1H AND 31P MRSI FOR EPILEPSY LOCALIZATION

这项应用的长期目标是通过结合神经成像技术，包括磁共振成像（MRI）、1H和31P磁共振光谱成像（MRSI）和18F-PET，更好地对医学难治性癫痫进行术前定位，从而改善癫痫发作手术的结果。这些技术将针对三组医学上难治性癫痫患者，他们正在评估癫痫发作手术（5年）：1)MRI不一致的内侧颞叶癫痫患者，即MRI未显示异常，或脑电图定义的癫痫发作病灶对侧异常（NC-mTLE, n=75）， 2)非病变性新皮层癫痫患者（NE, n=100）， 3)婴儿痉挛患儿（is, n=100）。NC-mTLE和NE患者经常需要有创性脑电图记录，手术后无癫痫发作的概率低于50%，通常不考虑手术。术后手术结果将根据术前神经影像学结果进行分析。假设：1)NC-mTLE - MRI不一致的难治性mTLE患者，其1H和31P MRI测量与脑电图定位（即脑叶和脑侧）一致，其术后预后明显优于MRI不一致的患者。2a) MRI无病变的NE - NE患者，1H和31P MRI与脑电图定位（即脑叶和脑侧）的一致性将大于18FDG-PET提供的一致性。2b) mri 1H和31P测量与脑电图定位一致的NE - NE患者术后预后明显优于mri不一致的患者。3a) IS -医学上难治性婴儿痉挛患儿的1H和31P MRI与两项或两项以上研究（VET、18FDG-PET和/或MRI）联合确定的癫痫发作灶一致，且这种一致性将大于MRI或18FDG-PET提供的一致性。3b) MRSI 1H和31P与其他临床和影像学研究提供的定位一致的IS - IS患儿，其术后预后明显优于无此一致性的患者。这些研究有望改善顽固性癫痫患者的手术效果，并减少不必要的手术。

The long term goal of this application is to improve the outcome of seizure surgery by better presurgical localization of medically refractory epilepsy using a combination of neuroimaging techniques including magnetic resonance imaging (MRI), 1H and 31P MR spectroscopic imaging (MRSI), and 18F-PET. These techniques will be directed at three groups with medically refractory epilepsy who are being evaluated for seizure surgery (numbers for 5 years): 1)patients with medial temporal lobe epilepsy in whom MRI is non-concordant i.e., MRI shows no abnormality, or an abnormality contralateral to the EEG-defined seizure focus (NC-mTLE, n=75), 2) patients with non-lesional neocortical epilepsy (NE, n=100), and 3) children with Infantile Spasms (IS, n=100). NC-mTLE and NE patients frequently require invasive EEG recording, have less than a 50 percent probability of becoming seizure free with surgery, and are often not considered for surgery. Post-operative surgical outcome will be analyzed in relation to the pre-operative neuroimaging findings. Hypotheses: 1) NC-mTLE -Patients with medically refractory mTLE without MRI concordance, who have 1H and 31P MRSI measures concordant with the EEG localization (i.e., lobe and side), will have a significantly better post surgical outcome than patients without MRSI concordance. 2a) NE - NE patients without lesions on MRI, will have 1H and 31P MRSI concordant with the EEG localization (i.e., lobe and side), and this concordance will be greater than that provided by 18FDG-PET. 2b) NE - NE patients, who have 1H and 31P MRSI measures concordant with the EEG localization will have a significantly better post surgical outcome than patients without MRSI concordance. 3a) IS - Children with medically refractory Infantile Spasms will have 1H and 31P MRSI concordant with the seizure focus determined by a combination of two or more studies (VET, 18FDG-PET, and/or MRI) and this concordance will be greater than that provided by MRI or 18FDG-PET. 3b) IS - IS children, who have 1H and 31P MRSI concordant with the localization provided by the other clinical and imaging studies will have a significantly better post surgical outcome than patients without such concordance. These studies are expected to lead to improved surgical outcome, and to reduce unnecessary surgery, in patients with intractable epilepsy.