Encephalographic MRI and Epilepsy Discharge Localization

脑成像 MRI 和癫痫放电定位

• 批准号: 8225777
• 负责人: Darren Benjamin Orbach
• 金额: $ 23.75万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8225777
• 关键词: 16 year old; Acceleration; Agar; Antiepileptic Agents; Area; Benign; Brain region; Cerebrum; Characteristics; Childhood; Clinical; Convection; Development; Diagnostic; Dimensions; Electrocorticogram; Electrodes; Electroencephalography; Epilepsy; Evaluation; Excision; Functional disorder; Gel; Goals; Image; Image Analysis; Imagery; Imaging Device; Impairment; Implant; Individual; Intractable Epilepsy; Lead; Left; Liquid substance; Magnetic Resonance Imaging; Maps; Measurement; Medical; Methods; Modeling; Monitor; Neurons; Noise; Operative Surgical Procedures; Partial Epilepsies; Patients; Pharmaceutical Preparations; Phase; Postoperative Period; Protocols documentation; Refractory; Relative (related person); Research; Resected; Resolution; Risk; Seizures; Signal Transduction; Slice; Solutions; Source; Speed; Staging; Surface; Surgical Management; Syndrome; Techniques; Testing; Thick; Time; Work; base; cohort; cost; gray matter; improved; magnetic field; neuropsychiatry; novel; operation; response; tool; treatment effect; white matter

DESCRIPTION (provided by applicant): The overarching aim of our research is to more directly image the cerebral discharges underlying epilepsy than has been achievable using standard techniques. Epilepsy patients often have abnormal neuronal discharges between seizures, called interictal spikes. Although their presence can be detected using EEG, the source of these spikes remains difficult to identify. We are developing a novel set of imaging tools and analysis methods to help us detect these discharges via their effect on MR images (encephalographic magnetic resonance imaging, or eMRI). The technique is based upon simultaneous high-speed acquisition of electroencephalography (EEG) and gradient-echo echo-planar MR images, with the EEG signal used to identify the images acquired during electrically active epochs. In a small cohort of patients with epilepsy, we have demonstrated fast responses in the MR images, nearly simultaneous with the interictal spikes seen on EEG. Our goals here are to extend eMRI as a tool with clinical utility for precise localization of the foci of epileptiform activity. Our first specific aim is to image pediatric patients with benign epilepsy with centrotemporal spikes (BECTS), in whom spikes are frequent and exquisitely well localized anatomically. The spatial extent of the regions involved by the interictal spikes will be studied, in order to determine if this correlates with the presence of neuropsychiatric or developmental abnormalities in this group of patients. Our second specific aim is to use eMRI to assess a cohort of patients with medically intractable epilepsy, in whom invasive cortical electrodes will be implanted intracranially as the first step in their epilepsy surgery. The regions identified by the invasive electrodes will be compared with the regions identified by eMRI. Finally, our third specific aim is to systematically vary the imaging parameters used in the eMRI acquisition, and make use of an electric current phantom, in order to optimize our protocol and to elucidate the mechanisms underlying the fast MR responses we have observed. eMRI has the potential to improve presurgical localization and to transform epilepsy resection into a one-stage surgical procedure, avoiding the need for prolonged intracranial recordings. More broadly, the technique would potentially allow for more efficacious deployment of antiepileptic medical therapy in the individual patient, as well as providing a means for testing novel agents, by directly demonstrating treatment effects on interictal activity. This work is likely to deepen our understanding of the pathophysiology of epileptiform discharges and their spread. PUBLIC HEALTH RELEVANCE: A technique, such as eMRI, that allows for more direct imaging of epileptiform discharges than is currently possible, is likely to be a powerful diagnostic tool for presurgical seizure focus localization, potentially transforming epilepsy resection into a one-stage surgical procedure, avoiding the need for prolonged intracranial recordings. More broadly, such an imaging tool would potentially allow for more efficacious deployment of antiepileptic medications in the individual patient, as well as providing a means for testing novel agents, by directly demonstrating their effects on cortical electrical discharges. This work is likely to deepen our understanding of the pathophysiology of epilepsy discharges and their spread.

描述（由申请人提供）：我们研究的首要目标是比使用标准技术更直接地成像癫痫的脑放电。癫痫患者在癫痫发作之间经常有异常的神经元放电，称为发作间期棘波。虽然可以使用EEG检测到它们的存在，但这些尖峰的来源仍然难以识别。我们正在开发一套新的成像工具和分析方法，以帮助我们通过它们对MR图像（脑电图磁共振成像，或eMRI）的影响来检测这些放电。该技术是基于同步高速采集脑电图（EEG）和梯度回波回波平面MR图像，与EEG信号用于识别在电活动时期采集的图像。在一小群癫痫患者中，我们已经证明了MR图像的快速反应，几乎与EEG上看到的发作间期尖峰同时发生。我们的目标是扩展eMRI作为一种具有临床实用性的工具，用于精确定位癫痫样活动的病灶。我们的第一个具体目标是成像小儿良性癫痫患者与中央颞棘波（BECTS），在这些棘波是频繁的和精美的解剖定位。将研究发作间期棘波所涉及区域的空间范围，以确定这是否与该组患者中神经精神或发育异常的存在相关。我们的第二个具体目标是使用eMRI来评估一组患有难治性癫痫的患者，在这些患者中，将颅内植入侵入性皮层电极作为癫痫手术的第一步。将有创电极识别的区域与eMRI识别的区域进行比较。最后，我们的第三个具体目标是系统地改变eMRI采集中使用的成像参数，并利用电流体模，以优化我们的协议，并阐明我们观察到的快速MR响应的机制。eMRI有可能改善术前定位，并将癫痫切除术转化为一个阶段的外科手术，避免需要长时间的颅内记录。更广泛地说，该技术可能允许在个体患者中更有效地部署抗癫痫药物治疗，并通过直接证明对发作间期活动的治疗效果来提供测试新型药物的方法。这项工作可能会加深我们对癫痫样放电及其传播的病理生理学的理解。 公共卫生关系：一种技术，如eMRI，允许更直接的癫痫样放电成像比目前可能的，可能是一个强大的诊断工具，术前癫痫灶定位，可能转化为一个阶段的外科手术癫痫切除术，避免需要长期的颅内记录。更广泛地说，这样的成像工具将可能允许在个体患者中更有效地部署抗癫痫药物，以及通过直接证明其对皮层放电的影响来提供用于测试新药剂的手段。这项工作可能会加深我们对癫痫放电及其传播的病理生理学的理解。