Abstract: Objective To study the alteration of interictal cerebral blood flow (CBF) of patients with generalized tonic-clonic seizure (GTCS) by pulsed arterial spin labeling (PASL), and uncover the neuropathophysiological mechanism of GTCS. Methods Twenty-nine patients with GTCS were included in this study, and the same number of age- and gender-matched healthy volunteers were set as controls. PASL data of all subjects were obtained on a Siemens MAGNETOM Trio 3.0T scanner. The regional cerebral blood flow of GTCS patients were compared with the controls by two-sample t -test. Results Compared with the controls, GTCS patients presented decreased regional cerebral blood flow in bilateral thalumus, brainstem and cerebellum, and also a part of cortical area of the right precuneus (P < 0.05, for all). The alteration of interictal regional cerebral blood flow in bilateral thalumus was not significantly related to seizure duration (r = -0.090, P = 0.643) and seizure frequency (r = -0.115, P = 0.551). Conclusion The decreased regional cerebral blood flow in bilateral thalumus, brainstem and cerebellum indicates the "mesencephalic epilepsy" theory in GTCS, which may contribute to the understanding of the pathophysiological mechanism of GTCS.

Key words: Epilepsy, tonic-clonic, Hemoperfusion, Cerebrovascular circulation, Magnetic resonance imaging

摘要： 目的 应用MRI 脉冲式动脉自旋标记（PASL）技术，研究全面性强直-阵挛发作患者发作间期局部脑血流量改变，阐述全面性强直?阵挛发作可能的神经病理生理学机制。方法 选择29例诊断明确、病程> 1 年且发作> 3 次的全面性强直-阵挛发作患者作为研究对象，以年龄、性别、利手性相匹配并例数相当的正常健康志愿者作为对照。通过Siemens 3.0T MRI 扫描仪采集全脑PASL 数据，通过两独立样本t 检验比较全面性强直-阵挛发作患者发作间期相对正常人脑血流量改变的脑区。结果 与对照组相比，全面性强直-阵挛发作患者发作间期脑血流量的改变以降低为主（P < 0.05），主要包括双侧丘脑、脑干和小脑，以及右侧楔前叶部分皮质区域；而且发作间期双侧丘脑局部脑血流量改变与发作时间（r = -0.090，P = 0.643）及发作频率（r = -0.115，P = 0.551）无明显相关关系。结论 全面性强直-阵挛发作患者在发作间期以丘脑、脑干和小脑等脑区血流灌注降低为主，支持特发性全面性癫痫的“中脑癫痫理论”。这些脑区可能与特发性全面性癫痫的病理生理学机制密切相关。

关键词: 癫痫, 强直阵挛性, 血液灌注, 脑血管循环, 磁共振成像