1H AND 31P MRSI FOR EPILEPSY LOCALIZATION

本申请的长期目标是通过使用神经成像技术（包括磁共振成像（MRI）、1H和31 P MR光谱成像（MRSI）和18F-PET）的组合，更好地对难治性癫痫进行术前定位，从而改善癫痫发作手术的结局。 这些技术将针对三组正在接受癫痫发作手术评估的难治性癫痫患者（5年的数量）：1）MRI不一致的内侧颞叶癫痫患者，即，MRI显示无异常或EEG定义的癫痫病灶对侧异常（NC-mTLE，n=75），2）非病灶性新皮质癫痫患者（NE，n=100），3）婴儿痉挛症儿童（IS，n=100）。 NC-mTLE和NE患者经常需要侵入性EEG记录，手术后无癫痫发作的概率小于50%，通常不考虑手术。 将根据术前神经影像学结果分析术后手术结局。 假设：1）NC-mTLE -患有医学难治性mTLE而没有MRI一致性的患者，其具有与EEG定位一致的1H和31 P MRSI测量（即，肺叶和侧），将有一个显着更好的术后结果比患者没有MRSI一致性。 2a）在MRI上没有病变的NE-NE患者将具有与EEG定位一致的1H和31 P MRSI（即，叶和侧），并且该一致性将大于18FDG-PET所提供的一致性。 2b）具有与EEG定位一致的1H和31 P MRSI测量的NE-NE患者将具有比没有MRSI一致性的患者显著更好的术后结果。3a）IS -患有医学难治性婴儿痉挛症的儿童的1H和31 P MRSI与通过两项或多项研究（VET、18 FDG-PET和/或MRI）的组合确定的癫痫发作病灶一致，并且这种一致性将大于MRI或18 FDG-PET提供的一致性。3b）具有与其他临床和成像研究提供的定位一致的1H和31 P MRSI的IS - IS儿童将具有比不具有这种一致性的患者显著更好的手术后结果。 这些研究有望改善难治性癫痫患者的手术结局，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.