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Patients with temporal lobe epilepsy are at high risk for comorbid depression, and it is hypothesized that these two diseases are share common pathogenic pathways. We aimed to characterize regional brain activation in treatment-naïve temporal lobe epilepsy patients with depressive symptoms and compare the results to epilepsy patients without depressive symptoms and to healthy controls.We recruited 23 treatment-naïve patients (including anti-epilepsy drugs (AEDs) and antidepressants) and 17 matched healthy controls for this study. The patients were further divided into two groups: patients with depressive symptoms and patients without; the patients then used a self-rating depression scale (SDS) to assess their depression. All participants underwent resting functional magnetic resonance imaging (fMRI) scans using the Trio Tim magnetic resonance (MR) image system (3.0 T). The data were processed and analyzed using REST and SPSS11.5 software.The patients with depressive symptoms showed significantly higher activity in the bilateral thalamus, insula and caudate and right anterior cingulate compared with the two other groups (p0.05, corrected). Brain network connectivity analysis revealed that connectivity decreased in the prefrontal-limbic system and increased within the limbic system and angular gyrus in patients with depressive symptoms (p0.05, corrected).The epilepsy patients with depressive symptoms showed regional brain activity alterations and disruption of the mood regulation network at the onset of seizures. The present study offers further insight into the underlying neuropathophysiology of epilepsy with depressive symptoms.

r Abstract: The basal ganglia, a brain structure related to motor control, is implicated in the modulation of epileptic discharges generalization in patients with idiopathic generalized epilepsy (IGE). Using group independent component analysis (ICA) on resting-state fMRI data, this study identified a resting state functional network that predominantly consisted of the basal ganglia in both healthy controls and patients with IGE. In order to gain a better understanding of the basal ganglia network(BGN) in IGE patients, we compared the BGN functional connectivity of controls with that of epilepsy patients, ei- ther with interictal epileptic discharges (with-discharge period, WDP) or without epileptic discharge (nondischarge period, NDP) while scanning. Compared with controls, functional connectivity of BGN in IGE patients demonstrated significantly more integration within BGN except cerebellum and supple- mentary motor area (SMA) during both periods. Compared with the NDP group, the increased func- tional connectivity was found in bilateral caudate nucleus and the putamen, and decreases were observed in the bilateral cerebellum and SMA in WDP group. In accord with the proposal that the ba- sal ganglia modulates epileptic discharge activity, the results showed that the modulation enhanced the integration in BGN of patients, and modulation during WDP was stronger than that during NDP. Furthermore, reduction of functional connectivity in cerebellum and SMA, the abnormality might be further aggravated during WDP, was consistent with the behavioral manifestations with disturbed motor function in IGE. These resting-state fMRI findings in the current study provided evidence confirming the role of the BGN as an important modulator in IGE. Hum Brain Mapp 33:1279-1294, 2012. V C 2011 Wiley Periodicals, Inc.

Background and Purpose— There have not been any new epidemiological studies related to stroke in Tibet for 20 years. This study aimed to collect stroke data from The City Staff Medical Insurance Registry in Lhasa, Tibet, to describe the incidence, clinical subtypes, and associated risk factors of stroke. Methods— We used retrospective, population-based descriptive analysis of all urban and rural workers in the City Staff Medical Insurance Registry who were admitted to designated hospitals from October 2006 to October 2008. Stroke was defined by the International Classification of Disease (ICD)-10 coded from hospital records. Results— Workers (81 298) were listed in the City Staff Medical Insurance Registry. Stroke patients (165) were included in the study, with 133 being first-ever patients. The age-standardized incidence rate was 88.725/100 000 per year (95% CI, 72.228–105.221), and mortality rate was 25.941/100 000 per year (95% CI, 16.416–35.466). The case fatality rate was 21.82%. Seventeen of the 133 patients (12.8%) were Conclusion— Since the last study 20 years ago in Lhasa, stroke remains the primary fatal disease for the elderly, and its occurrence at younger ages is higher in Lhasa than in other areas of China. However, the annual incidence rate and mortality rate have decreased. The annual incidence rate is at a similar level to that in other parts of China. The primary subtype of stroke in Lhasa is cerebral ischemia.

Summary Background Absence epilepsy is characterized clinically by the impairment of consciousness and 3 Hz generalized spike-wave discharges (GSWDs) on EEG. Clinical absence can be observed with ictal GSWDs, but interictal GSWD bursts are usually clinically silent. Simultaneous EEG and blood-oxygen-level-dependent (BOLD) functional MRI (EEG–fMRI) has been successfully used to link the changes in regional neuronal activity to the occurrence of GSWDs. Methods We used EEG–fMRI to investigate and compare the BOLD signal changes during interictal and ictal GSWDs in patients with childhood absence epilepsy (CAE). Results Fifteen drug-naive children with newly diagnosed CAE were studied using continuous EEG–fMRI. BOLD signal changes associated with interictal (nine sessions with six patients) and ictal (eight sessions with six patients) GSWDs were analyzed at the individual and group levels. GSWDs were associated with widespread and symmetrical deactivation in the cortex and caudate nucleus with a frontal maximum, and predominant activation in the thalamus bilaterally during ictal GSWDs and in the cortex during interictal GSWDs. The BOLD response was characterized by a higher statistical significance and a more widespread extent at the time of the ictal GSWDs as compared to the time of interictal GSWDs. Conclusions Both interictal and ictal GSWDs in patients with CAE are associated with BOLD signal changes in the basal ganglia–thalamocortical loop. Ictal GSWDs showing predominant thalamic activation and widespread cortical deactivation might cause a complete suspension of the normal brain's default state and manifest clinically as abrupt loss of consciousness (absence seizures).

We report the first case of a pilomotor seizure detected by electroencephalography /functional magnetic resonance imaging (EEG/fMRI). An adult woman presented with history of bouts of gooseflesh feeling and poilomotor activity in the left leg following viral encephalitis. 24-hour video-EEG and simultaneous EEG during fMRI revealed ictal discharges in the right parietal and temporal lobes. Associated blood oxygen level- dependent (BOLD) activations were found mainly in the right parietal region. The result represents a different generator of pilomotor seizure compared to prior reports. We suggests that the feeling of gooseflesh could be the core ictal symptom and a direct pathway from the sensory cortex to the lower autonomic system may exist bypassing the classic cerebral autonomic center.

The hemodynamic response function (HRF) describes the dynamic process of the blood oxygen level dependent (BOLD) signal evoked by a very short stimulus of unit intensity. Understanding HRF is a key issue for exploring the underlying dynamics of nervous system activation. Some researches suggested that the shape of HRF varied with different brain regions and different subjects, even at different time point in the same brain region of a subject. In this work, epilepsy discharges were adopted as markers of short stimuli, and then we use EEG-fMRI method to investigate HRF in temporal lobe epilepsy with interictal regional slow wave. Five patients with idiopathic temporal lobe epilepsy were enrolled in this study, the peak delay and amplitude of the estimated HRF was compared with Gamma, Glover and the SPM canonical HRF, and the results show that the delay of the estimated HRF is different from either one of the three theoretical model, thus further study on both theoretical model and real data estimation is needed.

Objective To establish an operational model of a network for managing patients with convulsive epilepsy in rural areas of West China. Methods The network is under unified leadership of the public health administration departments, who liaised with medical institutions and disease control and prevention organizations to foster local communities to participate. Patients with convulsive epilepsy were treated with phenobarbital. Trained local primary health care physicians carried out screening, treatment, and follow-up. Political, financial, and technological support was incrementally provided through the network. Efficacy was assessed as the percentage reduction in seizure frequency and the retention of patients on treatment. Results Two thousand five hundred fourteen patients with active convulsive epilepsy were enrolled. After more than 1 year of treatment, 78.4% of the patients had a 50% or greater reduction in seizure frequency and 43.3% remained seizure free. Probability of retention was 85.8% at 750 days. Nearly 20% patients withdrew from the project, and most of them migrated out of the study areas. Some regular training and educational programs were also carried out. Conclusion This pragmatic procedure suggests that the network could be suitable for managing convulsive epilepsy in resource-poor regions. Such a network could depend on existing primary health services to ensure its sustainability.