Clinical Neurophysiology Group, University of Twente, Enschede, the Netherlands.
Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands.
Epilepsia. 2024 Jan;65(1):177-189. doi: 10.1111/epi.17831. Epub 2023 Nov 30.
Postictal symptoms may result from cerebral hypoperfusion, which is possibly a consequence of seizure-induced vasoconstriction. Longer seizures have previously been shown to cause more severe postictal hypoperfusion in rats and epilepsy patients. We studied cerebral perfusion after generalized seizures elicited by electroconvulsive therapy (ECT) and its relation to seizure duration.
Patients with a major depressive episode who underwent ECT were included. During treatment, 21-channel continuous electroencephalogram (EEG) was recorded. Arterial spin labeling magnetic resonance imaging scans were acquired before the ECT course (baseline) and approximately 1 h after an ECT-induced seizure (postictal) to quantify global and regional gray matter cerebral blood flow (CBF). Seizure duration was assessed from the period of epileptiform discharges on the EEG. Healthy controls were scanned twice to assess test-retest variability. We performed hypothesis-driven Bayesian analyses to study the relation between global and regional perfusion changes and seizure duration.
Twenty-four patients and 27 healthy controls were included. Changes in postictal global and regional CBF were correlated with seizure duration. In patients with longer seizure durations, global decrease in CBF reached values up to 28 mL/100 g/min. Regional reductions in CBF were most prominent in the inferior frontal gyrus, cingulate gyrus, and insula (up to 35 mL/100 g/min). In patients with shorter seizures, global and regional perfusion increased (up to 20 mL/100 g/min). These perfusion changes were larger than changes observed in healthy controls, with a maximum median global CBF increase of 12 mL/100 g/min and a maximum median global CBF decrease of 20 mL/100 g/min.
Seizure duration is a key factor determining postictal perfusion changes. In future studies, seizure duration needs to be considered as a confounding factor due to its opposite effect on postictal perfusion.
发作后症状可能是由于脑灌注不足引起的，而脑灌注不足可能是癫痫发作引起的血管收缩的结果。先前的研究表明，在大鼠和癫痫患者中，发作时间较长会导致更严重的发作后低灌注。我们研究了电惊厥疗法（ECT）诱发全身性癫痫发作后的脑灌注及其与发作持续时间的关系。
纳入了患有重性抑郁发作并接受 ECT 治疗的患者。在治疗过程中，进行了 21 通道连续脑电图（EEG）记录。在 ECT 疗程前（基线）和 ECT 诱发癫痫发作后约 1 小时（发作后）采集动脉自旋标记磁共振成像扫描，以量化全脑和局部灰质脑血流（CBF）。从 EEG 上的癫痫样放电期间评估癫痫发作持续时间。健康对照者扫描两次以评估测试-重测变异性。我们进行了假设驱动的贝叶斯分析，以研究全脑和局部灌注变化与癫痫发作持续时间之间的关系。
纳入了 24 例患者和 27 例健康对照者。发作后全脑和局部 CBF 的变化与癫痫发作持续时间相关。在癫痫发作持续时间较长的患者中，CBF 的全脑下降幅度高达 28 mL/100 g/min。CBF 的区域性减少在额下回、扣带回和岛叶最为明显（高达 35 mL/100 g/min）。在癫痫发作持续时间较短的患者中，全脑和局部灌注增加（高达 20 mL/100 g/min）。这些灌注变化大于健康对照组的变化，最大中位全脑 CBF 增加 12 mL/100 g/min，最大中位全脑 CBF 减少 20 mL/100 g/min。
癫痫发作持续时间是决定发作后灌注变化的关键因素。在未来的研究中，由于其对发作后灌注的相反影响，需要将癫痫发作持续时间视为混杂因素。
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