PRESURGICAL APPLICATIONS OF FUNCTIONAL MRI IN EPILEPSY

描述（改编自申请人的摘要）：脑外科手术是一种 越来越普遍和有效的治疗顽固性癫痫。 成功的手术结果取决于正确识别大脑部位 癫痫发作的起源，并尽量减少切除重要的功能区， 大脑，但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。 本研究的目的 程序是定量评估功能磁的价值 磁共振成像（FMRI）在术前评估患者 癫痫 第一个具体目标是测试功能磁共振成像是否可以取代 颈动脉内异戊巴比妥（Wada）试验用于确定 语言和记忆功能。 两者之间的一致程度 测试，它们的相对可靠性，以及每种测试在预测 认知结果将被精确测量。 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。 的体积 手术患者中切除的功能性和非功能性组织，如 由术前功能磁共振成像图和定量解剖MRI定义，将 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指标， 确定功能磁共振成像的潜力，以帮助确定最佳的切除边界。 最后的具体目标是测试功能磁共振成像预测的能力， 颞叶癫痫患者癫痫发作的偏侧化和控制结果 脑叶癫痫 颞叶功能激活的偏侧化 功能磁共振成像将被用作癫痫灶偏侧化的指标。 的 该功能磁共振成像指数的预测能力将与标准技术进行比较 用于癫痫病灶识别，包括无创和颅内 EEG、常规和容积MRI、心理测试、SPECT和Wada test. 在实现这些目标的过程中，将为使用 功能磁共振成像对降低癫痫发病率和提高癫痫疗效的研究 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.