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Neuroimaging and the progression of epilepsy.

机译：神经影像学和癫痫的进展。

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Several lines of evidence can be used to try to answer the question of whether epilepsy is a progressive disease, and whether persistent seizures, or the underlying process itself, cause neuronal injury. The results of clinical studies have been inconclusive. Neuroimaging studies offer a quantitative approach. In patients with temporal lobe epilepsy, structural magnetic resonance imaging (MRI) has shown volume reductions ipsilateral to the epileptic focus in hippocampal and extrahippocampal regions; the former, in cross-sectional studies, increase with increasing epilepsy duration. Other factors associated with increasing hippocampal atrophy include a history of complex or prolonged febrile seizures, and generalized tonic-clonic seizure number. Positron emission tomography (PET) has shown supporting results. However, these studies have been cross-sectional rather than longitudinal. Preliminary results from prospective imaging studies using fluorodeoxyglucose PET and volumetric MRI show that patients with more recent seizure onset are less likely to have hypometabolism or volume loss than those with a long history of epilepsy. Alternate interpretations of these data include a possible progressive effect of epilepsy, or a tendency for patients with structural or functional findings at seizure onset to be more likely to develop uncontrolled epilepsy. In addition to the human studies that have been performed, parallel investigations in animal models using some of the same imaging techniques may help to unravel the factors associated with neuronal injury due to seizures, and aid in interpreting results of clinical studies.
机译：可以使用多种证据来尝试回答癫痫是否是进行性疾病，持续性癫痫发作或潜在过程本身是否引起神经元损伤的问题。临床研究的结果尚无定论。神经影像学研究提供了一种定量方法。对于颞叶癫痫患者，结构磁共振成像（MRI）显示在海马区和海马区癫痫病灶的同侧体积减小。在横断面研究中，前者随着癫痫持续时间的增加而增加。与海马萎缩增加相关的其他因素包括复杂或长时间的高热惊厥史，以及全身性强直-阵挛性惊厥次数。正电子发射断层扫描（PET）已显示出支持的结果。但是，这些研究是横断面而不是纵向的。使用氟脱氧葡萄糖PET和容积MRI进行的前瞻性影像研究的初步结果表明，发作较新近发作的患者比癫痫病史较长的患者发生代谢减少或体质减少的可能性更低。这些数据的替代解释包括癫痫的可能的渐进性作用，或癫痫发作时具有结构或功能发现的患者更容易发生不受控制的癫痫的趋势。除了已经进行的人类研究之外，使用某些相同的成像技术对动物模型进行的平行研究可能有助于揭示与癫痫发作所致神经元损伤相关的因素，并有助于解释临床研究的结果。

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