Hemodynamics And Correlation Study Of 3D Arterial Spin-labeled Perfusion Imaging In Patients With Idiopathic Generalized Epilepsy With Generallized Tonic Colonic Seizure

Objective:To evaluate the diagnostic value of 3D Arterial spin labeling(3D-ASL)examination in idiopathic generalized epilepsy with generalized tonic colonic seizure(IGE-GTCS)patients,we monitored the dynamic change of Cerebral blood flow(CBF).We looked into the co-relation of abnormal cerebral perfusion and linguistic function in patients using simplified Token test.Method:According to 3.0T conventional MRI results,24 patients who first diagnosed with IGE-GTCS(by senior clinician specialized in epilepsy according to ILAE diagnostic criteria,without structural abnormality in cranial MRI and all of them were sifted under the condition of right-handed hand)were selected as the study group and 24 healthy volunteers as the control group.Both groups received ambulatory electroencephalogram,MRI and 3D-ASL and simplified Token test.We also collect their medical history(including general background,educational background,family history,medical history and neurological disease history).Also,subjects in both groups have taken whole brain 3D-PCASL using GE3.0T MRI machine.MRI data of 16 ROI(bilateral front lobe,apical lobe,temporal lobe,occipital lobe,cerebellum,hippocampus,hypothalamus,basic ganglion)was collected.Data were then analysis and generated CBF value using GE AW4.6 Fuctool software.T-test was performed to analyse data according to different ROI.Also,simplified Token test was conducted on every subject.Correlation test was conducted between CBF and Token test score according to ROI,which have shown a statistically difference(P<0.05).Simplified Token test was performed in both groups and the individual score was recorded.Pearson test was conducted between CBF and Token test result of each ROI.P<0.05 was regarded as statistically meaningful.Result:1.The cerebral blood flow in the study group was statistically lower than that in the normal group.Our data also indicated that the decreased cerebral area was mainly located in the left thalamus,parietal lobe,temporal lobe and right frontal lobe.2.Only 23.08%of poor brain perfusion area shown by 3D-ASL is coincide with the abnormal epilepsy area according to AEEG.3.Our study indicated that all 24 subjects in the control group have normal Token test results,while 4 subjects in the study group showed linguistic disorder,of which 1 subject with medium disorder(17～24 point)and 3 with slightly disorder(25～28 point).4.The CBF value of temporal lobe showed positive correlation with simplified Token test score in patients.(r =0.587,p =0.03).Conclusion:1.The cerebral perfusion after IGE-GTCS attack resulted in a dramatic decreased in left thalamus,temporal lobe,parietal lobe and right frontal lobe.This may related to the onset mode of primary generalized epilepsy.2.There was no correlation between the loci of hypo-perfusion in IGE-GTCS patients and the epileptic wave discharge area according to AEEG.3.The linguistic function of IGE-GTCS patients was slightly compromised compared with normal subjects.4.The CBF value and comprehensive ability showed correlation in patients with IGE-GTCS according to Person analysis.Also,our data indicated that left temporal lobe is one of the hypo-perfusion brain areas.Therefore,we presumed that temporal lobe of dominate hemisphere is a critical area for the linguistic function.