目的 探讨颞叶癫痫(temporal lobe epilepsy ,TLE)患者执行功能的脑功能状态及激活模式.方法 应用注意网络测试(attentional networks test,ANT)软件,对12例TLE患者及12名健康受试者进行执行功能行为学测试;应用组块式功能磁共振(functional magnetic resonance imaging ,fMRI)扫描,使用统计参数图(Statistical Parametric Mapping 2,SPM 2)软件分析fMRI数据.结果 与健康受试组比较,TLE患者组执行功能反应时间(RT)较慢[患者组:(158.9±50.2)ms;健康受试组:(112.4±28.3)ms, t=2.63,P<0.05].健康受试组执行功能fMRI显示激活脑区右侧半球偏侧化,位于右扣带回后部、颞下回、前额叶、海马、顶叶及左颞中回.TLE患者组右侧前额叶和右额叶 (激活体素:53,34 voxel P<0.01)等靠近中线脑区激活体素较小.健康受试组存在与反应时间正、负相关脑区(P<0.001),TLE组则仅存与反应时间正相关脑区(P<0.001).结论 TLE患者存在执行功能障碍,与上述脑区激活功能低下和失调控有关,这些脑区可能是TLE患者执行功能损害的形态学基础.%Objective To investigate cerebral activation in patients with temporal lobe epilepsy ( TLE ) when they performed the executive network task using functional magnetic resonance imaging ( fMRI ). Methods Twelve patients with TLE and 12 controls were enrolled. The computer ANT software and Block - designed fMRI were used to evaluate the attentional network efficiency and the executive network cerebral activation and efficiency, respectively. FMRI date were preprocessed and analyzed using Statistical Parametric Mapping 2( SPM2 )software. Results The executive network efficiency reaction time of the TLE group were lower than that of the healthy control group[ TLE : ( 158.9±50.2 ) ms, Control: ( 112.4±28.3 ) ms , t = 2.63 ,P ＜ 0.05]. During the executive network fMRI task, the healthy controls demonstrated the right cerebral lateralized in the right midline cerebral areas of the prefrontal, parietal lobe while the TLE group showed significantly reduced activation in the right midline cerebral areas ( Right prefrontal lobe 53 voxel activated, Right frontal lohe 34 voxel activated P ＜ 0.01 ). Normal subjects had both reaction time correlative positive and negative cerebral areas while TLE patients only had negative correlative cerebral areas. Conclusions TLE may have executive impairment due to reduced activation of the right midline cerebral areas and deficiency of positive self-regulatory cerehral areas.
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