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目的采用静息态功能磁共振(fMRI)脑网络分析技术对儿童失神发作时静息态脑网络的改变进行观察,旨在发现癫癎发作时患儿认知功能受损情况。方法根据病例选择标准,共纳入12例诊断明确的失神发作患儿,采用同步脑电图-fMRI技术采集17对弥漫性棘慢波综合发放和无发放状态下fMRI数据;以独立成分分析法分别观察丘脑、默认网络、背侧注意网络、中央执行网络和感知觉网络等7个静息态脑网络在不同状态下的表现情况。结果配对t检验及相关分析结果提示,在弥漫性棘慢波综合发放状态下丘脑表现为脑电活动同步性增强,且其强度与弥漫性棘慢波综合发放持续时间呈正相关(r=0.890,P=0.000);默认网络(r=-0.706,P=0.000)、背侧注意网络(r=-0.829,P=0.000)、中央执行网络(r=-0.905,P=0.000)等负责高级认知功能处理的静息态脑网络则表现为脑电活动同步性降低,并与弥漫性棘慢波综合发放持续时间呈负相关。而低级的感知觉网络的改变与弥漫性棘慢波综合发放无显著相关关系(P>0.05)。结论本研究首次验证丘脑可能与儿童期失神癫癎弥漫性棘慢波综合发放有关,并首次提出,除默认网络功能外,儿童失神发作还可表现为注意力及执行控制能力等高级认知功能受损,而低级感知觉功能虽可能受累但不明显。这一发现有益于对儿童失神发作时意识受损的病理生理学机制的理解。
Objective To investigate the changes of resting brain network in children with absent seizures by resting state functional magnetic resonance (fMRI) brain network analysis, in order to find out the impaired cognition in children with seizures. Methods According to the case selection criteria, a total of 12 children with absent seizures were enrolled in this study. Seventeen pairs of diffuse spikes and slow waves (FMRI) data were collected by synchronous electroencephalography (fMRI), and the independent component analysis To observe the performance of seven resting brain networks such as thalamus, default network, dorsal attention network, central executive network and sensory perception network in different states. Results The paired t-test and correlation analysis indicated that the synaptic activity of the thalamus was enhanced synchronously in diffuse spike-and-wave synthesis state, and the intensity was positively correlated with the diffuse spike-wave duration (r = 0.890, (R = -0.806, P = 0.000); the default network (r = -0.706, P = 0.000), the dorsal attention network Cognitive function of resting state brain network showed decreased synchronization of EEG activity, and diffuse spike-wave synthesis release duration was negatively correlated. However, there was no significant correlation between the change of low-level perception network and diffuse spike-wave comprehensive distribution (P> 0.05). Conclusions This study, for the first time, verifies that thalamus may be associated with diffuse spike-and-wave diffusion in childhood absence of epilepsy. For the first time, in addition to the default network function, absence of seizures in children may manifest as advanced cognitive function such as attention and executive control Impaired, while the low-level sensory function may be involved but not obvious. This finding benefits the understanding of the pathophysiological mechanisms of impaired consciousness in children’s absence episodes.