| Objective: Working memory is a key component of cognitive function.Impaired working memory in temporal lobe epilepsy patients is universal and functionally important,but the mechanism of working memory impairment is not fully understood.We used structural and resting state functional MRI to study working memory impairment in patients with temporal lobe epilepsy,and explored the brain structure and brain network mechanism of temporal lobe epilepsy with impaired working memory.To study the brain structure of temporal lobe epilepsy with working memory disorders such as important areas of gray matter volume decline,white matter microstructure changes,abnormal white matter fiber bundle changes and changes in brain network functional connection characteristics,to clarify the important brain structure of working memory and the importance of brain network Functional connection.Methods: Recruit 31 patients with temporal lobe epilepsy and complete the visual working memory behavior test.According to the reaction time and correct rate,they were divided into the temporal lobe epilepsy with working memory disorder group(16 cases in WM group)and the temporal lobe epilepsy without working memory disorder group(15 cases in the TLE group).20 healthy subjects matched by age and gender were the control group(CON group).All subjects completed 3.0T MRI T1 WI,T2WI,Flair,resting state functional imaging scans,and all subjects underwent MMSE,MOCA,HAMD-17,BDI-21 cognitive and anxiety and depression evaluation.Some of the subjects did not enter the statistical analysis due to head movement and poor image registration.The DPARSFA V2.3 toolkit was used for post-processing of the resting state data under the MATLAB 2009 a environment,and the structural images of the SPM12 toolkit were used for statistical analysis.Perform a one-way analysis of variance and post-hoc post-hoc test analysis(P<0.05)for the differences between the three groups,perform Pearsen correlation analysis for the two variables that meet the normal distribution,and Spearman correlation analysis for the two variables that do not conform to the normal distribution..Correlation analysis of VBM results,VBA results,functional link strength and working memory behavior,MOCA,MMSE cognition,HAMD-17,BDI-21 depression scores(P<0.05).Results: The study subjects had no statistical differences in age,gender,time of onset,type of medication,MOCA,MMSE,BDI-21,HAMD-17 score,height,and weight;the cortical gray matter volume of the WM group was lower than that of the TLE group and the CON group The sites were all right cerebral hemisphere,right superior temporal gyrus,right temporal pole,midbrain,putamen,phalanx nucleus,right pale ball,left fusiform gyrus,right brodmann area 19 area(FWE correction,p <0.05),but there is no statistically significant difference in gray matter volume between the TLE group and the CON group(FWE correction,p>0.05);correlation analysis found that there was a positive correlation between the ACC of the TLE group and the right superior temporal gyrus in the VBM results(P<0.05),no significant correlation with other masses in VBM results,RT in patients with TLE has no correlation with all VBM results;RT in WM group has a negative correlation with the right superior temporal gyrus in VBM results(p< 0.05),there is a positive correlation between ACC and the right superior temporal gyrus in the VBM results(p<0.05),and no significant correlation with other masses.Using VBA method to analyze three groups of microstructures.It was found that the white matter microstructural damage sites of WM group compared with CON group were mainly in the right frontal and inferior frontal gyrus,right insular lobe,right marginal lobe,left parietal lobe,left ECNtral posterior gyrus,left BA3,left margin Leaf and left buckle back(P<0.001,Alphasim correction,Cluster size>89voxels);while there was no significant statistical difference between the WM group and the TLE group and between the TLE group and the CON group(P>0.001);but the white matter microstructure There was no correlation between the change and its behavior and clinical evaluation(p>0.05).Using TBSS to analyze the white matter fiber bundles among the three groups,there was no statistical difference between the three groups(p>0.001).Based on the functional connection of interest,compared with the CON group and the TLE group,the brain function connection of the left hippocampus-right posterior buckle and the left hippocampal gyrus-right posterior buckle of the WM group was significantly increased(FDR correction,P<0.05),these brain functional connections were significantly positively correlated with working memory response time(P<0.05),and were not related to ACC,MOCA,MMSE,HAMD-17,BDI-21(P>0.05).Conclusion: The working memory impairment of patients with temporal lobe epilepsy may be earlier than the clinically assessable cognitive impairment.Temporal lobe epilepsy with working memory impairment may be related to the right frontal midfrontal and inferior frontal gyrus,right insular lobe,right marginal lobe,left The lateral parietal lobe,the left ECNtral posterior gyrus,the left BA3,the left marginal lobe,and the left cingulate gyrus are related to the white matter microstructure changes,but there has not been obvious abnormal formation of white matter fiber bundles;temporal lobe epilepsy with working memory The main sites of gray matter volume reduction in the obstructive cortex are the right superior temporal gyrus,right temporal pole,midbrain,putamen,squamous nucleus,right globus pallidus,left fusiform gyrus,right brodmann area 19;temporal lobe epilepsy With working memory impairment,there is an increase in the functional connection between the left MTL structure(including the left hippocampus and the hippocampus)and the right rear buckle.This differential connection is related to working memory reaction time,but has no obvious correlation with the correct rate.The abnormality of this functional connection may be related to its functional compensation. |
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