Resting-state FMRI Study Of Temporal Lobe Epilepsy With Ictal Panic

Objective Temporal lobe epilepsy(TLE)is one of the most common focal epilepsy.Some TLE patients have ictal panic(IP),which is usually confused with panic attack(PA)in panic disorder(PD).Previous studies have described temporal lobe epilepsy with ictal panic(TLEIP),but the specific mechanism is unclear.Functional magnetic resonance imaging(f MRI)has been widely used in the study of TLE pathogenesis and mental diseases.Here,we use resting state functional magnetic resonance imaging(Rs-f MRI)to study the brain abnormalities of patients with temporal lobe epilepsy with ictal panic,and try to explore the causes and mechanism of ictal panic in patients with TLEIP.Methods A total of 40 TLE patients were included.According to whether there was ictal panic,TLE patients were divided into TLEIP group(n = 12)and TLE patient control group(n = 28),as well as 30 age-sex-matched healthy controls.We collected clinical,physiological and Rs-f MRI imaging data and neuropsychological data.In this study,Hamilton Anxiety Scale(HAMA)was used to measure and compare the anxiety levels of the three groups;In addition,the HAMA score of TLEIP was correlated with the time of panic symptoms,so as to evaluate whether the ictal panic of patients with TLEIP was caused by anxiety.After that,Rs-f MRI was used to study the local neural markers of three groups: fractional amplitude of low frequency fluctuation(Falff),regional homogeneity(Re Ho),degree centrality(DC),functional connectivity(FC),GCA and brain network topology.From point to surface,from local to overall,to explore the causes and mechanisms of ictal panic in patients with TLEIP.Finally,statistical tools such as SPSS are used for calculation.Results(1)The study of local nerve markers in the three groups: there was no significant difference in age and gender among TLEIP,TLE and HCs groups.There was no significant difference in education level,Montreal Cognitive Assessment(Mo CA)and HAMA between TLEIP group and TLE group.There was no correlation between IP symptom duration and HAMA score in 12 patients with TLEIP starting from the right temporal lobe.In addition,the duration of all IPS is less than 2 minutes,and most are less than 1 minute.Compared with the HCS group,the Re Ho value in the right middle frontal gyrus decreased significantly in the TLEIP group.Compared with the HCS and tle groups,the DC value in the left middle temporal gyrus was significantly increased in the TLEIP group.Compared with HCS and tle groups,no region showed significant difference in falff.(2)We found that there was a functional connection between the left cerebellar gyrus(tlei)and the left cerebellar gyrus(lmtg)in the tlei group compared with the LMFC group.Although FC was also found between lmtg and LITG in TLE group compared with HCS group,the area of LITG in TLE IP group and HCs group was larger than that in TLE group and HCs group.In addition,the FC intensity of TLEIP group and HCs group was stronger than that of TLE group and HCs group.(3)GCA of three groups of subjects: through the analysis of the three groups of data,we found that in the three groups,compared with the normal control group,there was significant information flow into the bilateral amygdala in the right middle frontal gyrus in the TLEIP group.Compared with HC group and TLE group,there was no corresponding significant information inflow or significant information outflow in hippocampus and thalamus in TLEIP group.(4)Changes of brain function topological network of the three groups: in the sparsity range of 0.04-0.40,all the three groups showed an efficient small world topological structure Compared with HC,TLE group γ Significantly lower in the TLEIP group γ stayα=0.05 there was no significant difference.Compared with HC,TLE group λSignificantly increased in the TLEIP group λ stay α= 0.05 there was no significant difference.Compared with HC,TLE group σ Significantly lower in the TLEIP group σ stay α= 0.05 there was no significant difference.In addition,after comparing Eglob and Eloc among the three groups,we found that Eglob in TLEIP and TLE group decreased significantly compared with HC group,but there was no significant difference in Eloc among the three groups Conclusion(1)The ictal panic of patients with TLEIP is different from the traditional anxiety induced panic attack,whether from the score of HAMA,the actual duration of each attack,or the relationship between the time of onset and HAMA.In addition,through the study of RS f MRI,we found that the Re Ho of the right middle frontal gyrus and the DC of the left MTG in the functional brain of TLEIP decreased,which seems to suggest that these two parts may be used as neural markers of the functional brain network of patients with TLEIP.(2)The functional connection in the brain of patients with TLEIP has significant changes compared with normal control and tle control,but the changed area is not in the classical fear circuit,which seems to suggest that the special FC of TLEIP is associated with ictal panic.(3)Through the study and discussion of GCA of three important fear circuit nodes in the brain of patients with TLEIP:amygdala,hippocampus and thalamus,we believe that ictal panic in patients with TLEIP is an epileptic,transient,repetitive and stereotyped attack that will not remain and solidify long-term fear memory.(4)Through the study of brain network topology attributes,we found that there was no significant difference in brain network topology attributes between TLEIP patients and TLE patients.