Mao L Y, Cai Y, Zhang Q Q, Luo W Y, Ding J, Wang X
Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2024 Jun 4;104(21):1994-1997. doi: 10.3760/cma.j.cn112137-20230919-00495.
The patients with temporal lobe epilepsy (TLE) admitted in the Department of Neurology, Zhongshan Hospital, Fudan University from June 2009 to February 2012 were prospectively enrolled. The diffusion tensor imaing was performed on the patients at the time of enrollment and 3 years later. The fractional anisotropy (FA) values of the white matter connecting fibers(bilateral hooked, arcuate, cingulate, and superior longitudinal tracts), the connecting fibers of both hemispheres(anterior union, anterior callosal forceps, posterior forceps, and bilateral fornix), and fibers of perirhinal cortices system(bilateral radiating crown and anterior limb of the internal capsule) were measured by the region of interest method. The severity of epilepsy was evaluated using the Veterans Administration Seizure Type and Frequency Rating Scale(VA-2) and National Hospital Seizure Severity Scale (NHS3). A total of 51 patients with TLE were screened, with 27 patients completing the 3-year follow-up. There were 13 males and 14 females with an age of (32±11) years and a follow-up duration of (39.1±1.1) months. During the follow-up, 6 patients had increased/unchanged NHS3 or VA-2 scores, while 21 patients had decreased scores. Three years later, the FA values of the bilateral arcuate fasciculus, the right superior longitudinal fasciculus, the right radial coronal and corpus callosum anterior forceps in TLE patients decreased compared to baseline(<0.05). However, compared to the patients with decreased VA-2 scores during the follow-up, the degree of increase in FA values (ΔFA, follow-up FA value-baseline FA value) of the ipsilateral hook bundle caused by epilepsy was more significant in the group with increased/unchanged VA-2 scores (decreased score group vs increased/unchanged score group:-0.032±0.063 vs 0.018±0.043, =2.305, =0.035). The value of ΔFA in epileptic patients with increased/unchanged NHS3 scores (0.075±0.113) was higher compared to those with decreased scores (-0.079±0.099, t=2.804, =0.010). Correlation analysis also showed the changes in FA values of epileptic lateral fasciculus (=0.503, =0.009) and arcuate fasciculus (=0.602, =0.001)were positively correlated with the changes in VA-2 and HNS3 scores, respectively. The seizure severity in patients with TLE was closely associated with the microstructure changes in the frontal and temporal white matter, especially the arcuate and uncinate tracts, on the same side that caused seizures, which may indicate the white matter remodeling and abnormal network reformation associated with seizures.
前瞻性纳入2009年6月至2012年2月在复旦大学附属中山医院神经内科住院的颞叶癫痫（TLE）患者。在入组时和3年后对患者进行弥散张量成像。采用感兴趣区法测量连接纤维（双侧钩束、弓状束、扣带束和上纵束）、双侧半球连接纤维（前联合、胼胝体前钳、后钳和双侧穹窿）以及嗅周皮质系统纤维（双侧放射冠和内囊前肢）的分数各向异性（FA）值。采用美国退伍军人事务部癫痫发作类型和频率评定量表（VA - 2）和国家医院癫痫发作严重程度量表（NHS3）评估癫痫严重程度。共筛查51例TLE患者，27例完成3年随访。其中男性13例，女性14例，年龄（32±11）岁，随访时间（39.1±1.1）个月。随访期间，6例患者的NHS3或VA - 2评分升高/不变，21例患者评分降低。3年后，TLE患者双侧弓状束、右侧上纵束、右侧放射冠和胼胝体前钳的FA值较基线下降（<0.05）。然而，与随访期间VA - 2评分降低的患者相比，VA - 2评分升高/不变组中癫痫导致的同侧钩束FA值增加程度（ΔFA，随访FA值 - 基线FA值）更显著（评分降低组 vs 评分升高/不变组：-0.032±0.063 vs 0.018±0.043，t = 2.305，P = 0.035）。NHS3评分升高/不变的癫痫患者的ΔFA值（0.075±0.113）高于评分降低的患者（-0.079±0.099，t = 2.804，P = 0.010）。相关性分析还显示，癫痫患者外侧束（r = 0.503，P = 0.009）和弓状束（r = 0.602，P = 0.001）的FA值变化分别与VA - 2和HNS3评分变化呈正相关。TLE患者的癫痫严重程度与额叶和颞叶白质的微观结构变化密切相关，尤其是导致癫痫发作同侧的弓状束和钩束，这可能表明与癫痫发作相关的白质重塑和异常网络重构。
