Functional Connectivity of Intrinsic Brain Activity for Presurgical Mapping

描述(申请人提供)：癫痫患者生存和改善生活质量的最大希望是尽可能多地切除导致癫痫发作的病变，同时尽可能多地保留正常功能的大脑。目前，癫痫患者的术前标测需要一种多层次的方法，涉及几种不同的程序和测试。许多年幼的儿童由于无法完成任务而无法进行术前标测，而且经常需要麻醉才能进行核磁共振检查。我们希望开发一种神经成像方法，几乎可以在任何患者身上进行，在大约10分钟内绘制所有相关的口才皮质-包括运动系统、语言系统和记忆系统-而不需要患者的积极参与。我们假设，使用功能连接磁共振成像(FcMRI)可以基于固有的功能连接准确地标测皮质的基本区域。在静息状态下，甚至在麻醉状态下，患者不需要依从性，只需一个简单的程序就可以对特定的神经系统进行功能映射。这项技术使绘制语言、记忆和运动系统的地图成为可能，这些患者可能在遵循英语指令方面存在困难，例如儿童、发育障碍者，甚至是昏迷的人。这种类型的神经成像可能会导致一种新的语言和记忆定侧技术，当传统的侵入性WADA测试和侵入性脑图不可能时，这种类型的神经成像可能会很有用。在这里，我们提出了一个计划，在健康的受试者中开发这项技术，然后在接受手术矫正癫痫的患者中验证它。该项目为癫痫患者提出了一种新的术前定位方法，如果成功，将允许目前无法进行功能定位的患者进行术前功能神经成像。

DESCRIPTION (provided by applicant): The best hope for survival and improved quality of life in patients with epilepsy is to remove of as much of the lesion causing seizures as possible, while preserving as much normal functioning brain as possible. Currently, presurgical mapping of patients with epilepsy requires a multi-layered approach that involves several different procedures and tests. Many young children cannot have presurgical mapping due to the inability to follow tasks and often need anesthesia for a MRI. We hope to develop a neuroimaging method that can be performed in virtually any patient that maps all relevant eloquent cortex-including the motor system, language systems, and memory systems-in about 10 minutes, and without the need of patient active participation. We hypothesize that essential areas of cortex can be accurately mapped based on intrinsic functional connectivity using functional connectivity magnetic resonance imaging (fcMRI). While at rest, and even under anestheisa, patient compliance will not be required and a single, simple procedure could be used for functional mapping of specific neural systems. This technique makes it possible to map language, memory, and motor systems in patients who might have difficulty following English directions, such as children, the developmentally impaired, and even people who are unconscious. This type of neuroimaging may lead to a new language and memory lateralization technique, and might be useful when the traditional invasive Wada test and invasive brain mapping are not possible. Here, we propose a plan to develop the technique in healthy subjects and then validate it in patients who undergo surgery to correct their epilepsy. This project proposes a new approach for presurgical mapping for epilepsy patients that, if successful, would allow presurgical functional neuroimaging in patients who currently are unable to have functional mapping.