A Preliminary Study Of The Brain Stem Sonography In Epileptic Patients With Depression

Objective Transcranial sonography(TCS)is a promising neuroimaging technique for detecting small deep brain parenchyma.TCS has been used in the diagnosis and differential diagnosis of Parkinson's disease(PD).Sonographic hypoechogenicity of brainstem raphe(BR)has been depicted in patients with major depression(MD)and depressed patients with different neurodegenerative disease such as PD and Huntington disease.But,up to date,the association of BR alterations in TCS in epileptic patients with depression has never been reported.This study was to investigate the possible role of BR examination via TCS in epileptic patients with depression.Methods 46 patients with idiopathic generized tonic-clonic seizures and 45 healthy controls were recruited.The diagnosis of epilepsy meets the diagnostic criteria established by the international league against epilepsy(ILAE).The diagnosis of depression was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV(DSM-IV),and the severity of depression was measured by the Chinese version Neurological Disorders Depression Inventory for Epilepsy(C-NDDI-E)and Beck Depression Inventory-?(BDI-?).TCS was performed by an experienced sonographer.Echogenicity of caudate nuclei(CN),lentiform nuclei(LN),substantia nigra(SN)and brainstem raphe(BR)and width of the lateral ventricle frontal horns(WFLV)and the third ventricle(WTV)were assessed via TCS.Results The width of the third ventricle in epileptic patients was significantly larger than that in healthy controls(P=0.001),and there was no significant differences in the width of the third ventricle between epileptic patients with depression and epileptic patients without depression(P=0.293).There were no significant differences between epileptic patients and healthy controls in the width of frontal horn of the lateral ventricle(P=0.193),as well as in the echogenicity of SN(P=0.054),CN(P=0.838),LN(P=0.592)and BR(P=0.235).We found that epileptic patients with hypoechogenic BR had significantly higher C-NDDI-E and BDI-? scores than those with normal BR signal(P < 0.05 for both C-NDDI-E and BDI-?),and most epileptic patients with depression(75%)exhibited hypoechogenic BR but few epileptic patients without depression(3.33%)exhibited hypoechogenic BR(P= 0.000).Conclusions TCS signal alteration of BR can be a biomarker for depression in epilepsy but not be associated with epilepsy itself.The patients with idiopathic generized tonic-clonic epilepsy may have a wider third ventricle than healthy people.