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MTL患者对药物治疗有耐药性，并从手术切除MTL中获益。然而，MTL在关系记忆中起着关键作用，关系记忆是一种记忆形式，负责我们记住丰富的联想信息的能力。术后记忆下降是MTL切除后的主要问题，缺乏可靠的预测术后记忆结果的指标。目前评估术后结果的技术只关注MTL，这是不够的，因为它们没有考虑重要的神经网络与非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器，明确考虑MTL之外的大规模神经网络相互作用。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如何影响该网络，我们将结合互补的最先进的脑成像技术（即fMRI， DTI， T2松弛测量，脑电图和颅内脑电图）。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的记忆结果。我们预计，具有正态分布关系记忆网络的患者术后记忆衰退的风险大于具有代偿机制处理关系信息的患者。总之，本项目的应用目的是帮助临床医生预测MTL切除术后记忆衰退的风险。此外，我强调，拟议的项目将为记忆过程的基本理解提供新的见解，以及当关键结构MTL被损坏时，底层神经网络如何变化的问题。这不仅对MTL很重要，而且对许多其他影响MTL的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.