The Study On Diffusion Tensor Imaging In MRI Negative Epilepsy Comorbid Sleep Disorder

Objective:Polysomnography（PSG）and diffusion tensor imaging（DTI）were used to explore the sleep characteristics and changes of brain structure network in patients with MRI negative epilepsy comorbid sleep disorder,analyze the relevant factors affecting the changes of brain structure network,and explore the possible neuropathological mechanism.Methods:Select epileptic patients with normal brain 3.0T MRI plain scan results,collect epilepsy related clinical data,and complete Epworth Sleepiness Scale（ESS）and Pittsburgh sleep quality index（PSQI）.Patients with epilepsy who complained of sleep disorder and PSQI index≥11 were monitored by nighttime polysomnography（PSG）.Those with objective sleep disorder confirmed by PSG were included in the epilepsy comorbid sleep disorder group;Those who had no chief complaint of sleep disorder and PSQI score<11 were included in epilepsy group;Healthy people matched by age and sex were selected as healthy control group.All subjects underwent cranial magnetic resonance diffusion tensor imaging（MRI-DTI）.The PSG monitoring results of epileptic comorbid sleep disorder group were collected and their sleep characteristics were analyzed.The DTI image data of all subjects were processed and analyzed by using the spatial statistical analysis method based on white matter skeleton（TBSS）.The differences of whole brain anisotropy score（FA）and mean diffusion coefficient（MD）were compared between the epileptic sleep disorder group,the epileptic group and the healthy control group,and the different brain regions were extracted.Finally,the significantly changed FA value,MD value and epilepsy related factors in the epileptic sleep disorder group were analyzed Spearman correlation analysis of PSG index.Results:This study included 36 patients with epilepsy,35 patients with epilepsy and 35healthy controls.There was no difference in age and gender among epilepsy comorbid sleep disorder group,epilepsy group and healthy control group.Compared with epilepsy group,there was no difference in onset age,seizure frequency,seizure type and anti seizure drug（ASM）treatment between epilepsy comorbid sleep disorder group and epilepsy group;There were significant differences in the course of disease（P=0.048<0.05）and the tendency of nocturnal attack（P=0.044<0.05）,and there were significant differences in HAMD score and HAMA score（P=0.000<0.05）.The results of PSG analysis showed that the sleep characteristics of epilepsy comorbid sleep disorder group were shortened sleep latency,imbalance of sleep structure,shortened N1 phase,prolonged N2 phase,shortened REM phase,significantly increased wake-up time after falling asleep,fragmented sleep and reduced sleep efficiency.DTI data analysis found that the FA values of MCP,GCC,BCC,SCC,ACR,EC and R-PTR decreased,and the MD values of GCC,BCC,ALIC,ACR,SCR,EC and R-PLIC increased significantly,suggesting extensive white matter injury.The FA values of SCC（R~2=0.3515,P=0.0001）,CSS（R~2=0.3559,P=0.0001）,BCC（R~2=0.3608,P=0.0001）,ACR（left:R~2=0.2117,P=0.0047;right R~2=0.3029,P=0.0005）and R-PTR（R~2=,0.2070,P=0.0053）were negatively correlated with the course of epilepsy;The MD values of BCC（R~2=0.3561;P=0.0001）,GCC（R~2=0.3389,P=0.0002）,ACR（right::R~2=0.2033,P=0.01382;left:R~2=0.2452,P=0.0119）were positively correlated with the course of epilepsy;The FA value of R-ACRwas positively correlated with REM%（R~2=0.3017,P=0.0016）,and the FA value of R-ACR was negatively correlated with N2%（R~2=0.2669,P=0.0026）.There was no correlation in other brain regions,suggesting that the longer the course of disease,the heavier the damage of neural network,and the abnormal R-ACR network of right radiation crown was related to the disorder of sleep structure.Conclusion:1.The objective sleep disorder characteristics of patients with epilepsy comorbid sleep disorder:shortened sleep latency,imbalance of sleep structure,fragmented sleep and reduced sleep efficiency.2.Patients with epilepsy and epilepsy comorbid sleep disorder have extensive white matter injury,namely abnormal neural network,which mainly involves the following brain regions::MCP,GCC,BCC,SCC,ACR,ALIC,SCR,EC,R-PTR and R-PLIC.3.The longer the course of epilepsy,the more serious the damage of neural network.The abnormal r-ACR network of the right radiation crown is related to the disorder of sleep structure.