Functional MRI of the pre-ictal state

被引:102
作者
Federico, P
Abbott, DF
Briellmann, RS
Harvey, AS
Jackson, GD
机构
[1] Brain Res Inst, Heidelberg West, Vic 3081, Australia
[2] Univ Melbourne, Dept Med, Parkville, Vic 3052, Australia
[3] Univ Melbourne, Dept Radiol, Parkville, Vic 3052, Australia
[4] Royal Childrens Hosp, Dept Neurol, Parkville, Vic 3052, Australia
[5] Univ Calgary, Dept Clin Neurosci, Calgary, AB T2N 1N4, Canada
基金
英国医学研究理事会;
关键词
pre-ictal; functional MRI; epilepsy; seizure; EEG; magnetic resonance;
D O I
10.1093/brain/awh533
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The mechanisms underlying the transition from interictal to ictal states are poorly understood. Non-linear mathematical analysis of EEG frequency components has confirmed the presence of a pre-ictal state in focal epilepsy. We report on functional MRI (fMRI) analysis of the pre-ictal state in three patients with intractable focal epilepsy. Each subject had a typical partial seizure in the scanner while continuous blood oxygen level dependent (BOLD) fMRI images were acquired. The pre-ictal BOLD changes were first analysed by statistically comparing BOLD signals of two one-minute blocks. Further examination of the full time course was then performed. Each patient showed highly significant, focal BOLD signal changes. In Patient 1, a striking pre-ictal BOLD signal increase was seen over the region of the seizure focus identified on complementary epilepsy investigations. No significant BOLD signal decreases were observed. Patient 2 showed widespread pre-ictal BOLD increase contralateral to the presumed seizure focus, as well as a focal BOLD decrease near the presumed seizure focus. In Patient 3, pre-ictal BOLD increase was co-localized with the site of hyperperfusion seen on ictal single photon emission computed tomography (SPECT). However, this was contralateral to the seizure focus localization based on seizure symptomatology. No significant BOLD decreases were seen. The time course data in each patient studied showed change of the BOLD signal several minutes before the onset of the seizure. Highly significant BOLD fMRI signal changes occur before the onset of seizures, supporting the presence of a pre-ictal state. These changes can be localized to the site of the presumed seizure focus, as well as to other brain regions, suggesting that the pre-ictal BOLD signal changes and their underlying mechanisms are complex.
引用
收藏
页码:1811 / 1817
页数:7
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