Jibiki I, Maeda T, Kubota T, Yamaguchi N
Department of Neuropsychiatry, Kanazawa University School of Medicine, Ishikawa Prefecture, Japan.
Neuropsychobiology. 1993;28(4):207-11. doi: 10.1159/000119025.
To examine the relationship between functional abnormality of the brain and the development of epileptic psychosis, regional cerebral blood flow (rCBF) patterns with single photon emission computed tomography (SPECT) using N-isopropyl-(iodine-123)-p-iodoamphetamine (123I-IMP) were serially examined in interictal stages with and without the psychotic state in 2 medicated patients with temporal lobe epilepsy with schizophrenia-like syndrome. Both patients had epileptic EEG foci in the left temporal lobe and schizophrenia-like syndrome in Bruens' classification of epileptic psychosis, mainly consisting of auditory hallucinations and delusions of persecution and reference accompanying the enhancement of interictal epileptic discharges. In both patients, the SPECT scans obtained in the stages without the psychotic state revealed focal hypoperfusion images in the left temporal lobe regionally consistent with the EEG foci. On the other hand, the SPECT scans in the stages with the psychotic states revealed focal hyperperfusion images in the left temporal lobe or amygdala in case 1, and a normal perfusion pattern without asymmetric images of the right and left temporal lobes in case 2. These results suggest that temporo-limbic dysfunction, in particular hyperfunction in the temporo-limbic system in the left dominant hemisphere, arises at the time of the psychotic state in epileptic psychosis.
为研究大脑功能异常与癫痫性精神病发展之间的关系，我们对2例患有颞叶癫痫伴精神分裂症样综合征的服药患者，在发作间期有或无精神病状态时，使用N-异丙基-(碘-123)-对碘安非他明(123I-IMP)通过单光子发射计算机断层扫描(SPECT)连续检测了局部脑血流量(rCBF)模式。两名患者在左侧颞叶均有癫痫性脑电图病灶，且在布伦斯癫痫性精神病分类中属于精神分裂症样综合征，主要表现为听觉幻觉、被害妄想和牵连观念，并伴有发作间期癫痫放电增强。在两名患者中，无精神病状态阶段的SPECT扫描显示左侧颞叶局部灌注减低图像，其区域与脑电图病灶一致。另一方面，有精神病状态阶段的SPECT扫描显示，病例1左侧颞叶或杏仁核有局部灌注增加图像，病例2则显示正常灌注模式，左右颞叶无不对称图像。这些结果表明，颞叶-边缘系统功能障碍，特别是左侧优势半球颞叶-边缘系统功能亢进，在癫痫性精神病的精神病状态时出现。
