左乙拉西坦对伴中央颞区棘波的儿童良性癫痫脑活动影响的静息态功能磁共振成像评价

李志鹏1; 杨  昉1; 胡  正2; 张其锐1; 权  巍1; 许  强1; 张志强1; 卢光明1

中国临床医学影像杂志 ›› 2017, Vol. 28 ›› Issue (10) : 707-711.

李志鹏1，杨昉1，胡正2，张其锐1，权巍1，许强1，张志强1，卢光明1

作者信息 +

Effect of levetiracetam in benign childhood epilepsy with centro-temporal spikes: #br# a resting-state fMRI study based on amplitude of low frequence fluctuation

LI Zhi-peng1, YANG Fang1, HU Zheng2, ZHANG Qi-rui1, QUAN Wei1, XU Qiang1, ZHANG Zhi-qiang1, LU Guang-ming1

Author information +

文章历史 +

摘要

目的：采用基于静息态脑功能成像的低频振荡振幅（ALFF）算法，观察左乙拉西坦（LEV）治疗对伴中央颞区棘波的儿童良性癫痫（BECTS）的脑活动影响和作用机制。方法：纳入22例服用LEV的BECTS、22例未服药的BECTS和22名年龄和性别匹配的正常儿童，均在3T MRI仪器下采集fMRI数据，经数据预处理后，应用SPM8软件的方差分析比较三组被试的ALFF改变，并与癫痫病程、起病年龄及用药时间等临床指标进行相关分析。结果：与正常儿童对照组比较，未治疗BECTS组和LEV治疗BECTS组的双侧Rolandic区ALFF均增加，而与未治疗BECTS组比较，LEV治疗BECTS组的双侧Rolandic区ALFF减低。未治疗BECTS组左侧中央前/后回和额下回ALFF值与其病程呈正相关，LEV治疗BECTS组左侧中央前回和右侧额上回与其用药时间呈负相关，左侧楔前叶和右侧颞中回与其用药时间呈正相关。结论：未经治疗的BECTS异常放电脑区内在脑活动增加，而LEV治疗可使其脑活动减低，并且可以影响语言、注意力和默认模式网络（DMN）的相关脑区，从静息态功能成像角度证实了LEV治疗BECTS的有效性。

Abstract

Objective: To use amplitude of low frequence fluctuation(ALFF) to evaluate the brain functional change of benign childhood epilepsy with centro-temporal spikes(BECTS) and the influence of levetiracetam(LEV) on BECTS. Methods: Twenty-two BECTS treated with LEV, twenty-two BECTS with no treatment and twenty-two age and sex-matched healthy children were included to preform functional magnetic resonance imaging(fMRI). After data preprocessing, the difference of ALFF among the three groups was obtained by the analysis of variance, and their correlation with clinical index were reported. Results: Compared to the healthy group, the ALFF of bilateral Rolandic areas in both untreated group and the LEV group were increased. And compared to the non-treatment group, the ALFF of bilateral Rolandic areas in the LEV group were decreased. The ALFF of left precentral/postcentral gyrus and left inferior frontal gyrus showed positive correlation with the duration of untreated BECTS, while the left precentral gyrus and the right superior frontal gyrus showed negative correlation with the duration of the LEV effects and the left precuneus and right middle temporal gyrus showed a positive correlation with the duration of the LEV effects in LEV group. Conclusion: The discharge areas of BECTS in brain show increased activities, and LEV can effectively reduce the intrinsic brain activity in these areas of BECTS and impact on the areas about language, attention and default mode network(DMN). These evidences based on fMRI show that LEV is useful in the treatment of BECTS.

导出引用

李志鹏1，杨昉1，胡正2，张其锐1，权巍1，许强1，张志强1，卢光明1. 左乙拉西坦对伴中央颞区棘波的儿童良性癫痫脑活动影响的静息态功能磁共振成像评价[J]. 中国临床医学影像杂志. 2017, 28(10): 707-711

LI Zhi-peng1, YANG Fang1, HU Zheng2, ZHANG Qi-rui1, QUAN Wei1, XU Qiang1, ZHANG Zhi-qiang1, LU Guang-ming1. Effect of levetiracetam in benign childhood epilepsy with centro-temporal spikes: #br# a resting-state fMRI study based on amplitude of low frequence fluctuation[J]. Journal of China Clinic Medical Imaging. 2017, 28(10): 707-711

中图分类号： Ｒ742.1 Ｒ445.2

参考文献

[1]Park JT, Shahid AM, Jammoul A. Common pediatric epilepsy syndromes[J]. Pediatr Ann, 2015, 44(2): e30-e35.
[2]Bouma PA, Bovenkerk AC, Westendorp RG, et al. The course of benign partial epilepsy of childhood with centrotemporal spikes: a meta-analysis[J]. Neurology, 1997, 48(2): 430-437.
[3]Verrotti A, Filippini M, Matricardi S, et al. Memory impairment and Benign Epilepsy with centrotemporal spike(BECTS): a growing suspicion[J]. Brain Cognition, 2014, 84(1): 123-131.
[4]Carreno M, Fernandez S. Sleep-Related Epilepsy[J]. Curr Treat Option Ne, 2016, 18(5): 23.
[5]Weijenberg A, Brouwer OF, Callenbach PM. Levetiracetam Monotherapy in Children with Epilepsy: A Systematic Review[J]. CNS Drugs, 2015, 29(5): 371-382.
[6]Bakke KA, Larsson PG, Eriksson AS, et al. Levetiracetam reduces the frequency of interictal epileptiform discharges during NREM sleep in children with ADHD[J]. Eur J Paediatr Neuro, 2011, 15(6): 532-538.
[7]Hu Y, Mi X, Xu X, et al. The Brain Activity in Brodmann Area 17: A Potential Bio-Marker to Predict Patient Responses to Antiepileptic Drugs[J]. PLoS One, 2015, 10(10): e0139819.
[8]Wandschneider B, Stretton J, Sidhu M, et al. Levetiracetam reduces abnormal network activations in temporal lobe epilepsy[J]. Neurology, 2014, 83(17): 1508-1512.
[9]Zhang Q, Yang F, Hu Z, et al. Resting-state fMRI revealed different brain activities responding to valproic acid and levetiracetam in benign epilepsy with central-temporal spikes[J]. Eur Radio, 2017, 27(5): 2137-2145.
[10]Zang YF, He Y, Zhu CZ, et al. Altered baseline brain activity in children with ADHD revealed by resting-state functional MRI[J]. Brain Develop, 2007, 29(2): 83-91.
[11]杜贵金，李晓东，张权，等. 基于比率低频振幅fMRI评价青少年网络游戏成瘾者静息态下脑功能活动 [J]. 中国临床医学影像杂志，2014，25（8）：555-559.
[12]Zhang Z, Lu G, Zhong Y, et al. fMRI study of mesial temporal lobe epilepsy using amplitude of low-frequency fluctuation analysis[J]. Hum Brain Mapp, 2010, 31(12): 1851-1861.
[13]Zhu Y, Yu Y, Shinkareva SV, et al. Intrinsic brain activity as a diagnostic biomarker in children with benign epilepsy with centrotemporal spikes[J]. Hum Brain Mapp, 2015, 36(10): 3878-3889.
[14]刘光耀，杨晓萍，张喆，等. 原发性全面强直阵挛癫痫全脑比率低频振幅的静息态fMRI研究[J]. 中国临床医学影像杂志，2013，24（9）：609-612.
[15]Kellaway P. The electroencephalographic features of benign centrotemporal(rolandic) epilepsy of childhood[J]. Epilepsia, 2000, 41(8): 1053-1056.
[16]Niespodziany I, Klitgaard H, Margineanu DG. Levetiracetam inhibits the high-voltage-activated Ca(2+) current in pyramidal neurones of rat hippocampal slices[J]. Neurosci Lett, 2001, 306(1-2): 5-8.
[17]Surges R, Volynski KE, Walker MC. Is levetiracetam different from other antiepileptic drugs? Levetiracetam and its cellular mechanism of action in epilepsy revisited[J]. Ther Adv Neurol Diso, 2008, 1(1): 13-24.
[18]Xiao F, An D, Lei D, et al. Real-time effects of centrotemporal spikes on cognition in rolandic epilepsy: An EEG-fMRI study[J]. Neurology, 2016, 86(6): 544-551.
[19]Palaniyappan L, Liddle PF. Does the salience network play a cardinal role in psychosis? An emerging hypothesis of insular dysfunction[J]. J Psychiatr Neurosc, 2012, 37(1): 17-27.
[20]Wager TD, Sylvester CY, Lacey SC, et al. Common and unique components of response inhibition revealed by fMRI[J]. NeuroImage, 2005, 27(2): 323-340.
[21]Piazzini A, Chifari R, Canevini MP, et al. Levetiracetam: an improvement of attention and of oral fluency in patients with partial epilepsy[J]. Epilepsy Res, 2006, 68(3): 181-188.
[22]Luo C, Li Q, Lai Y, et al. Altered functional connectivity in default mode network in absence epilepsy: a resting-state fMRI study[J]. Hum Brain Mapp, 2011, 32(3): 438-449.