Encephalographic MRI and Epilepsy Discharge Localization

脑成像 MRI 和癫痫放电定位

基本信息

批准号：
8225777
负责人：
Darren Benjamin Orbach
金额：
$ 23.75万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-01 至 2013-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8225777
关键词：
16 year old Acceleration Agar Antiepileptic Agents Area Benign Brain region Cerebrum Characteristics Childhood Clinical Convection Development Diagnostic Dimensions Electrocorticogram Electrodes Electroencephalography Epilepsy Evaluation Excision Functional disorder Gel Goals Image Image Analysis Imagery Imaging Device Impairment Implant Individual Intractable Epilepsy Lead Left Liquid substance Magnetic Resonance Imaging Maps Measurement Medical Methods Modeling Monitor Neurons Noise Operative Surgical Procedures Partial Epilepsies Patients Pharmaceutical Preparations Phase Postoperative Period Protocols documentation Refractory Relative (related person)Research Resected Resolution Risk Seizures Signal Transduction Slice Solutions Source Speed Staging Surface Surgical Management Syndrome Techniques Testing Thick Time Work base cohort cost gray matter improved magnetic field neuropsychiatry novel operation response tool treatment effect white matter

项目摘要

DESCRIPTION (provided by applicant): The overarching aim of our research is to more directly image the cerebral discharges underlying epilepsy than has been achievable using standard techniques. Epilepsy patients often have abnormal neuronal discharges between seizures, called interictal spikes. Although their presence can be detected using EEG, the source of these spikes remains difficult to identify. We are developing a novel set of imaging tools and analysis methods to help us detect these discharges via their effect on MR images (encephalographic magnetic resonance imaging, or eMRI). The technique is based upon simultaneous high-speed acquisition of electroencephalography (EEG) and gradient-echo echo-planar MR images, with the EEG signal used to identify the images acquired during electrically active epochs. In a small cohort of patients with epilepsy, we have demonstrated fast responses in the MR images, nearly simultaneous with the interictal spikes seen on EEG. Our goals here are to extend eMRI as a tool with clinical utility for precise localization of the foci of epileptiform activity. Our first specific aim is to image pediatric patients with benign epilepsy with centrotemporal spikes (BECTS), in whom spikes are frequent and exquisitely well localized anatomically. The spatial extent of the regions involved by the interictal spikes will be studied, in order to determine if this correlates with the presence of neuropsychiatric or developmental abnormalities in this group of patients. Our second specific aim is to use eMRI to assess a cohort of patients with medically intractable epilepsy, in whom invasive cortical electrodes will be implanted intracranially as the first step in their epilepsy surgery. The regions identified by the invasive electrodes will be compared with the regions identified by eMRI. Finally, our third specific aim is to systematically vary the imaging parameters used in the eMRI acquisition, and make use of an electric current phantom, in order to optimize our protocol and to elucidate the mechanisms underlying the fast MR responses we have observed. eMRI has the potential to improve presurgical localization and to transform epilepsy resection into a one-stage surgical procedure, avoiding the need for prolonged intracranial recordings. More broadly, the technique would potentially allow for more efficacious deployment of antiepileptic medical therapy in the individual patient, as well as providing a means for testing novel agents, by directly demonstrating treatment effects on interictal activity. This work is likely to deepen our understanding of the pathophysiology of epileptiform discharges and their spread. PUBLIC HEALTH RELEVANCE: A technique, such as eMRI, that allows for more direct imaging of epileptiform discharges than is currently possible, is likely to be a powerful diagnostic tool for presurgical seizure focus localization, potentially transforming epilepsy resection into a one-stage surgical procedure, avoiding the need for prolonged intracranial recordings. More broadly, such an imaging tool would potentially allow for more efficacious deployment of antiepileptic medications in the individual patient, as well as providing a means for testing novel agents, by directly demonstrating their effects on cortical electrical discharges. This work is likely to deepen our understanding of the pathophysiology of epilepsy discharges and their spread.

描述（由申请人提供）：我们研究的总体目标是比使用标准技术更直接地对癫痫引起的脑放电进行成像。癫痫患者在癫痫发作之间经常会出现异常的神经元放电，称为发作间期尖峰。尽管可以使用脑电图检测到它们的存在，但这些尖峰的来源仍然难以识别。我们正在开发一套新颖的成像工具和分析方法，以帮助我们通过其对 MR 图像（脑部磁共振成像或 eMRI）的影响来检测这些放电。该技术基于同时高速采集脑电图 (EEG) 和梯度回波回波平面 MR 图像，并使用 EEG 信号来识别在电活动时期采集的图像。在一小群癫痫患者中，我们在 MR 图像中展示了快速反应，几乎与脑电图上看到的发作间期尖峰同时发生。我们的目标是将 eMRI 扩展为一种具有临床实用性的工具，用于精确定位癫痫样活动的病灶。我们的第一个具体目标是对伴有中央颞区棘波（BECTS）的良性癫痫儿科患者进行成像，这些患者的棘波在解剖学上是频繁且精确定位的。将研究发作间期尖峰所涉及区域的空间范围，以确定这是否与该组患者中神经精神或发育异常的存在相关。我们的第二个具体目标是使用 eMRI 来评估一组患有难治性癫痫的患者，作为癫痫手术的第一步，将侵入性皮质电极植入到这些患者的颅内。侵入式电极识别的区域将与 eMRI 识别的区域进行比较。最后，我们的第三个具体目标是系统地改变 eMRI 采集中使用的成像参数，并利用电流模型，以优化我们的协议并阐明我们观察到的快速 MR 响应背后的机制。 eMRI 有潜力改善术前定位并将癫痫切除转变为一阶段外科手术，从而避免长时间颅内记录的需要。更广泛地说，该技术可能允许在个体患者中更有效地部署抗癫痫药物治疗，并通过直接展示对发作间期活动的治疗效果来提供测试新药物的手段。这项工作可能会加深我们对癫痫样放电的病理生理学及其传播的理解。公共卫生相关性：eMRI 等技术可以比目前更直接地对癫痫样放电进行成像，可能成为术前癫痫病灶定位的强大诊断工具，有可能将癫痫切除转变为一阶段外科手术，避免了长时间颅内记录的需要。更广泛地说，这种成像工具可能会允许在个体患者中更有效地部署抗癫痫药物，并通过直接展示新药物对皮质放电的影响来提供测试新药物的方法。这项工作可能会加深我们对癫痫放电的病理生理学及其传播的理解。