PRESURGICAL APPLICATIONS OF FUNCTIONAL MRI IN EPILEPSY

描述(改编自申请者摘要)：脑外科是一种 顽固性癫痫的治疗越来越普遍和有效。 成功的手术结果取决于正确地识别大脑轨迹 癫痫的起源和尽量减少重要功能区的切除 大脑，然而目前实现这些目标的侵入性技术增加了 手术治疗的风险和成本。这项研究的目的是 计划是定量评估功能磁力的价值 磁共振成像(FMRI)在脑出血患者术前评估中的应用 癫痫。第一个具体目标是测试fMRI是否可以取代 颈内动脉异巴比妥钠(WADA)试验在确定脑缺血侧化中的应用 语言和记忆功能。两者之间的协议程度 测试，它们的相对可靠性，以及每个测试在预测方面的能力 认知结果将得到精确衡量。第二个目标是评估 功能磁共振成像对神经外科手术计划的预测价值。的音量 手术患者切除的功能性和非功能性组织，如 由术前fMRI图和定量解剖MRI定义的，将是 与术后语言和记忆的出现相关 缺陷、术后癫痫控制和生活质量措施 确定功能磁共振成像的潜力，以帮助确定最佳切除边界。 最终的具体目标是测试功能磁共振成像在预测 颞叶癫痫患者的癫痫偏侧化与癫痫控制结局 脑叶癫痫。颞叶功能激活的定侧化 功能磁共振成像将被用作癫痫灶定侧的指标。这个 这项功能磁共振成像指标的预测能力将与标准技术进行比较 用于癫痫灶识别，包括非侵入性和颅内 EEG、常规和容量MRI、心理测量测试、SPECT和WADA 测试。在实现这些目标的过程中，将为使用 功能磁共振成像降低癫痫的发病率和提高疗效 做手术。

DESCRIPTION (Adapted from Applicant's Abstract): Brain surgery is an increasingly common and effective treatment for intractable epilepsy. Successful surgical outcome depends on correctly identifying a brain locus of seizure origin and minimizing resection of important functional areas in the brain, yet current invasive techniques for accomplishing these goals add to the risk and cost of surgical treatment. The goal of this research program is to quantitatively assess the value of functional magnetic resonance imaging (FMRI) in the presurgical assessment of patients with epilepsy. The first specific aim is to test whether FMRI can replace the intracarotid amobarbital (Wada) test used for determining lateralization of language and memory functions. The level of agreement between the two tests, their relative reliability, and the power of each in predicting cognitive outcome will be precisely measured. The second aim is to assess the predictive value of FMRI for neurosurgical planning. The volume of resected functional and nonfunctional tissue in operated patients, as defined by preoperative FMRI maps and quantitative anatomical MRI, will be correlated with the appearance of postoperative language and memory deficits, postoperative seizure control, and quality of life measures to determine the potential of FMRI to help define optimal resection boundaries. The final specific aim is to test the capability of FMRI in predicting seizure lateralization and seizure control outcome in patients with temporal lobe epilepsy. Lateralization of temporal lobe functional activation by FMRI will be used as an indicator of seizure focus lateralization. The predictive power of this FMRI index will be compared to standard techniques for seizure focus identification, including noninvasive and intracranial EEG, routine and volumetric MRI, psychometric testing, SPECT, and the Wada test. In accomplishing these aims, a basis will be established for using FMRI to reduce the morbidity and to increase the effectiveness of epilepsy surgery.