- 學位論文
癲癇在年長族群的腦部影像結構及髓鞘變化
The change of structural brain image and myelin in Epilepsy in elderly
摘要
研究目的:癲癇，以反覆自發性異常放電為特色，為在年齡上有雙極分布的疾病、而老年癲癇與老化或是失智症1，在過去，做為病因經常被低估，而在近年來被發現其實他們之間的關係相當緊密，有文獻指出兩個疾病之間會互相影響。另一方面，癲癇研究中常提到皮質，而位於皮質下層的髓鞘相對少被提到，其髓鞘的發展與退化大大影響我們的認知功能、其中正常老化發現到腦部的髓鞘會流失，有些也報導與阿茲海默症有關2，但其與老人癲癇的關聯並不明確，我們想研究髓鞘在年長的癲癇患者有無特殊的位置變化 研究方法及資料：本研究以標準化的腦部影像工具，對本院門診收集癲癇患者及召募正常受試者，目標為年齡為45歲以上進行腦部核磁共振，紀錄年齡、發作年齡、發作時長等等、進行敘述性分析及使用SPSS for window 18.0軟體進行T檢定及卡方檢定，腦部影像使用HCP Pipeline進行影像處理及使用廣義線性模型進行組間比較 研究結果：有31為正常受試者及30位癲癇患者，在正常受試者年齡均值為61.03歲(標準差為3.146)，而癲癇患者組年齡均值為60.52(標準差為6.653)，組別之間年齡沒有顯著差異，而皮質厚度及表面積在各腦分區上，在各自分區在T統計上有統計顯著，但在經過多重校正後，兩組在皮質厚度及表面積並無差異，而在腦部髓鞘在癲癇與對照組在顳葉及額葉有不同影響 結論與建議：我們發現老年癲癇患者與對照組比較影響較多的位置，如顳葉的部分，也有對照組相對老年癲癇患者較多的部分，例如額葉，這可能暗示髓鞘的變化或缺失在癲癇不同腦區可能有不同的機轉
並列摘要
Objective: Epilepsy, characterized by recurrent spontaneous abnormal discharges, is a disease that exhibits a bimodal distribution with age. In the past, the relationship between elderly epilepsy and aging or dementia was often underestimated, but in recent years, it has been discovered that they are closely interconnected. Literature suggests mutual influence between these two conditions. With the cortex being frequently mentioned in epilepsy research, while the myelin sheath, located beneath the cortex, is relatively less discussed. The development and degeneration of myelin sheath significantly impact our cognitive function. It has been found that normal aging is associated with loss of myelin in the brain, and some reports have linked it to Alzheimer's disease. However, the association between elderly epilepsy and myelin sheath remains unclear. We wander it there were specific myelin change on specific brain area Methods and Materials: This study utilized standardized brain imaging tools to collect brain magnetic resonance data from epilepsy patients and recruited normal participants from our outpatient department. The target age group was 45 years and older. Descriptive analysis was conducted on variables such as age, age of onset, and duration of seizures. T-tests and chi-square tests were performed using SPSS for Windows 18.0 software. Group comparisons of brain imaging data were conducted using a generalized linear model. Results: There were 31 normal participants and 30 epilepsy patients. The mean age for the normal group was 61.03 years (standard deviation = 3.146), while the mean age for the epilepsy group was 60.52 years (standard deviation = 6.653). There was no significant difference in age between the two groups. Regarding cortical thickness and surface area in different brain regions, there were statistically significant differences within each respective region based on the T-statistics. However, after adjusting for multiple comparisons, there were no significant differences in cortical thickness and surface area between the two groups. In terms of white matter in the brain, there were differences between the two groups in the temporal and frontal lobes. Conclusion and Suggestion: We found that there were certain locations in which epilepsy patients showed more effects compared to the control group, such as in certain regions of the temporal lobe. Conversely, there were also areas where the control group showed more effects compared to the epilepsy group, such as in regions of the frontal lobe. This observation may suggest that the deposition or loss of myelin could have different mechanisms in various brain regions affected by epilepsy.