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目的:研究癫痫性脑功能异常对抑郁障碍产生的影响,以利于临床的早期识别和防治。方法:选择颞叶癫痫患者共36名,根据贝克抑郁自评量表及汉密尔顿抑郁量表评分,分为颞叶癫痫伴抑郁组18例及非抑郁组18例。入组患者均行视频脑电图(VEEG)、3.0T头核磁共振(MRI)、静息态功能磁共振(RS-f MRI)及磁共振波谱(MRS)检查,并对两组患者的各项检查资料进行分析。结果:两组患者的性别、年龄、发作频率比较差异无统计学意义(P>0.05),两组的癫痫病程比较差异有统计学意义(P<0.05)。VEEG检查颞叶的发作间期痫性放电(IEDs)的侧别、颞叶与颞叶伴颞叶外IEDs两组间比较差异有统计学意义(P<0.05),抑郁组左侧受累更多见。局部一致性、低频振幅、低频振幅分数(3种RS-fMRI分析方法)基于全脑水平的单样本t检验显示抑郁组脑激活区多于非抑郁组,且抑郁组中线结构的激活突出;两样本独立t检验结果显示,抑郁组比非抑郁组激活更增强的脑区涉及丘脑以及默认网络中的前额、楔前叶、腹前扣带回、海马等脑区。抑郁组MRS检查5/18例颞叶放电优势侧海马的NAA、NAA/Cho+Cr减低,且3/5例有海马萎缩;非抑郁组未发现明显异常。结论:颞叶癫痫病程长,放电累及颞叶外脑区、优势半球侧受累,海马结构功能异常及脑默认网络活动增强等因素与抑郁障碍的发生有关。
Objective: To study the effect of epileptic brain dysfunction on depression, in order to facilitate the early identification and prevention of clinical. Methods: A total of 36 patients with temporal lobe epilepsy were selected. According to the Beck Depression Scale and Hamilton Depression Rating Scale, 18 patients with temporal lobe epilepsy and depression group and 18 non-depression group were divided into two groups. The patients underwent VEEG, 3.0T MR, RS-f MRI and MRS examinations. The patients in each group Items to check the data for analysis. Results: There was no significant difference in gender, age and seizure frequency between the two groups (P> 0.05). There was significant difference in epilepsy duration between the two groups (P <0.05). VEEG examination temporal lobe interictal epileptic discharge (IEDs) side, temporal lobe and temporal lobe with temporal lobe IEDs between the two groups was statistically significant difference (P <0.05), depressed left group more affected see. The single-sample t-test based on global brain level showed that there were more brain activation areas in depression group than in non-depression group, and the activation of midline structure in depression group was prominent. Two Sample independent t-test results showed that brain regions that were more strongly activated in the depression group than the non-depression group involved the thalamus and the default network in the forehead, wedge anterior lobe, anterior cingulate gyrus, hippocampus and other brain regions. In the depression group, the NAA and NAA / Cho + Cr in 5/18 hippocampus on the predominant side of temporal lobe discharge were decreased in 5/18 MRS patients and hippocampus was atrophied in 3/5 patients. No obvious abnormality was found in non-depressed group. Conclusion: The long duration of temporal lobe epilepsy, the discharge involving the temporal lobe brain region, the dominant hemisphere side involvement, dysfunction of the hippocampus and increased brain default network activity and other factors related to the occurrence of depression.