Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.
Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.
Epilepsia Open. 2023 Dec;8(4):1541-1555. doi: 10.1002/epi4.12838. Epub 2023 Nov 1.
Epilepsy and depression share neurobiological origins, and evidence suggests a possible bidirectional relationship that remains poorly understood. This exploratory, cross-sectional study aimed to investigate this relationship by employing magnetic resonance spectroscopic imaging (MRSI) and thermometry (MRSI-t) in patients with temporal lobe epilepsy (TLE) with comorbid depressive symptoms and control participants. This is the first study to combine MRSI and MRSI-t to examine brain temperature and choline abnormalities in regions implicated in seizure onset and depression.
Twenty-six patients with TLE and 26 controls completed questionnaires and underwent imaging at 3T. Volumetric echo-planar MRSI/MRSI-t data were processed within the Metabolite Imaging and Data Analysis System (MIDAS). Choline (CHO) was quantified as a ratio over creatine (CRE; CHO/CRE). Brain temperature (T ) was calculated based on the chemical shift difference of H O relative to CRE's stable location on the ppm spectrum. The Hospital Anxiety and Depression Scale measured anxiety and depressive symptoms. The Chalfont Seizure Severity Scale measured seizure severity in patients with TLE. Two sets of voxelwise independent sample t tests examined group differences in CHO/CRE and T maps. Voxel-based multimodal canonical correlation analysis (mCCA) linked both datasets to investigate if, how, and where CHO/CRE and T abnormalities were correlated in TLE participants and controls.
Compared to controls, patients with TLE reported more depressive symptoms (P = 0.04) and showed CHO/CRE and T elevations in left temporal and bilateral frontal regions implicated in seizure onset and depressive disorders (p < 0.05). For the TLE group, CHO/CRE levels in temporal and frontal cortices were associated with elevated T in bilateral frontal and temporal gyri (r = 0.96), and decreased T in bilateral fronto-parietal regions (r = -0.95).
Abnormalities in T and CHO/CRE were observed in seizure-producing areas and in regions implicated in depression. These preliminary findings suggest that common metabolic changes may underlie TLE and depression. Our results suggest further investigations into the proposed bidirectional mechanisms underlying this relationship are warranted.
癫痫和抑郁具有神经生物学起源，有证据表明两者之间可能存在双向关系，但目前对此仍知之甚少。本探索性横断面研究旨在通过对伴有抑郁症状的颞叶癫痫（TLE）患者和对照组患者使用磁共振波谱成像（MRSI）和测温（MRSI-t）来研究这种关系。这是第一项结合 MRSI 和 MRSI-t 来检查与癫痫发作和抑郁相关区域的脑温及胆碱异常的研究。
26 例 TLE 患者和 26 例对照完成问卷并在 3T 下进行成像。代谢物成像和数据分析系统（MIDAS）内处理容积式回波平面 MRSI/MRSI-t 数据。胆碱（CHO）与肌酸（CRE）的比值进行量化（CHO/CRE）。基于 H2O 相对于 CRE 在 ppm 谱中稳定位置的化学位移差异计算脑温（T）。医院焦虑抑郁量表（HADS）评估焦虑和抑郁症状。Chalfont 癫痫严重程度量表（CSS）评估 TLE 患者的癫痫发作严重程度。两组独立样本 t 检验检验 CHO/CRE 和 T 图的组间差异。基于体素的多模态典型相关分析（mCCA）将两个数据集联系起来，以调查 TLE 患者和对照组中 CHO/CRE 和 T 异常是否存在相关性、如何存在相关性以及存在于何处。
与对照组相比，TLE 患者报告更多的抑郁症状（P=0.04），并显示左侧颞叶和双侧额叶与癫痫发作和抑郁障碍相关的区域出现 CHO/CRE 和 T 升高（p<0.05）。对于 TLE 组，颞叶和额叶皮质的 CHO/CRE 水平与双侧额叶和颞叶回的 T 升高（r=0.96）以及双侧额顶叶区域的 T 降低（r=0.95）相关。
在产生癫痫的区域和与抑郁相关的区域中观察到 T 和 CHO/CRE 的异常。这些初步结果表明，共同的代谢变化可能是 TLE 和抑郁的基础。我们的结果表明，有必要进一步研究这种关系背后的双向机制。
