Multimodal imaging of memory reorganization in epilepsy from whole brain networks to local neuronal responses: Implications for surgical-decision-making

前额叶切除术(ATL)是一种非常成功的消除癫痫发作的治疗方法。 颞叶癫痫(TLE)。然而，ATL诱导的记忆力下降是频繁的，通常是严重的，具有 对生活质量和功能结果的有害影响。立体定向激光杏仁核海马区切除术 (SLAH)已经作为一种可以将内存风险降至最低的微创替代方案而引入 拒绝。然而，目前尚不清楚哪些患者将从SLAH中受益最大，以及SLAH是否 与ATL相比，降低了发作记忆下降的目标方面的风险。在上一次 在拨款期间，我们展示了结合结构信息(SMRI)的临床价值， 扩散成像(DTI)和功能磁共振成像(FMRI)，以更好地表征基础神经网络 术前语言和记忆障碍及(重新)组织和TLE。我们建议同样的 多模式成像(MMI)方法可用于量化术后记忆衰退的风险。在这 在竞争更新方面，我们扩展了我们的MMI方法，将sMRI/DTI/fMRI与颅内记录(IEEG)相结合， 这使我们能够深入研究TLE中情节记忆网络的空间和时间动力学。我们 使用具有真实世界含义的多模式联想学习任务(即，将面孔与名字配对)， 以前还没有在外科背景下进行过研究。此外，我们从临床前和计算中吸取了 海马体功能模型可能解释了为什么许多患者难以做出细微的区分 在记忆中(即，模式分离受损)，即使简单的项目记忆看起来完好无损。我们建议 我们的MMI方法将产生TLE中情节记忆网络的更完整的特征，揭示 患者个体的结构和功能重组模式，并使个性化方法能够 在考虑手术方案时进行风险评估。最后，我们将跟踪术后认知和成像的变化 ATL和SLAH，并确定促进重组和改善认知的患者特定因素 结果。这次更新的目标与2014年NINDS癫痫基准完全一致 研究(第四部分，限制或预防癫痫发作及其治疗的不良后果 寿命)，鼓励减轻手术干预对认知合并症的影响 得了癫痫。我们的续签直接满足了这一要求，努力改善手术决策，这将 对病人护理产生直接和持续的影响。癫痫是一种常见的神经系统疾病， 医疗保健系统每年约为155亿美元，会对生活质量、就业、 以及健康状况。目前的项目对公共卫生有很大的影响，因为它努力改善 使用先进的非侵入性技术识别个体对癫痫患者的健康结果 记忆力下降的预测指标可以帮助指导手术决定，并可能减少相关的发病率 移除了能言善辩的大脑区域。

Anterior temporal lobectomy (ATL) is a highly sucessful treatment for eliminating seizures in patients with temporal lobe epilepsy (TLE). However, ATL-induced memory decline is frequent and often severe, having a deleterious impact on quality of life and functional outcomes. Stereotactic laser amygdalohippocampectomy (SLAH) has been introduced as a minimally-invasive alternative that could minimize risk of memory decline. However, it is unclear which patients would benefit the most from SLAH and whether SLAH decreases risk for targeted aspects of episodic memory decline compared to ATL. During the previous grant funding period, we demonstrated the clinical value of combining information from structural (sMRI), diffusion (DTI), and functional (fMRI) imaging to better characterize the neural networks that underlie preoperative language and memory impairment and (re)organization and in TLE. We propose that the same multimodal imaging (MMI) approach can be used to quantify risk for postoperative memory decline. In this competing renewal, we extend our MMI approach, combining sMRI/DTI/fMRI with intracranial recordings (iEEG), enabling us to delve deep into the spatial and temporal dynamics of episodic memory networks in TLE. We employ multimodal associative learning tasks with real-world implications (i.e., pairing a face with a name) that have not before been studied in the surgical context. In addition, we draw from preclinical and computational models of hippocampal functioning that may inform why many patients struggle to make fine-grain distinctions in memory (i.e., impaired pattern separation), even when simple item memory appears intact. We propose that our MMI approach will yield a more complete characterization of episodic memory networks in TLE, reveal patterns of structural and functional reorganization in individual patients, and enable a personalized approach to risk assessment when considering surgical options. Finally, we will track cognitive and imaging changes post- ATL and SLAH and identify patient-specific factors that promote reorganization and improved cognitive outcomes. The goals of this renewal are perfectly aligned with the 2014 NINDS Benchmarks for Epilepsy Research (Part IV, Limit or prevent adverse consequences of seizures and their treatment across the lifespan), which encourage mitigating the effects of surgical interventions on cognitive co-morbidities in epilepsy. Our renewal directly addresses this request, striving to improve surgical decision-making, which will have an immediate and sustained impact on patient care. Epilepsy is a common neurological disease that costs the healthcare system approximately $15.5 billion annually and can negatively impact quality of life, employment, and health status. The current project has strong implications for public health because it strives to improve health outcomes in patients with epilepsy by using advanced, noninvasive technology to identify individual predictors of memory decline that can help to guide surgical decisions and possibly reduce morbidity associated with removal of eloquent brain regions.