Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China.
Department of Echocardiography, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China.
Epilepsy Behav. 2021 Apr;117:107884. doi: 10.1016/j.yebeh.2021.107884. Epub 2021 Mar 11.
Brainstem raphe nucleus (BRN) hypoechogenicity in transcranial sonography (TCS) has been demonstrated in patients with major depression, possibly representing a sonographic manifestation of serotonergic dysfunction in depression. Most patients with epilepsy with comorbid depression exhibit hypoechogenic BRN in TCS. However, the role of BRN in the pathogenesis of epilepsy is unclear. This study aimed to evaluate the correlation of BRN echogenicity with epilepsy itself, and the echogenicity of other midbrain structures and the size of lateral ventricle (LV) will also be evaluated in patients with epilepsy.
Thirty-six patients with epilepsy without depression and 37 healthy controls were recruited. Sonographic echogenicity of BRN, caudate nucleus (CN), lentiform nucleus (LN), substantia nigra (SN), and the width of frontal horns of the lateral ventricles (LV) and the third ventricle (TV) were evaluated with TCS. The frequency of interictal epileptiform discharges (IEDs) was assessed with ambulatory electroencephalogram (AEEG).
Hypoechogenicity of BRN was depicted in 36.1% of patients with epilepsy and 18.9% of controls, showing no significant difference. Patients with epilepsy with BRN hypoechogenicity had higher epileptic discharge index (EDI) than those with normal BRN echogenecity. Especially, higher EDI in patients with BRN hypoechogenicity was observed during the sleep period but not during awake period. The width of TV was significantly larger in patients with epilepsy than that in controls. We did not find any difference between patients with epilepsy and controls in the echogenicity of CN, LN, and SN, as well as in the width of frontal horn of LV.
Hypoechogenic BRN is correlated with a high frequency of epileptic discharges in electroencephalogram (EEG), especially during sleep period but not during awake period, indicating that BRN alterations may play a potential role in the pathogenesis of epilepsy in association with sleep cycle.
经颅超声（TCS）中脑桥被盖核（BRN）低回声已在重度抑郁症患者中得到证实，可能代表抑郁时 5-羟色胺能功能障碍的超声表现。大多数伴有抑郁共病的癫痫患者在 TCS 中显示 BRN 低回声。然而，BRN 在癫痫发病机制中的作用尚不清楚。本研究旨在评估 BRN 回声与癫痫本身的相关性，并评估癫痫患者 BRN 回声、其他中脑结构回声及侧脑室（LV）宽度的相关性。
招募 36 例无抑郁的癫痫患者和 37 例健康对照者。应用 TCS 评估 BRN、尾状核（CN）、豆状核（LN）、黑质（SN）、侧脑室（LV）额角及第三脑室（TV）宽度的超声回声，并进行动态脑电图（AEEG）评估发作间期癫痫样放电（IED）的频率。
36.1%的癫痫患者和 18.9%的对照组出现 BRN 低回声，差异无统计学意义。BRN 低回声的癫痫患者的癫痫放电指数（EDI）高于 BRN 回声正常的患者。尤其是在睡眠期，BRN 低回声的患者 EDI 更高，但在觉醒期无差异。与对照组相比，癫痫患者的 TV 宽度明显更大。BRN 回声、CN、LN 和 SN 回声以及 LV 额角宽度在癫痫患者和对照组之间无差异。
BRN 低回声与 EEG 中癫痫放电频率升高相关，尤其是在睡眠期，但在觉醒期无差异，表明 BRN 改变可能在与睡眠周期相关的癫痫发病机制中发挥潜在作用。
