Improving the presurgical evaluation of patients with refractory focal epilepsy using advanced neuroimaging techniques

癫痫是一种常见的神经疾病，影响着大约1%的人口(英国有60万人)。频繁的癫痫发作有受伤和死亡的风险，并产生重大的心理社会后果，影响人际关系、就业和驾驶能力。治疗癫痫的药物有20多种，但三分之一的癫痫患者在服用药物后仍有癫痫发作。切除大脑异常部分的手术治疗癫痫是治愈或改善癫痫发作的有效技术，适用于某些癫痫患者。国家神经学和神经外科医院与癫痫学会和伦敦大学学院神经学研究所合作，是英国最大的癫痫手术中心(每年100次手术)，并有一个国际知名的研究计划，以提高对手术患者的识别，并了解和改进结果。为了使一个人适合手术，有必要确认癫痫发作是由大脑的一个部分引起的，并且移除这一部分是安全的。这需要包括核磁共振脑部扫描在内的许多测试。尽管技术进步，但约30%的癫痫患者大脑某一部位的核磁共振扫描完全正常。与MRI不同的是，进一步的其他类型的扫描检查费用很高，可能涉及辐射暴露，而且在大多数地方都无法获得。如果成像无法确定癫痫发作的来源，可以将记录线直接放置在大脑表面。这只在几个地方可以使用，具有侵入性，非常昂贵，并且有一些风险。在我之前的研究中，我开发了MRI技术来提高手术的安全性，了解它对大脑的影响。我展示了新的MRI技术可以在MRI扫描正常的患者中识别癫痫发作来源的初步结果。在这个项目的第一部分，我将评估几种新的MRI技术，以确定哪些有助于在标准扫描正常的严重癫痫患者中识别癫痫发作的来源。我将使用获取核磁共振扫描的新方法，并将与伦敦大学学院医学图像计算中心的同事以及蒙特利尔神经研究所合作，开发通过计算机分析扫描的新方法，以检测人眼看不到的细微异常。这些发展将使更多的癫痫患者能够接受手术，治愈或显著改善癫痫。核磁共振可能会取代一些更昂贵、更不容易获得的扫描。这将简化和缩短研究路径，从而使手术可以更快地进行。由于核磁共振在所有癫痫外科中心都可以广泛使用，新技术可以在其他地方引入，以改善对癫痫患者的评估和治疗。对这些技术的理解也可以应用于其他情况，如痴呆症和中风。在第二部分，我将在我之前使用MRI的工作的基础上，使手术变得更安全。我使用了一种特殊类型的核磁共振扫描来识别大脑中对视力重要的连接，并在外科医生手术时向他们展示这些连接，这样他们就可以在不损害视力的情况下治疗癫痫，从而允许人们恢复驾驶。目前，这方面的研究还存在诸多局限性，分析时间较长。我将改进技术，以便更快地提供更详细、更准确的大脑图像。结果和软件将免费提供，以允许其他中心采用该技术。总体上，将更多的人被确定为适合手术治疗，使用适用于所有癫痫手术中心的技术，而不是仅适用于高度专科病房的技术，速度更快，成本更低。对这些新的磁共振成像技术的更多了解将使它们能够在许多其他情况下使用。

Epilepsy is a common neurological condition affecting around 1% of the population (600,000 people in the UK). Frequent seizures carry risk of injury and death and significant psychosocial consequences, affecting relationships, employment and the ability to drive. There are over 20 medications to treat epilepsy, but a third of people with epilepsy continue to have seizures despite medication.Surgical treatment of epilepsy in which the abnormal part of the brain is removed is an effective technique to cure or improve seizures suitable for some people with epilepsy. The National Hospital for Neurology and Neurosurgery, with the Epilepsy Society and UCL Institute of Neurology, is the largest centre in the UK undertaking epilepsy surgery (100 operations a year) and has an internationally known research programme to improve the identification of patients for surgery and understand and improve the outcomes.In order for a person to be suitable for surgery, it is necessary to confirm that seizures are arising from one part of the brain and that it is safe to remove this part. This requires many tests including MRI brain scans. Despite advances in technology, around 30% of people with seizures arising from one part of the brain have completely normal MRI scans. Further investigation with other types of scan is expensive, may involve radiation exposure and is not available in most places, unlike MRI. If imaging cannot identify the source of seizures, recording wires may be placed directly onto the brain surface. This is available in only a few places, is invasive, very expensive and carries some risk.In my previous research, presented and published internationally, I developed MRI techniques to improve the safety of surgery and understand its effects on the brain. I showed preliminary results in which new MRI techniques could identify the source of seizures in patients with normal MRI scans.In the first part of this project, I will assess several new MRI techniques to determine which are helpful in identifying the source of seizures in people with severe epilepsy and normal standard scans. I will use new ways of acquiring MRI scans and will work with colleagues in the UCL Centre for Medical Image Computing, with whom I have worked for the last 5 years, and the Montreal Neurological Institute to develop new ways to analyze the scans by computer to detect subtle abnormalities not seen by the human eye.These developments will enable a larger proportion of people with epilepsy to undergo surgery and be cured or significantly improved from epilepsy. MRI may replace some more expensive and less readily available scans. This will simplify and shorten the investigation pathway so surgery can take place more quickly. Since MRI is widely available at all epilepsy surgery centres, the new techniques can be introduced elsewhere to improve assessment and treatment for people with epilepsy. Understanding of these techniques can also be applied to other conditions such as dementia and stroke.In the second part, I will build on my prior work using MRI to make surgery safer. I used a special type of MRI scan to identify connections in the brain important for vision and displayed these connections to the surgeon when they were operating so they could treat epilepsy without damaging vision and thus allow people to return to driving. At present, there are many limitations with this and analysis takes a long time. I will improve the technique to give more detailed and accurate images of the brain more quickly. The results and software will be made freely available to allow other centres to adopt the technique.Overall more people will be identified as suitable for surgical treatment, more quickly and at lower cost using techniques that are applicable to all epilepsy surgery centres rather than just at highly specialised units. A greater understanding of these new MRI techniques will allow them to be used in many other conditions.