PRE-SURGICAL APPLICATIONS OF FUNCTIONAL MRI IN EPILEPSY

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。脑外科手术是一种有效的治疗方法，许多人谁患有药物难治性癫痫。功能性脑映射技术有可能通过识别处于认知发病率特定风险的患者，通过识别不应在手术中移除的重要脑组织，以及通过帮助识别应移除的异常致癫痫脑组织来改善这种治疗的结果。然而，在这些应用方面仍有许多未解决的问题。目前还没有普遍接受的协议定位语言或记忆系统，这两个认知领域的风险最大的癫痫手术。目前尚不清楚哪些标测方案（如果有的话）能够可靠地识别前颞叶或前海马中的重要组织，而大多数癫痫切除术都是在这些部位进行的。目前还没有研究提供证据表明功能性脑映射有助于最大限度地减少认知能力下降或改善癫痫控制。该提案是为了继续一个正在进行的项目，以开发用于这些目的的标准化和可靠的功能磁共振成像（fMRI）方法。第一个目标是最大限度地减少癫痫手术引起的语言和记忆衰退，这取决于这些处理系统的关键组件的精确术前定位。第二个长期目标是尽量减少对颈动脉内注射异戊巴比妥（Wada试验）的侵入性技术的依赖，用于术前认知映射和癫痫灶识别。为了实现这些目标，我们将（1）评估两种功能磁共振语言映射方案和一种记忆映射方案，用于预测前颞叶切除术（最常见的癫痫手术形式）后语言和言语记忆的下降;（2）评估这些功能磁共振方案识别颞叶癫痫患者癫痫发作起源侧的能力;（3）比较fMRI与Wada试验的预测能力。这些研究将首次对癫痫患者术前脑功能标测的临床有效性和实用性进行大规模和严格的评估。它们的成功完成将为使用这些技术来改善癫痫手术的结果奠定坚实的基础。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Brain surgery is an effective treatment for many individuals who suffer from medically intractable epilepsy. Functional brain mapping techniques have the potential to improve the outcome of this treatment by identifying patients at particular risk of cognitive morbidity, by identifying vital brain tissue that should not be removed at surgery, and by helping to identify abnormal, epileptogenic brain tissue that should be removed. There remain, however, many unresolved issues regarding these applications. There are as yet no generally-accepted protocols for localization of language or memory systems, the two cognitive domains at greatest risk from epilepsy surgery. It is not clear which mapping protocols, if any, reliably identify vital tissue in the anterior temporal lobe or anterior hippocampus, where the majority of epilepsy resections are performed. No studies have yet provided evidence that functional brain mapping helps to minimize cognitive decline or improve seizure control. This proposal is for continuation of an ongoing project to develop standardized and reliable functional magnetic resonance imaging (fMRI) methods for these purposes. The first goal is to minimize language and memory decline from epilepsy surgery, which depends on precise presurgical localization of the critical components of these processing systems. The second, longer-term goal is to minimize reliance on the invasive technique of intracarotid amobarbital injection (Wada testing) for presurgical cognitive mapping and seizure focus identification. To achieve these goals, we will (1) assess two fMRI language mapping protocols and one memory mapping protocol for predicting language and verbal memory decline after anterior temporal lobectomy, the most common form of epilepsy surgery; (2) assess the ability of these fMRI protocols to identify the side of seizure origin in patients with temporal lobe epilepsy; and (3) compare the predictive power of fMRI with that of the Wada test. These studies will constitute the first large-scale and rigorous assessments of the clinical validity and utility of presurgical functional brain mapping in epilepsy. Their successful completion will lay a firm foundation for use of these techniques to improve the outcome of epilepsy surgery.