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Connectivity of the supplementary motor area in juvenile myoclonic epilepsy and frontal lobe epilepsy

机译:青少年肌阵挛性癫痫和额叶癫痫的辅助运动区的连通性

摘要

PPurpose: Subtle structural abnormalities of frontal lobe gray and white matter have been described in cryptogenic frontal lobe and idiopathic generalized epilepsies. The supplementary motor area (SMA) has a role in motor control, and its involvement during frontal lobe epileptic seizures is characterized by a typical asymmetric tonic posturing. Moreover, motor networks are dysfunctional in juvenile myoclonic epilepsy (JME). We tested the hypothesis that SMA structural connectivity is altered in focal frontal lobe epilepsy (FLE) and JME compared to healthy controls. Methods: Diffusion tensor imaging (DTI) and probabilistic tractography were used to map the structural connectivity of the SMA, defined by motor functional magnetic resonance imaging (MRI), in 15 patients with JME, 36 patients with FLE, and 18 healthy controls. Key Findings: Structural connectivity of the SMA was significantly reduced in JME compared to controls (reduced fractional anisotropy and increased mean diffusivity). In FLE there was no significant difference compared to controls, and in all groups there was stronger connectivity in the left hemisphere (higher fractional anisotropy) compared to the right. There was no difference in SMA connectivity between patients with medial or lateral frontal lobe epileptic foci. Significance: Reduced white matter connectivity is the structural correlate of functional frontal lobe abnormalities in JME. In FLE, the structural connectivity of the SMA was preserved, suggesting a robust motor network that is not compromised by longstanding epilepsy involving the medial frontal lobes.
机译:目的:额叶灰质和白质的细微结构异常已在隐源性额叶和特发性全身性癫痫中得到描述。辅助运动区(SMA)在运动控制中起作用,其在额叶癫痫发作中的参与具有典型的非对称性强直姿势。此外,在青少年肌阵挛性癫痫(JME)中,运动网络功能失调。我们测试了以下假设:与健康对照组相比,局灶性额叶癫痫(FLE)和JME中SMA结构的连接性发生了改变。方法:对15例JME患者,36例FLE患者和18例健康对照者,采用弥散张量成像(DTI)和概率束摄影术绘制了SMA的结构连通性,并通过运动功能磁共振成像(MRI)进行了定义。关键发现:与对照相比,JME中SMA的结构连通性显着降低(分数各向异性降低和平均扩散率提高)。与对照组相比,在FLE中没有显着差异,并且与右侧相比,所有组中左半球的连接性都更强(分数各向异性更高)。内侧或外侧额叶癫痫灶患者之间的SMA连接性无差异。启示:白质连通性降低是JME中功能性额叶异常的结构相关性。在FLE中,SMA的结构连通性得以保留,这表明强大的运动网络不会受到涉及内侧额叶的长期癫痫病的危害。

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