癫痫患者的小脑影像学研究进展_Journal of Epilepsy

Authors：

 朱琼彬 , 丁瑶 ,  丁美萍

浙江大学附属第二医院神经内科癫痫中心(杭州，310009);

Corresponding author：

丁美萍, Email: meipingd@163.com

Keywords：

癫痫; 小脑; 影像学

DOI：

10.7507/2096-0247.20160028

Video：

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回顾癫痫患者小脑结构和功能影像学研究，发现癫痫患者存在小脑萎缩、血流灌注异常、代谢异常和功能障碍。癫痫患者小脑萎缩的相关因素有原发性脑损伤、癫痫发作相关因素(如癫痫发作时间和全身性强直阵挛性癫痫发作)、抗癫痫药物(如苯妥英钠)等。癫痫患者存在小脑血流动力学的改变，且常表现为小脑的过度灌注。癫痫发作间期小脑糖代谢水平下降，但特异的神经递质改变并未被发现。此外，癫痫患者的小脑与其他脑结构(如旁扣代回、丘脑)有静息态功能联系受损，并存在注意力、视空间记忆等功能网络的异常。研究均提示小脑参与了癫痫受损的神经功能网络，或癫痫发作的控制环路。

Citation： 朱琼彬, 丁瑶, 丁美萍. 癫痫患者的小脑影像学研究进展. Journal of Epilepsy, 2016, 2(2): 145-149. doi: 10.7507/2096-0247.20160028 Copy

1.	Fine EJ, Ionita CC, Lohr L. The history of the development of the cerebellar examination. Seminars In Neurology, 2002, 22(4): 375-384.
2.	Sandok EK, O’Brien TJ, Jack CR, et al. Significance of cerebellar atrophy in intractable temporal lobe epilepsy: a quantitative MRI study. Epilepsia, 2000, 41(10): 1315-1320.
3.	Keller SS, Wieshmann UC, Mackay CE, et al. Voxel based morphometry of grey matter abnormalities in patients with medically intractable temporal lobe epilepsy: effects of side of seizure onset and epilepsy duration. J Neurol Neurosurg Psychiatry, 2002, 73(6): 648-655.
4.	De Marco FA, Ghizoni E, Kobayashi E, et al. Cerebellar volume and long-term use of phenytoin. Seizure-European Journal Of Epilepsy, 2003, 12(5): 312-315.
5.	Hermann BP, Bayless K, Hansen R, et al. Cerebellar atrophy in temporal lobe epilepsy. Epilepsy & Behavior, 2005, 7(2): 279-287.
6.	Szabo CA, Lancaster JL, Lee S, et al. MR imaging volumetry of subcortical structures and cerebellar hemispheres in temporal lobe epilepsy. AJNR Am J Neuroradiol, 2006, 27(10): 2155-2160.
7.	Oyegbile TO, Bayless K, Dabbs K, et al. The nature and extent of cerebellar atrophy in chronic temporal lobe epilepsy. Epilepsia, 2011, 52(4): 698-706.
8.	Dabbs K, Becker T, Jones J, et al. Brain structure and aging in chronic temporal lobe epilepsy. Epilepsia, 2012, 53(6): 1033-1043.
9.	Moeller F, Maneshi M, Pittau F, et al. Functional connectivity in patients with idiopathic generalized epilepsy. Epilepsia, 2011, 52(3): 515-522.
10.	Shin WC, Hong SB, Tae WS, et al. Ictal hyperperfusion of cerebellum and basal ganglia in temporal lobe epilepsy: SPECT subtraction with MRI coregistration. Journal Of Nuclear Medicine, 2001, 42(6): 853-858.
11.	Theodore WH, Fishbein D, Deitz M, et al. Complex Partial Seizures - Cerebellar Metabolism. Epilepsia, 1987, 28(4): 319-323.
12.	Kay BP, Holland SK, Privitera MD, et al. Differences in paracingulate connectivity associated with epileptiform discharges and uncontrolled seizures in genetic generalized epilepsy. Epilepsia, 2014, 55(2): 256-63.
13.	Crooks R,Mitchell T, Thom M. Patterns of cerebellar atrophy in patients with chronic epilepsy: a quantitative neuropathological study. Epilepsy Res, 2000, 41(1): 63-73.
14.	Newham BJ, Curwood EK, Jackson GD, et al. Pontine and cerebral atrophy in Lennox-Gastaut syndrome. Epilepsy Res, 2015, 120(1): 98-103.
15.	Tae WS, Joo EY, Kim ST, et al. Gray, White Matter Concentration Changes and Their Correlation with Heterotopic Neurons in Temporal Lobe Epilepsy. Korean Journal Of Radiology, 2010, 11(1): 25-36.
16.	Park KM, Han YH, Kim TH, et al. Cerebellar white matter changes in patients with newly diagnosed partial epilepsy of unknown etiology. Clin Neurol Neurosurg, 2015, 138(2): 25-30.
17.	Riley JD, Franklin DL, Choi V, et al. Altered white matter integrity in temporal lobe epilepsy: Association with cognitive and clinical profiles. Epilepsia, 2010, 51(4): 536-545.
18.	Li YH, Du HJ, Xie B, et al. Cerebellum Abnormalities in Idiopathic Generalized Epilepsy with Generalized Tonic-Clonic Seizures Revealed by Diffusion Tensor Imaging. Plos One, 2010, 5(12): e15219.
19.	Wiest R, Estermann L, Scheidegger O, et al. Widespread grey matter changes and hemodynamic correlates to interictal epileptiform discharges in pharmacoresistant mesial temporal epilepsy. Journal Of Neurology, 2013, 260(6): 1601-1610.
20.	Liu RS, Lemieux L, Bell GS, et al. Cerebral damage in epilepsy: a population-based longitudinal quantitative MRI study. Epilepsia, 2005, 46(9): 1482-1494.
21.	McDonald CR, Hagler DJ, Jr Ahmadi ME, et al. Subcortical and cerebellar atrophy in mesial temporal lobe epilepsy revealed by automatic segmentation. Epilepsy Res, 2008, 79(2-3): 130-138.
22.	Bohnen NI, O’Brien TJ, Mullan BP, et al. Cerebellar changes in partial seizures: Clinical correlations of quantitative SPECT and MRI analysis. Epilepsia, 1998, 39(6): 640-650.
23.	Lawson JA, Vogrin S, Bleasel AF, et al. Predictors of hippocampal, cerebral, and cerebellar volume reduction in childhood epilepsy. Epilepsia, 2000, 41(12): 1540-1545.
24.	Dam M, Bolwig T, Hertz M, et al. Does Seizure Activity Produce Purkinje-Cell Loss. Epilepsia, 1984, 25(6): 747-751.
25.	Mclain LW3Martin JT, Allen JH. Cerebellar Degeneration Due To Chronic Phenytoin Therapy. Annals Of Neurology, 1980, 7(1): 18-23.
26.	Ney GC, Lantos G, Barr WB, et al. Cerebellar Atrophy In Patients with Long-Term Phenytoin Exposure And Epilepsy. Archives Of Neurology, 1994, 51(8): 767-771.
27.	Luef G, Burtscher J, Kremser C, et al. Magnetic resonance volumetry of the cerebellum in epileptic patients after phenytoin overdosages. European Neurology, 1996, 36(5): 273-277.
28.	Spielmeyer W. The anatomic substratum of the convulsive state. Archives Of Neurology And Psychiatry, 1930, 23(5): 869-875.
29.	Specht U, May T, Schulz R, et al. Cerebellar atrophy and prognosis after temporal lobe resection. J Neurol Neurosurg Psychiatry, 1997, 62(5): 501-506.
30.	Benuzzi F, Mirandola L, Pugnaghi M, et al. Increased cortical BOLD signal anticipates generalized spike and wave discharges in adolescents and adults with idiopathic generalized lepsies. Epilepsia, 2012, 53(4): 622-630.
31.	Tousseyn S, Dupont P, Goffin K, et al. Correspondence between large-scale ictal and interictal epileptic networks revealed by single photon emission computed tomography (SPECT) and electroencephalography (EEG)-functional magnetic resonance imaging (fMRI). Epilepsia, 2015, 56(3): 382-392.
32.	Won JH, Lee JD, Chung TS, et al. Increased contralateral cerebellar uptake of technetium-99m-HMPAO on ictal brain SPECT. Journal Of Nuclear Medicine, 1996, 37(3): 426-429.
33.	Laich E, Kuzniecky R, Mountz J, et al. Supplementary sensorimotor area epilepsy - Seizure localization, cortical propagation and subcortical activation pathways using ictal SPECT. Brain, 1997, 120(3): 855-864.
34.	Al-Jafen BN, Alanazy MH, Scott JN, et al. Magnetic resonance imaging of crossed cerebellar diaschisis and bright pulvinar in status epilepticus. Neurosciences, 2012, 17(3): 259-261.
35.	Fujita K, Izumi Y, Harada M, et al. Crossed cerebellar hyperperfusion without restricted diffusion in status epilepticus. Journal Of Neurology, 2013, 260(2): 674-676.
36.	Zaidi SA, Haq MA, Bindman D, et al. Crossed cerebellar diaschisis: a radiological finding in status epilepticus not to miss. BMJ Case Rep, 2013, 2013(84): e2.
37.	Sequeira KM, Tabesh A, Sainju RK, et al. Perfusion network shift during seizures in medial temporal lobe epilepsy. PLOS One, 2013, 8(1): e53204.
38.	Fahoum F, Lopes R, Pittau F, et al. Widespread epileptic networks in focal epilepsies: EEG-fMRI study. Epilepsia, 2012, 53(9): 1618-1627.
39.	Stubgen JP. Crossed Cerebellar Diaschisis Related To Recurrent Focal Seizures. Epilepsia, 1995, 36(3): 316-318.
40.	Gold L, Lauritzen M. Neuronal deactivation explains decreased cerebellar blood flow in response to focal cerebral ischemia or suppressed neocortical function. Proceedings Of the National Academy Of Sciences Of the United States Of America, 2002, 99(11): 7699-7704.
41.	Schlaug G, Antke C, Holthausen H, et al. Ictal motor signs and interictal regional cerebral hypometabolism. Neurology, 1997, 49(2): 341-350.
42.	Hikima A, Mochizuki H, Oriuchi N, et al. Semiquantitative analysis of interictal glucose metabolism between generalized epilepsy and localization related epilepsy. Annals Of Nuclear Medicine, 2004, 18(7): 579-584.
43.	Koepp MJ, Richardson MP, Brooks DJ, et al. Central benzodiazepine/gamma-aminobutyric acidAreceptors in idiopathic generalized epilepsy: an [¹¹C]flumazenil positron emission tomography study. Epilepsia, 1997, 38(10): 1089-1097.
44.	Theodore WH, Carson RE, Andreasen P, et al. Pet Imaging Of Opiate Receptor-Binding In Human Epilepsy Using [F-18] Cyclofoxy. Epilepsy Research, 1992, 13(2): 129-139.
45.	Chen XM, Huang DH, Chen ZR, et al. Temporal lobe epilepsy: Decreased thalamic resting-state functional connectivity and their relationships with alertness performance. Epilepsy & Behavior, 2015, 44(6): 47-54.
46.	Zheng J, Qin B, Dang C, et al. Alertness network in patients with temporal lobe epilepsy: a fMRI study. Epilepsy Res, 2012, 100(1-2): 67-73.
47.	Lv ZX, Huang DH, Ye W, et al. Alteration of functional connectivity within visuospatial working memory-related brain network in patients with right temporal lobe epilepsy:Aresting-state fMRI study. Epilepsy & Behavior, 2014, 35(2): 64-71.

1. Fine EJ, Ionita CC, Lohr L. The history of the development of the cerebellar examination. Seminars In Neurology, 2002, 22(4): 375-384.
2. Sandok EK, O’Brien TJ, Jack CR, et al. Significance of cerebellar atrophy in intractable temporal lobe epilepsy: a quantitative MRI study. Epilepsia, 2000, 41(10): 1315-1320.
3. Keller SS, Wieshmann UC, Mackay CE, et al. Voxel based morphometry of grey matter abnormalities in patients with medically intractable temporal lobe epilepsy: effects of side of seizure onset and epilepsy duration. J Neurol Neurosurg Psychiatry, 2002, 73(6): 648-655.
4. De Marco FA, Ghizoni E, Kobayashi E, et al. Cerebellar volume and long-term use of phenytoin. Seizure-European Journal Of Epilepsy, 2003, 12(5): 312-315.
5. Hermann BP, Bayless K, Hansen R, et al. Cerebellar atrophy in temporal lobe epilepsy. Epilepsy & Behavior, 2005, 7(2): 279-287.
6. Szabo CA, Lancaster JL, Lee S, et al. MR imaging volumetry of subcortical structures and cerebellar hemispheres in temporal lobe epilepsy. AJNR Am J Neuroradiol, 2006, 27(10): 2155-2160.
7. Oyegbile TO, Bayless K, Dabbs K, et al. The nature and extent of cerebellar atrophy in chronic temporal lobe epilepsy. Epilepsia, 2011, 52(4): 698-706.
8. Dabbs K, Becker T, Jones J, et al. Brain structure and aging in chronic temporal lobe epilepsy. Epilepsia, 2012, 53(6): 1033-1043.
9. Moeller F, Maneshi M, Pittau F, et al. Functional connectivity in patients with idiopathic generalized epilepsy. Epilepsia, 2011, 52(3): 515-522.
10. Shin WC, Hong SB, Tae WS, et al. Ictal hyperperfusion of cerebellum and basal ganglia in temporal lobe epilepsy: SPECT subtraction with MRI coregistration. Journal Of Nuclear Medicine, 2001, 42(6): 853-858.
11. Theodore WH, Fishbein D, Deitz M, et al. Complex Partial Seizures - Cerebellar Metabolism. Epilepsia, 1987, 28(4): 319-323.
12. Kay BP, Holland SK, Privitera MD, et al. Differences in paracingulate connectivity associated with epileptiform discharges and uncontrolled seizures in genetic generalized epilepsy. Epilepsia, 2014, 55(2): 256-63.
13. Crooks R,Mitchell T, Thom M. Patterns of cerebellar atrophy in patients with chronic epilepsy: a quantitative neuropathological study. Epilepsy Res, 2000, 41(1): 63-73.
14. Newham BJ, Curwood EK, Jackson GD, et al. Pontine and cerebral atrophy in Lennox-Gastaut syndrome. Epilepsy Res, 2015, 120(1): 98-103.
15. Tae WS, Joo EY, Kim ST, et al. Gray, White Matter Concentration Changes and Their Correlation with Heterotopic Neurons in Temporal Lobe Epilepsy. Korean Journal Of Radiology, 2010, 11(1): 25-36.
16. Park KM, Han YH, Kim TH, et al. Cerebellar white matter changes in patients with newly diagnosed partial epilepsy of unknown etiology. Clin Neurol Neurosurg, 2015, 138(2): 25-30.
17. Riley JD, Franklin DL, Choi V, et al. Altered white matter integrity in temporal lobe epilepsy: Association with cognitive and clinical profiles. Epilepsia, 2010, 51(4): 536-545.
18. Li YH, Du HJ, Xie B, et al. Cerebellum Abnormalities in Idiopathic Generalized Epilepsy with Generalized Tonic-Clonic Seizures Revealed by Diffusion Tensor Imaging. Plos One, 2010, 5(12): e15219.
19. Wiest R, Estermann L, Scheidegger O, et al. Widespread grey matter changes and hemodynamic correlates to interictal epileptiform discharges in pharmacoresistant mesial temporal epilepsy. Journal Of Neurology, 2013, 260(6): 1601-1610.
20. Liu RS, Lemieux L, Bell GS, et al. Cerebral damage in epilepsy: a population-based longitudinal quantitative MRI study. Epilepsia, 2005, 46(9): 1482-1494.
21. McDonald CR, Hagler DJ, Jr Ahmadi ME, et al. Subcortical and cerebellar atrophy in mesial temporal lobe epilepsy revealed by automatic segmentation. Epilepsy Res, 2008, 79(2-3): 130-138.
22. Bohnen NI, O’Brien TJ, Mullan BP, et al. Cerebellar changes in partial seizures: Clinical correlations of quantitative SPECT and MRI analysis. Epilepsia, 1998, 39(6): 640-650.
23. Lawson JA, Vogrin S, Bleasel AF, et al. Predictors of hippocampal, cerebral, and cerebellar volume reduction in childhood epilepsy. Epilepsia, 2000, 41(12): 1540-1545.
24. Dam M, Bolwig T, Hertz M, et al. Does Seizure Activity Produce Purkinje-Cell Loss. Epilepsia, 1984, 25(6): 747-751.
25. Mclain LW3Martin JT, Allen JH. Cerebellar Degeneration Due To Chronic Phenytoin Therapy. Annals Of Neurology, 1980, 7(1): 18-23.
26. Ney GC, Lantos G, Barr WB, et al. Cerebellar Atrophy In Patients with Long-Term Phenytoin Exposure And Epilepsy. Archives Of Neurology, 1994, 51(8): 767-771.
27. Luef G, Burtscher J, Kremser C, et al. Magnetic resonance volumetry of the cerebellum in epileptic patients after phenytoin overdosages. European Neurology, 1996, 36(5): 273-277.
28. Spielmeyer W. The anatomic substratum of the convulsive state. Archives Of Neurology And Psychiatry, 1930, 23(5): 869-875.
29. Specht U, May T, Schulz R, et al. Cerebellar atrophy and prognosis after temporal lobe resection. J Neurol Neurosurg Psychiatry, 1997, 62(5): 501-506.
30. Benuzzi F, Mirandola L, Pugnaghi M, et al. Increased cortical BOLD signal anticipates generalized spike and wave discharges in adolescents and adults with idiopathic generalized lepsies. Epilepsia, 2012, 53(4): 622-630.
31. Tousseyn S, Dupont P, Goffin K, et al. Correspondence between large-scale ictal and interictal epileptic networks revealed by single photon emission computed tomography (SPECT) and electroencephalography (EEG)-functional magnetic resonance imaging (fMRI). Epilepsia, 2015, 56(3): 382-392.
32. Won JH, Lee JD, Chung TS, et al. Increased contralateral cerebellar uptake of technetium-99m-HMPAO on ictal brain SPECT. Journal Of Nuclear Medicine, 1996, 37(3): 426-429.
33. Laich E, Kuzniecky R, Mountz J, et al. Supplementary sensorimotor area epilepsy - Seizure localization, cortical propagation and subcortical activation pathways using ictal SPECT. Brain, 1997, 120(3): 855-864.
34. Al-Jafen BN, Alanazy MH, Scott JN, et al. Magnetic resonance imaging of crossed cerebellar diaschisis and bright pulvinar in status epilepticus. Neurosciences, 2012, 17(3): 259-261.
35. Fujita K, Izumi Y, Harada M, et al. Crossed cerebellar hyperperfusion without restricted diffusion in status epilepticus. Journal Of Neurology, 2013, 260(2): 674-676.
36. Zaidi SA, Haq MA, Bindman D, et al. Crossed cerebellar diaschisis: a radiological finding in status epilepticus not to miss. BMJ Case Rep, 2013, 2013(84): e2.
37. Sequeira KM, Tabesh A, Sainju RK, et al. Perfusion network shift during seizures in medial temporal lobe epilepsy. PLOS One, 2013, 8(1): e53204.
38. Fahoum F, Lopes R, Pittau F, et al. Widespread epileptic networks in focal epilepsies: EEG-fMRI study. Epilepsia, 2012, 53(9): 1618-1627.
39. Stubgen JP. Crossed Cerebellar Diaschisis Related To Recurrent Focal Seizures. Epilepsia, 1995, 36(3): 316-318.
40. Gold L, Lauritzen M. Neuronal deactivation explains decreased cerebellar blood flow in response to focal cerebral ischemia or suppressed neocortical function. Proceedings Of the National Academy Of Sciences Of the United States Of America, 2002, 99(11): 7699-7704.
41. Schlaug G, Antke C, Holthausen H, et al. Ictal motor signs and interictal regional cerebral hypometabolism. Neurology, 1997, 49(2): 341-350.
42. Hikima A, Mochizuki H, Oriuchi N, et al. Semiquantitative analysis of interictal glucose metabolism between generalized epilepsy and localization related epilepsy. Annals Of Nuclear Medicine, 2004, 18(7): 579-584.
43. Koepp MJ, Richardson MP, Brooks DJ, et al. Central benzodiazepine/gamma-aminobutyric acidAreceptors in idiopathic generalized epilepsy: an [¹¹C]flumazenil positron emission tomography study. Epilepsia, 1997, 38(10): 1089-1097.
44. Theodore WH, Carson RE, Andreasen P, et al. Pet Imaging Of Opiate Receptor-Binding In Human Epilepsy Using [F-18] Cyclofoxy. Epilepsy Research, 1992, 13(2): 129-139.
45. Chen XM, Huang DH, Chen ZR, et al. Temporal lobe epilepsy: Decreased thalamic resting-state functional connectivity and their relationships with alertness performance. Epilepsy & Behavior, 2015, 44(6): 47-54.
46. Zheng J, Qin B, Dang C, et al. Alertness network in patients with temporal lobe epilepsy: a fMRI study. Epilepsy Res, 2012, 100(1-2): 67-73.
47. Lv ZX, Huang DH, Ye W, et al. Alteration of functional connectivity within visuospatial working memory-related brain network in patients with right temporal lobe epilepsy:Aresting-state fMRI study. Epilepsy & Behavior, 2014, 35(2): 64-71.

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