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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

22卷

期数:

2016年04期

页码:

302-306

栏目:

临床医学

出版日期:

2016-07-19

文章信息/Info

Title:

Effect of brain dysfunction in temporal lobe epilepsy on depressive disorder

文章编号:

1006-8147（2016）04-0302-05

作者:

郜玉婷¹ ; 毓 青¹ ; 姚晓娟¹ ; 安 阳² ; 陈旨娟¹; 尹建忠²; 杨卫东¹;  吴韶蕊¹ ; 陈 英¹

(1.天津医科大学总医院神经内科,天津300052;2.天津市第一中心医院放射科,天津300192)

Author(s):

GAO Yu-ting¹;  YU Qing¹;  YAO Xiao-juan¹;  AN Yang²;  CHEN Zhi-juan¹;  YIN Jian-zhong²;  YANG Wei-dong¹;  WU Shao-rui¹;  CHEN Ying¹

（1.Department of Neurology, General Hospital, Tianjin Medical University, Tianjin 300052,China；2.Department of Radiology, The First Central Hospital of Tianjin, Tianjin 300192， China）

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关键词:

颞叶癫痫 ; 抑郁 ; 视频脑电图; 静息态功能磁共振; 脑功能异常

Keywords:

temporal lobe epilepsy ;  depression;  VEEG;  RS-fMRI;  brain dysfunction

分类号:

R742.1

DOI:

-

文献标志码:

A

摘要:

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-fMRI）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（三种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。

Abstract:

?Objective: To study the effect of epileptic brain dysfunction on depression by analysing the brain electrical activity ， brain structure and functional imaging data from patients with temporal lobe epilepsy(TLE) . Methods: According to Beck depression self rating scale and Hamilton Depression Rating Scale score, 36 cases were divided to two groups: depression group 18 cases,non-depression group 18 cases. All patients underwent video—electroencephalogram（ VEEG） and 3.0T Magnetic resonance imaging （MRI） and Resting-State functional Magnetic resonance imaging（ RS-fMRI）as well as magnetic resonance spectroscopy（ MRS） examination, and then analyzing examination data of the two groups. Results :There were no significant differences in sex, age, seizure frequency between the two groups (P＞0.05) , the duration of epilepsy was different (P＜0.05). Statistically significant differences were found in interictal epileptiform discharges(IEDs) which was restricted to temporal lobe or spread to other brain lobe including temporal lobe between the two groups in VEEG examination，and the advantage side of discharge (P ＜0.05), the patients in depression group whose IEDs with left side advantage were more than non-depression group . Single sample t test based on whole brain level from local consistency, low frequency amplitude and low frequency amplitude fraction （three kinds of RS-fMRI analysis methods） showed that the active area in the brain in the depression group was more than the non- depression group, and the middle line structures was activated. Compared with the non-depression group, test results showed that stronger activate brain regions were included the thalamus and the frontal area, the precuneus，the anterior cingulate cortex, the hippocampus which belonged to default-mode network. The NAA and NAA/Cho+Cr in the hippocampus of the ipsilateral dominant side of discharge were decreased in 5/18 patients with depression in MRS and 3/5 patients with hippocampal atrophy , while the non-depression group had no such abnormalities. Conclusion: Factors such as the longer duration of TLE, discharge involving the multiple brain lobes and advantages hemisphere , abnormal structure and function of hippocampus and strength of brain default-mode network activity may be related to the occurrence of depression .

参考文献/References:

[1]Andrade-Machado R, Benjumea-Cuartas V, Santos-Santos A, et al. Mortality in patients with refractory temporal lobe epilepsy at a tertiary center in Cuba[J]. Epilepsy Behav, 2015, 53: 154

[2]Gon?alves E B, Cendes F. Depression in patients with refractory temporal lobe epilepsy[J]. Arq Neuropsiquiatr, 2011, 69(5): 775

[3]Kandratavicius L, Ruggiero R N, Hallak J E, et al. Pathophysiology of mood disorders in temporal lobe epilepsy[J]. Rev Bras Psiquiatr, 2012, 34(Suppl 2): S233

[4]Beck A T, Beamesderfer A. Assessment of depression:the depression inventory[J]. Mod Probl Pharmacopsychiatry, 1974, 7(0): 151

[5]Hamilton M. Development of a rating scale for primary depressive illness[J]. Br J Soc Clin Psychol, 1967, 6(4): 278

[6]Hecimovic H, Santos J, Price J L, et al. Severe hippocampal atrophy is not associated with depression in temporal lobe epilepsy[J]. Epilepsy Behav, 2014,34:9

[7]Gilliam F G, Maton B M, Martin R C, et al. Hippocampal 1H-MRSI correlates with severity of depression symptoms in temporal lobe epilepsy[J]. Neurology, 2007, 68(5): 364

[8]Kleen J K, Scott R C, Holmes G L, et al. Hippocampal interictal epileptiform activity disrupts cognition in humans[J]. Neurology, 2013, 81(1): 18

[9]姚晓娟，陈旨娟，毓青，等．脑电图-功能磁共振成像技术对局灶性癫痫致痫灶定位的价值[J]．中华医学杂志，2015，95（13）：987

[10]Whitfield-Gabrieli S, Ford J M. Default mode network activity and connectivity in psychopathology[J]. Annu Rev Clin Psychol, 2012, 8: 49

[11]Andrews-Hanna J R, Smallwood J, Spreng R N. The default network and self-generated thought: component processes, dynamic control, and clinical relevance[J]. Ann N Y Acad Sci, 2014, 1316: 29

[12]Northoff G, Heinzel A, De Greck M, et al. Self-referential processing in our brain--a meta-analysis of imaging studies on the self[J]. Neuroimage, 2006, 31(1): 440

[13]Morgan V L, Gore J C, Abou-Khalil B. Functional epileptic network in left mesial temporal lobe epilepsy detected using resting fMRI[J]. Epilepsy Res, 2010, 88(2/3): 168

[14]Erickson K I, Miller D L, Roecklein K A. The aging hippocampus: interactions between exercise, depression, and BDNF[J]. Neuroscientist, 2012, 18(1): 82

[15]Hermann B P, Seidenberg M, Bell B, et al. Comorbid psychiatric symptoms in temporal lobe epilepsy: association with chronicity of epilepsy and impact on quality of Life[J]. Epilepsy Behav, 2000, 1(3): 184

[16]Kwon O Y, Park S P. Depression and anxiety in People with epilepsy[J]. J Clin Neurol, 2014, 10(3): 175

[17]Stratmann M, Konrad C, Kugel H, et al. Insular and hippocampal gray matter volume reductions in patients with major depressive disorder[J]. PLoS One, 2014, 9(7): e102692

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相似文献/References:

备注/Memo

备注/Memo:

基金项目 天津市科委科学基金资助项目（12JCYBJC16900）；国家临床重点专科建设项目

作者简介 郜玉婷（1989-），女，硕士在读，研究方向：癫痫病及神经电生理；

通信作者：毓青，E-mail:yq_yuqing@163.com。

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更新日期/Last Update: 2016-07-13