ObjectiveTo explore the clinical features and surgical treatment effects of the temporal lobe epilepsy with hippocampal sclerosis.MethodsForty two patients diagnosed as temporal lobe epilepsy with hippocampal sclerosis and underwent protemporal lobectomy in Wuhan Brain Hospital from Jan. 2012 to Dec. 2018 were collected, which included 30 males and 12 females, with the age between 9 to 60 years. Their disease duration ranged from 3 to 10 years. The clinical manifestations showed complex partial seizure in 18 cases, partial-secondary –generalized seizure in 4 cases, and generalized tonic-clonic seizure in 20 cases. Based on their results of clinical manifestations, combined with MRI and VEEG results, all the patients underwent anterior temporal lobectomy (including the most parts of the hippocampus and amydala).ResultsThe postoperative pathology confirmed the diagnosis of hippocampal sclerosis. The follow-up of more than 1 year showed seizure-free in 38 cases, and significant improvement in 4 cases.ConclusionsTo the patients of temporal lobe epilepsy with hippocampal sclerosis, anterior temporal lobectomy should be performed (including the most parts of the hippocampus and amydala) if the VEEG monitoring results show that there are epileptic discharges in the ipsilateral temporal lobe. And the postoperative curative result is satisfactory.
This study aims to determine the salient brain regions with abnormal changes in white matter structures from diffusion tensor imaging (DTI) images of the patients with temporal lobe epilepsy (TLE), and to discriminate the patients with TLE from normal controls (NCs). Firstly, the DTI images from 50 subjects (28 NCs and 22 TLE) were acquired. Secondly, the four measures including the fractional anisotropy (FA), the mean diffusivity (MD), the axial diffusivity (AD) and the radial diffusivity (RD) were calculated. Thirdly, the tract-based spatial statistics (TBSS) was adopted to extract the measures in brain regions with significant differences between the two compared groups. Fourthly, the obtained measures were used as input features of the support vector machine (SVM) for classification, and the support vector machine-recursive feature elimination (SVM-RFE) was compared with the support vector machine-tract-based spatial statistics (SVM-TBSS) method. Finally, the essential brain regions and their spatial distribution were analyzed and discussed. The experimental results showed that the FA measures of the TLE group decreased significantly in the corpus callosum, superior longitudinal fasciculus, corona radiata, external capsule, internal capsule, inferior fronto-occipital fasciculus, fasciculus uncinatus and sagittal stratum, which were nearly bilaterally distributed, while the MD and RD increased significantly in most of these brain regions of the TLE group. Although the AD also increased, the differences were not statistically significant. The SVM-TBSS classifier obtained accuracies of 82%, 76% and 76% using the FA, MD and RD for classification, respectively, and 80% using combined measures. The SVM-RFE classifier obtained accuracies of 90%, 90% and 92% using the FA, MD and RD respectively, while the highest accuracy was 100% using combined measures. These results demonstrated that the SVM-RFE outperformed the SVM-TBSS, and the dominant characteristic influencing classification in brain regions were in associative and commissural fibers. These results illustrated that the measures of DTI images could reveal the abnormal changes in white matter structure of patients with TLE, providing effective information to clarify its pathological mechanism, localize the focus and diagnose automatically.
ObjectiveImpaired breathing during and following seizures is an important cause of sudden unexpected death in epilepsy (SUDEP), but the network mechanisms by which seizures impair breathing have not been thoroughly investigated. Progress would be greatly facilitated by a model in which breathing could be investigated during seizures in a controlled setting. MethodRecent work with an acute Long-Evans rat model of limbic seizures has demonstrated that depression of brainstem arousal systems may be critical for impaired consciousness during and after seizures. We now utilize the same rat model to investigate breathing during partial seizures with secondary generalization. ResultBreathing is markedly impaired during seizures(P < 0.05;n=21), and that the severity of breathing impairment is strongly correlated with the extent of seizure propagation (Pearson R=-0.73;P < 0.001;n=30). ConclusionSeizure propagation could increase the severity of breathing impairment caused by seizures. Based on these results, we suggest that this animal model would help us to improve understanding of pathways involved in impairment of breathing caused by seizures and this is an important initial step in addressing this significant cause of SUDEP in people living with epilepsy.
目的 利用磁共振弥散张量成像技术（DTI）对右侧难治性颞叶癫痫（TLE）患者术前及术后脑白质各向异性分数（FA）进行纵向随访研究，并对其与病程等临床症状之间的相关性进行分析，探讨右侧TLE患者的脑白质FA变化模式。 方法 2008年7月－2009年8月纳入10例右侧难治性TLE患者。对每个受试者采用GE 3.0 T磁共振及8通道头线圈扫描，所有DTI图像通过单次回波平面成像序列采集。采用基于体素分析的SPM8软件对受试患者术前术后FA图进行配对t检验，观察难治性TLE患者脑白质变化模式。采用Pearson相关计算FA变化幅度与病程等临床症状之间的相关性，经比较校正后P值＜0.05的区域为有统计学意义的区域。 结果 右侧TLE患者FA值降低的区域包括左侧颞下回、双侧额中回及左侧壳核、右侧楔叶。FA升高的区域包括左侧海马旁回、左侧颞叶、右侧额下回和左侧中央旁小叶。相关分析发现，右侧TLE患者右侧额下回FA变化值与发病年龄呈负相关，左侧颞下回FA变化值与术后随访间隔时间呈负相关。 结论 右侧难治性TLE患者手术治疗后大脑白质变化不仅局限于颞叶，还涉及颞叶外结构。
ObjectiveTo investigate the role of amygdala volume index(AVI) in surgcial evaluation in patients with mesial temporal lobe epilepsy (mTLE), including clinical features, etiologies and surgical outcome. MethodsThirty six patients were diagnosed as mTLE after surgical evaluation including clinical manifestations, video-electroencephalogram (VEEG) and magnetic resonance imaging (MRI) at the Second Affiliated Hospital of Zhejiang University between March 2013 and March 2016. Bilateral amygdala AVI was then calculated from amygdala volumes on MRI, which were measured with region of interest (ROI) analysis. All patients were treated surgically. Etiologies of mTLE were further confirmed by the histopathology of the resected tissue. ResultsAmong the 35 patients, there is a strong correlation between AVI on the lesion side and age of onset (R =-0.389, P = 0.019) as well as age of surgery (R =-0.357, P = 0.032). No obvious relation can be seen between AVI and gender, history of febrile convulsion, duration of epilepsy, secondary generalized seizure, side of lesion, presurgical seizure frequency and electrode implantation. There is no significant difference in AVI among the five etiologies. At follow-up, thirty patients (80.5%) reached seizure-free, AVI on the lesion side is nota predictor of surgical failure (P > 0.05). ConclusionAVI plays a role in etiology evaluation in patients with mesial temporal lobe epilepsy. Moreover, a larger AVI on the lesion side is correlated with an earlier age of onset. There is limited value of amygdala volume insurgical outcome prediction of patients with mTLE.
ObjectiveTo explore the dynamic changes of microvessels in the hippocampal CA3 area in mice model of temporal lobe epilepsy (TLE) induced by pilocarpine. MethodsEighteen health SPF male C57BL/6 mice were randomly divided into control group and status epilepticus (SE) group. The SE group was subdivided into three groups:SE-7 days, SE-28 days and SE-56 days. SE was induced by intraperitoneal injection of pilocarpine. And immunohistochemical staining was used to detected the localization of platelet endothelial cell adhesion molecule-1 (PECAM-1). ResultsIn the control group, PECAM-1 labeled microvessels arranged in a layered structure, and the microvessel of the orient layer was most prominent. After SE, the microvessels started to form an unorganized vascular plexus and appeared fibrous and fragmented, which was prominent at SE-28 days. Furthermore, the microvessels density increased the top at SE-28 days compared to the control (P < 0.001). ConclusionThe angiogenesis exists during the hippocampus formation in the mice model of TLE induced by pilocarpine, which could direct a new explanation for TLE formation and development.