Epileptogenic Tissue Localization using EEG-fMRI

使用 EEG-fMRI 定位致癫痫组织

• 批准号: 6987461
• 负责人: R Todd Constable
• 金额: $ 36.87万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6987461
• 关键词: bioimaging /biomedical imaging; brain circulation; brain electrical activity; clinical research; electroencephalography; epilepsy; functional magnetic resonance imaging; human subject; neurophysiology; oxygen consumption; patient oriented research; tissues

DESCRIPTION (provided by applicant): Each year a significant number of epilepsy patients present to the Yale Epilepsy Center with highly debilitating intractable epilepsy. When epilepsy is refractory to drug therapy, the best outcome occurs if the epileptogenic tissue is removed surgically. However, this approach to curing epilepsy is only effective if the epileptogenic tissue is limited in extent (focal) and identifiable. Many of these patients have no abnormalities visible on MR, PET, or SPECT scanning, or they have discordant findings across several measures, making localization of the epileptogenic tissue that generates the seizures difficult. This proposal is aimed at further developing and understanding combined electroencephalography and functional magnetic resonance imaging (EEG-fMRI). In this approach, EEG monitoring is performed during a functional MRI scanning session. A number of functional imaging approaches including, blood oxygenation level dependent (BOLD) contrast, cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2)) will be investigated to identify local tissue regions that exhibit signal changes in synchrony with interictal epileptiform discharges (lEDs). The experiments are designed to improve our understanding of the relationship between MR measures of neuronal activity in the presence of epileptiform activity, and neuronal signatures of activity based on surface or depth recorded EEG. Characteristics of the measured response (peak integration, time-to-peak, amplitude, and duration) for specific tissues will be compared in an F-test with type of epilepsy and concordance with difference SPECT and intracranial recordings. In addition, the EEG-fMRI localization will be directly compared spatially, with the epileptogenic tissue localization obtained using difference SPECT imaging, and with the clinical gold standard of invasive recordings from intracranial implanted electrodes, and finally with surgical outcome. Little is currently known about the neurophysiological response to lEDs, the relationship between EEG and fMRI measures, nor of the relationship between this inter-ictal and ictal activity. The experiments proposed in this work will provide a better understanding of these issues at a basic neuroscience level, while also allowing validation through invasive monitoring. These developments will improve the efficacy of seizure localization, allow for more precise targeting of surgical interventions through better localization, and improve outcomes from surgery. A large epilepsy population exists that could benefit greatly from better mapping techniques and these techniques may ultimately replace invasive methods decreasing health care costs and morbidity.

描述（由申请人提供）：每年都有大量癫痫患者因高度衰弱的难治性癫痫而到耶鲁癫痫中心就诊。当癫痫对药物治疗无效时，通过手术切除致癫痫组织会获得最佳结果。然而，这种治疗癫痫的方法只有在致癫痫组织的范围（局灶性）有限且可识别的情况下才有效。这些患者中的许多人在 MR、PET 或 SPECT 扫描中没有发现异常，或者在多项测量中发现不一致的结果，这使得定位引起癫痫发作的致癫痫组织变得困难。该提案旨在进一步开发和理解脑电图和功能磁共振成像（EEG-fMRI）相结合。在这种方法中，脑电图监测是在功能性 MRI 扫描过程中进行的。将研究多种功能成像方法，包括血氧水平依赖性 (BOLD) 对比度、脑血流量 (CBF) 和脑耗氧代谢率 (CMRO2)），以识别与信号同步变化的局部组织区域。发作间期癫痫样放电 (LED)。这些实验旨在提高我们对癫痫样活动时神经元活动的磁共振测量与基于表面或深度记录的脑电图的神经元活动特征之间关系的理解。特定组织的测量响应特征（峰值积分、峰值时间、幅度和持续时间）将在 F 检验中与癫痫类型进行比较，并与差异 SPECT 和颅内记录进行比较。此外，EEG-fMRI 定位将直接在空间上与使用差异 SPECT 成像获得的致癫痫组织定位、颅内植入电极侵入性记录的临床金标准进行比较，最后与手术结果进行比较。目前对 IED 的神经生理学反应、脑电图和功能磁共振成像测量之间的关系以及发作间期和发作期活动之间的关系知之甚少。这项工作中提出的实验将在基础神经科学水平上更好地理解这些问题，同时还允许通过侵入性监测进行验证。这些进展将提高癫痫定位的功效，通过更好的定位来更精确地定位手术干预，并改善手术结果。大量的癫痫患者可以从更好的绘图技术中受益匪浅，这些技术最终可能会取代侵入性方法，从而降低医疗保健成本和发病率。