MRI Mechanisms of Adverse Outcome in Preterm Infants with Seizures

早产儿癫痫发作不良后果的 MRI 机制

• 批准号: 8037069
• 负责人: Hannah Cranley Glass
• 金额: $ 16.51万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8037069
• 关键词: Accounting; Basic Science; Biostatistical Methods; Brain; Brain Injuries; California; Caring; Characteristics; Clinical Research; Clinical Trials; Cohort Studies; Data; Detection; Development; Diffusion Magnetic Resonance Imaging; Electroencephalography; Enrollment; Evolution; Foundations; Future; Glass; Goals; Gold; Hippocampus (Brain); Impact Seizures; Infant; Injury; Intensive Care; Lead; Lobar; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Metabolism; Methods; Monitor; Neonatal; Neurology; Newborn Infant; Nurseries; Outcome; Parents; Pattern; Pediatric Neurology; Population; Pregnancy; Premature Birth; Premature Infant; Research; Research Design; Research Infrastructure; Research Personnel; Risk; San Francisco; School-Age Population; Seizures; Survivors; Testing; Time; Translational Research; United States; Universities; adverse outcome; age group; career; disability; follow-up; improved; neuroimaging; neurophysiology; novel; patient oriented; patient oriented research; prevent; professor; public health relevance; radiologist; spectroscopic imaging

DESCRIPTION (provided by applicant): Accumulating evidence suggests that seizures harm the developing brain, however little is known about their impact in preterm infants. Dr. Hannah Glass' proposed research will use the infrastructure of her mentor's ongoing longitudinal cohort study to examine magnetic resonance measures of brain injury, brain development, and outcome in preterm infants with seizures. This parent study enrolls infants born <32 weeks gestation, examines them with MRI at two neonatal time points and follows them through school age. There are currently no routine seizure measurements in this study, and seizures in this age group are difficult to detect clinically and without prolonged monitoring. Improving seizure detection for the parent study will allow Dr. Glass to use the high-quality MRI and follow-up data from that study to investigate whether seizures act to alter brain development and lead to impaired neurodevelopmental outcome in the preterm population. The specific aims for this proposal are to compare seizure characteristics (presence, ictal lobar onset, evolution, etc) in preterm newborns with: (1) qualitatitve patterns of injury on conventional MRI; (2) quantitative measures of the hippocampus (size, metabolism and microstructure); and (3) developmental outcome. To improve seizure detection, we will add gold standard video-EEG monitoring to the parent study. MRI data from the parent study will be used to examine novel measures of the hippocampus (volume, microstructure using diffusion tensor imaging, and metabolites using 3D MR spectroscopic imaging). This project is part of an application for a K23 award for Dr. Glass, an Assistant Professor in Neurology & Pediatrics at the University of California, San Francisco, who is establishing herself as a young investigator in patient-oriented clinical and translational research in neonatal neurology. This K23 award will enable her to accomplish the following career goals: (1) to become expert in patient-oriented research in neonatal neurology and to develop an independent clinical research career; (2) to conduct clinical investigations of seizures in preterm infants using advanced MRI methods and EEG; and (3) to implement advanced biostatistical methods in clinical studies. To achieve these goals, Dr. Glass has assembled a mentoring team comprised of Dr. Donna Ferriero, who conducts basic science and clinical investigations in neonatal neurology), and Dr. A. James Barkovich (a radiologist who focuses on neuroimaging in newborns), and two scientific advisors: Dr. David Glidden (an expert in study design and biostatistical analysis) and Dr. Joseph Sullivan (epileptologist with expertise in neonatal neurophysiology). PUBLIC HEALTH RELEVANCE: Preterm birth accounts for 12.5% of deliveries in the United States. Advances in care are resulting in rising numbers of intensive care nursery survivors, many of whom are at risk for disabilities. Understanding the impact of seizures in preterm infants will lay the foundation for future multi-center studies testing new strategies for preventing and treating seizures in this population. We expect that reducing seizure burden will lead to improved neurodevelopmental outcomes following preterm birth.

描述（由申请人提供）：积累证据表明癫痫发作会损害发育中的大脑，但是对它们对早产儿的影响知之甚少。汉娜·格拉斯（Hannah Glass）博士提出的研究将利用其导师正在进行的纵向队列研究的基础设施来检查癫痫发作早产儿的脑损伤，脑发育和结果的磁共振测量。这项父母研究招募了<32周妊娠的婴儿，在两个新生儿时间点检查了MRI，并在学龄前跟随他们。目前，本研究中没有常规的癫痫发作测量值，并且该年龄组的癫痫发作很难在临床上检测到没有长时间的监测。父母研究的提高癫痫发作检测将使Glass博士能够使用高质量的MRI和该研究的随访数据来研究癫痫发作是否可以改变脑发育的作用并导致早产群体的神经发育结果受损。 该提案的具体目的是比较早产新生儿中的癫痫发作特征（存在，发作，进化等）与以下方式：（1）传统MRI的损伤质量模式； （2）海马的定量度量（大小，代谢和微观结构）； （3）发展结果。为了改善癫痫发作检测，我们将为父母的研究添加黄金标准视频EEG监控。来自家长研究的MRI数据将用于检查海马的新型测量（使用扩散张量成像的体积，微结构，使用3D MR光谱成像代谢物）。 该项目是Glass博士申请K23奖的一部分，Glass是加州大学旧金山神经病学和儿科助理教授，后者正在建立自己的新生儿神经病学临床和转化研究的年轻研究者。这项K23奖将使她能够实现以下职业目标：（1）成为新生神经学研究的专家，并发展独立的临床研究职业； （2）使用高级MRI方法和EEG对早产儿进行癫痫发作的临床研究； （3）在临床研究中实施先进的生物统计学方法。 To achieve these goals, Dr. Glass has assembled a mentoring team comprised of Dr. Donna Ferriero, who conducts basic science and clinical investigations in neonatal neurology), and Dr. A. James Barkovich (a radiologist who focuses on neuroimaging in newborns), and two scientific advisors: Dr. David Glidden (an expert in study design and biostatistical analysis) and Dr. Joseph Sullivan (epileptologist with expertise in新生儿神经生理学）。 公共卫生相关性：早产占美国分娩的12.5％。护理进步导致重症监护幼儿园幸存者数量增加，其中许多人有残疾风险。了解早产儿的癫痫发作的影响将为未来的多中心研究奠定基础，以测试预防和治疗该人群癫痫发作的新策略。我们预计，减轻癫痫发作负担将导致早产后的神经发育结果改善。