The integrity of the neuronal networks underlying relational memory as a predictor of post-surgical memory outcome in patients with mesial temporal lobe epilepsy: a multimodal neuroimaging approach

内侧颞叶癫痫(MTLE)是一种常见的神经系统疾病，其特征是起源于内侧颞叶(MTL)的反复发作。三分之一的MTLE患者对药物治疗有抵抗力，并从手术切除MTL中受益。然而，MTL在关系记忆中扮演着关键角色，关系记忆是一种记忆形式，负责我们记忆丰富的联想信息的能力。手术后记忆力下降是MTL摘除后的一个主要问题，而对手术后记忆结果的可靠预测尚不存在。目前用于评估术后结果的技术主要集中在MTL，这是不够的，因为它们没有考虑重要的神经元网络与非MTL脑结构的相互作用。该项目的主要目标是开发可靠的术后预测指标，明确考虑MTL以外的大规模神经元网络相互作用。为了揭示健康对照组全脑关系记忆网络的时空特征以及MTLE是如何影响这一网络的，我们将结合最先进的脑成像技术(即fMRI、DTI、T2弛豫测量、EEG和颅内EEG)。然后，我们将研究这个复杂网络的完整性水平如何预测手术后记忆结果。我们预计，拥有正常分布关系记忆网络的患者比具有补偿机制来处理关系信息的患者术后记忆下降的风险更大。综上所述，该项目的应用目的是帮助临床医生预测MTL切除后记忆下降的风险。此外，我强调，拟议的项目将提供对记忆过程的基本理解的新见解，以及当关键结构MTL受损时潜在神经网络如何变化的问题。这不仅对MTLE很重要，而且对影响MTL的许多其他神经和精神疾病也很重要。

Mesial temporal lobe epilepsy (mTLE) is a common neurological disorder characterized by recurrent seizures originating in the mesial temporal lobe (MTL). One third of mTLE patients are resistant to pharmacotherapy and benefit from surgical removal of the MTL. However, the MTL plays a key role in relational memory, a form of memory responsible for our ability to remember association-rich information. Post-surgical memory decline is a major problem following MTL removal, and reliable predictors of memory outcome after surgery are missing. Current techniques for assessing post-surgical outcome focus exclusively on the MTL, which is insufficient as they do not consider important neuronal network interactions with non-MTL brain structures.The main goal of this project is the development of reliable post-surgical predictors that explicitly consider large-scale neuronal network interactions beyond the MTL. To unravel the spatiotemporal characteristics of the brain-wide relational memory network in healthy controls and how mTLE affects this network, we will combine complementary state-of-the-art brain imaging techniques (i.e. fMRI, DTI, T2 relaxometry, EEG and intracranial EEG). We will then examine how the integrity level of this complex network predicts post-surgical memory outcome. We expect that patients with normal distributed relational memory networks are at greater risk of post-surgical memory decline than patients who have developed compensatory mechanisms to process relational information.In sum, the applied aim of this project is to help clinicians predict the risk of memory decline after MTL resection. Moreover, I emphasize that the proposed project will offer new insights into both the fundamental understanding of memory processes, and the question of how the underlying neuronal network changes when a key structure, the MTL, is damaged. This is important not only for mTLE but for many other neurological and psychiatric diseases in which the MTL is affected.