Quantification of Thalamic Atrophy and Connectivity in Medial Temporal Lobe Epile

描述（由申请人提供）：本奖学金的目标是为申请人（丹尼尔S。巴伦）学习先进的神经影像学研究方法，并获得显着暴露于临床癫痫护理。申请人将接受结构，功能和弥散磁共振图像分析方法的培训;他将使用这些方法来量化内侧颞叶癫痫（MTLE）的海马外病理。 MTLE是外科中心最常见的癫痫类型，也是成人中最常见的定位相关癫痫。（Tellez-Zenteno等人，2012年）。MTLE中最常见的病理是海马硬化（HS）。（Wieser，2004）当HS是磁共振图像目视检查观察到的唯一病理时，HS是积极手术结局的预测因子。（Engel，2008）相反，海马外病变是预后较差的预测因素，实际上是手术的禁忌症。(Thom例如，2010）海马外病理学通常是微妙的，并且在手术前评估中视觉上未被检测到，因此海马外病理学继续导致手术失败。(Thom例如，2010年）的定量，有针对性的分析 海马外病理学可以指导术前评估，告知新的治疗干预，并减轻手术失败。到目前为止，这种尝试取得了有限的成功，并代表了改善术前评估和患者护理的关键障碍。 我们的近期研究目标是确定MTLE-HS中海马外病理的区域，长期目标是了解手术失败。我们最近对24个基于体素的形态测量实验进行的荟萃分析（手稿在审查中）表明，MTLE中海马外病理学最一致的区域是丘脑内侧背核（MDN）。我们假设MTLE与MDN中的选择性组织损伤相关，MDN与海马之间的功能和解剖连接增加。为了检验这一假设，我们将对MTLE-HS患者数据进行以下分析： 目标1。我们将使用结构MR数据测量MDN体积的变化。 目标二。我们将使用扩散MR数据测量连接海马和MDN的白色物质束的解剖连接性。 目标3：我们将测量海马和MDN之间的功能连接使用区域种子分析的静息状态功能MR数据。 为了学习这些神经影像学分析方法，申请人将利用校内和校外课程和合作。申请人还将临床接触MTLE的病理生理学、临床护理和手术治疗。这项研究培训将使申请人学习神经影像学分析方法，他将使用作为一个神经影像学研究人员和癫痫病学家。

DESCRIPTION (provided by applicant): The goal of this fellowship is for the applicant (Daniel S. Barron) to learn advanced neuroimaging research methods and to gain significant exposure to clinical epilepsy care. The applicant will receive training in structural, functional, and diffuion magnetic resonance image analysis methods; he will use these methods to quantify extra-hippocampal pathology in medial temporal lobe epilepsy (MTLE). MTLE is the most common type of epilepsy referred to surgical centers and the most common localization- related epilepsy in adults. (Tellez-Zenteno et al., 2012). The most common pathology in MTLE is hippocampal sclerosis (HS). (Wieser, 2004) When it is the sole pathology observed on visual inspection of magnetic resonance images, HS is a predictor of positive surgical outcome. (Engel, 2008) Conversely, extra-hippocampal pathology is a predictor of poorer outcome and is, in fact, a contraindication for surgery. (Thom et al., 2010) Extra-hippocampal pathology is often subtle and goes visually undetected on the pre-surgical evaluation, thus extra-hippocampal pathology continues to contribute to surgical failure. (Thom et al., 2010) Quantitative, targeted analyses of extrahippocampal pathology could guide the pre-surgical evaluation, inform new therapeutic interventions, and mitigate surgical failure. Thus far such attempts have met with limited success and represent a critical barrier to improved pre-surgical evaluation and patient care. Our immediate research goal is to define regions of extra-hippocampal pathology in MTLE-HS with the long- term goal of understanding surgical failure. Our recent meta-analysis of 24 voxel-based morphometry experiments (manuscript in review) demonstrated the most consistent area of extra-hippocampal pathology in MTLE is the medial dorsal nucleus of the thalamus (MDN). We hypothesize that MTLE is associated with selective tissue damage in the MDN related to increased functional and anatomical connectivity between the MDN and the hippocampus. To test this hypothesis we will perform the following analyses on MTLE-HS patient data: Aim 1. We will measure changes in MDN volume using structural MR data. Aim 2. We will measure anatomic connectivity in white matter tracts connecting the hippocampus and MDN using diffusion MR data. Aim 3. We will measure functional connectivity between the hippocampus and MDN using region-seeded analyses of resting-state functional MR data. To learn these neuroimaging analysis methods, the applicant will leverage intra-mural and extra-mural courses and collaborations. The applicant will also have clinical exposure to the pathophysiology, clinical care, and surgical treatment of MTLE. This research training will allow the applicant to learn neuroimaging analysis methods he will use as a neuroimaging researcher and epileptologist.