
Subjects were recruited from Shenzhen Children's Hospital between September 2015 and December 2016. MTLE was confirmed by the experienced neurological physician based on International League Against Epilepsy (ILAE) diagnosis criteria, and structural magnetic resonance imaging (MRI) was performed at 3T for quantitative assessment of cortical thickness. A general linear model with age and gender as covariates was used to examine the vertex-wise differences in cortical thickness between 1) left MTLE-HS (LMTLE-HS) and healthy controls (HC), and 2) right MTLE-HS (RMTLE-HS) and HC. The family-wise error corrected significance threshold was set at P < 0.05. Through a combination of probability and cluster-size thresholding, cluster-wise P values were obtained for the resulting clusters.
RESULTS
13 LMTLE-HS, 6 RMTLE-HS, and 20 age-matched HC were finally enrolled in the study. No significant difference in the mean age (LMTLE-HS vs. HC, p=0.57; RMTLE-HS vs. HC, p=0.39) and gender ratio (LMTLE-HS vs. HC, p=0.24; RMTLE-HS vs. HC, p=0.72) was found between MTLE-HS and HC. In LMTLE-HS, cortical thickness was found significantly decreased in the ipsilateral caudal middle frontal gyrus (p=0.012) and increased in the contralateral inferior temporal gyrus (p=0.020). In RMTLE-HS, cortical thickness significantly decreased in the ipsilateral posterior parietal lobe (superior, p<0.001 and inferior parietal gyrus, p=0.03), the anterior parietal lobe (postcentral gyrus, p=0.006), the posterior frontal lobe (precentral gyrus, p=0.04 and the lateral occipital gyrus, p<0.001), and the contralateral lateral occipital gyrus, middle frontal (p<0.0001) and superior frontal gyrus (p<0.001), and pericalcarine cortex (p=0.020).
CONCLUSION
We detected significant cortical abnormalities in pediatric MTLE-HS patients compared with HC. These cortical abnormalities could be explained by specific pathogenesis in MTLE-HS, and may finally contribute to understanding the intrinsic mechanism of MTLE-HS.
目的
伴海马硬化的内侧颞叶癫痫（MTLE-HS）是儿童癫痫中最常见的难治性癫痫类型，整个大脑的皮质都发生了改变。本研究旨在探讨儿童 MTLE-HS 的皮质厚度异常。
方法
研究对象于 2015 年 9 月至 2016 年 12 月期间在深圳市儿童医院招募。根据国际抗癫痫联盟（ILAE）的诊断标准，由经验丰富的神经科医生确认 MTLE，在 3T 下进行结构磁共振成像（MRI）以定量评估皮质厚度。使用包含年龄和性别的一般线性模型来检查 1）左 MTLE-HS（LMTLE-HS）与健康对照组（HC）之间和 2）右 MTLE-HS（RMTLE-HS）与 HC 之间皮质厚度的顶点差异。采用家族性错误校正显著阈值，设定 P<0.05。通过概率和聚类大小阈值的组合，获得结果聚类的聚类 P 值。
结果
最终纳入 13 例 LMTLE-HS、6 例 RMTLE-HS 和 20 例年龄匹配的 HC。MTLE-HS 与 HC 之间的平均年龄（LMTLE-HS 与 HC，p=0.57；RMTLE-HS 与 HC，p=0.39）和性别比例（LMTLE-HS 与 HC，p=0.24；RMTLE-HS 与 HC，p=0.72）无显著差异。在 LMTLE-HS 中，同侧尾状额中回的皮质厚度明显降低（p=0.012），对侧颞下回的皮质厚度增加（p=0.020）。在 RMTLE-HS 中，同侧顶后叶（superior，p<0.001 和 inferior parietal gyrus，p=0.03）、前顶叶（postcentral gyrus，p=0.006）、后额叶（precentral gyrus，p=0.04 和 lateral occipital gyrus，p<0.001）以及对侧外侧枕叶、额中回（p<0.0001）和额上回（p<0.001）以及距状皮质（p=0.020）的皮质厚度显著降低。
结论
与 HC 相比，我们在儿童 MTLE-HS 患者中检测到明显的皮质异常。这些皮质异常可能由 MTLE-HS 中的特定发病机制解释，并最终有助于理解 MTLE-HS 的内在机制。
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