| 摘要: | 磁振造影下計算小腦體積對於癲癇致病機轉之探討 目的: 此篇研究在於探討癲癇病人小腦體積的改變的意義。 在局部癲癇的患者小腦萎縮的流行率大約是30%， 癲癇病人的小腦萎縮已有人認為是因為癲癇發作所造成的腦部傷害而引起的或是因為長期抗癲癇藥物所造成的，有些研究認為是跟癲癇本身的原因有關，本研究的目的在於 1.分析病人小腦體積和正常人的不同. 2.可能導致小腦萎縮的因素及其意義 方法: 本實驗為一回顧性、個案控制、橫斷性研究，我們收集了15位癲癇門診的病人，詳細紀錄其病史、包括抽搐過程、服藥病史、癲癇症原因、抽搐型態及癲癇病灶。我們也從我們的神經健康檢查中心收案有19位健康個案 (10位男性9位女性)。病人組及對照組個案均有接受磁振造影檢查並測量其顱內體積(TIV)、小腦體積 (包括右小腦及左小腦)及小腦引部矢狀切面面積。我們利用統計軟體來作數據的分析。 結果：顯示顱內體積 (TIV) 於對照組及病人組並沒有不同(對照組TIV的平均值=1477.6ml、病人組TIV的平均值=1434.05ml)，正常人的顱內體積 (TIV)和小腦體積差異來自於性別、年紀，其中有男性TIV的平均值=1545.9ml女性=1401.7ml 、P值等於0.0026；男性小腦體積(CV) 的平均值等於149.9ml女性等於133.8ml、P值 0.003 有顯著不同。在CV/TIV係數正常化後男性和女性的小腦體積並沒有顯示出不同，但在病人組及對照組之C/TIV值則有明顯之不同；對照組之C/TIV=0.0964而病人組之C/TIV值＝0.0881，F=5.28，P=0.00074<0.01，單尾T檢定 P=0.028<0.05。 小腦引部矢狀切面面積在病人組及對照組無明顯之不同。我們進一步分析在不同變數下對C/TIV值的影響，結果發現症狀性癲癇病人的小腦體積明顯較原發性癲癇病人的小腦體積為小。 結論： 造成癲癇病人小腦萎縮的原因為多重因素，除了癲癇發作及藥物傷害外，先天體質因素及後天器質性傷害造成之功能異常的小腦可能使癲癇發作的閾值降低， 因 此如果我們發現在頭部外傷後、大腦出血、阻塞後或其他器質性腦病變之後有小腦萎縮或基底核萎縮之現象我們可能預測其癲癇發作之可能性較高，而可作一些告知及預防的動作。; Abstract Purpose: To investigate the cerebellar volume change in epileptic patients. It’s said that the prevalence of cerebellar atrophy in chronic focal epilepsy is about 30%. Cerebellar atrophy in epileptic patient was told to be due to the damage of seizure itself, drug intoxication and other factor related to epilepsy. The aim in this study is to 1.analyze the cerebellar volume difference between patient and control group. 2.the possible factors that cause cerebellar atrophy and it’s significance Methods: A retrospective, case-controlled cross-sectional study. We collected 15 epileptic patients from epileptic clinic and detail the history about seizure duration, drug history, epileptic syndrome, seizure type and epileptic focus. We also enrolled 19 healthy (10 male and 9 female) subjects from our neurological health examination clinic. MR volumetric Total intracranial volume (TIV), cerebellar volume (CV), right cerebellar volume (Rc), left cerebellar volume and mid-sagittal vermian area (M-SVA) was performed in both control and patient group. Microsoft excels statistic software wave use to analyze the data. Result: TIV volume shows no difference between control and patient groups (control group TIV=1477.6 vs patient group=1434.05ml). The TIV and cerebellum differed by sex, with mean male TIV=1545.9, female=1401.7, p=0.0026<0.01, mean male CV=149.9, female CV=133.8, p=0.003<0.01. After the CV/TIV normalization, there shows no difference of cerebellum between male and female There is difference of C/TIV between control and patient group with mean control/patient C/TIV=0.0964/0.0881, F=5.28, p=0.00074<0.01, t-test p=0.028<0.05. No difference can be found in Mid-sagittal vermian area. We further evaluate and analyze the C/TIV among the different parameters. Only the symptomatic group shows significant decreased cerebellum volume as compared with the idiopathic group. Conclusion: Functional abnormality of cerebellum of variable cause might lower the threshold of seizure attack. We might predict the seizure tendency and do some prevention if we found cerebellar atrophy, basal ganglion atrophy in case such as post-head injury, post- cerebral hemorrhage and other organic brain lesion. |
