Multimodal imaging of cognitive networks in epilepsy: Implications for surgery

癫痫认知网络的多模态成像：对手术的影响

基本信息

批准号：
9026942
负责人：
CARRIE R MCDONALD
金额：
$ 58.17万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-01 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9026942
关键词：
Address Affect Age Amygdaloid structure Anterior Temporal Lobectomy Benchmarking Biological Neural Networks Biological Preservation Blood Vessels Brain Clinical Cognition Cognitive Comorbidity Cost of Illness Coupled Data Decision Making Diffusion Diffusion Magnetic Resonance Imaging Employment Epilepsy Episodic memory Excision Fiber Functional Imaging Functional Magnetic Resonance Imaging Funding Goals Grant Health Health Status Healthcare Systems Hippocampus (Brain)Image Imaging Techniques Impaired cognition Impairment Individual Investigation Ipsilateral Language Lasers Lead Left Longevity Magnetic Resonance Imaging Measures Medial Memory Memory Loss Memory impairment Methods Modeling Morbidity - disease rate Multimodal Imaging National Institute of Neurological Disorders and Stroke Nature Neocortex Operative Surgical Procedures Outcome Parietal Patient Care Patients Pattern Performance Postoperative Period Public Health Quality of life Refractory Relative (related person)Research Rest Restriction Spectrum Imaging Risk Seizures Short-Term Memory Structure Techniques Technology Temporal Lobe Temporal Lobe Epilepsy Tissues adverse outcome base cognitive change cognitive skill density executive function functional outcomes improved innovation language processing minimally invasive neocortical nervous system disorder neuroimaging novel performance tests prevent public health relevance relating to nervous system skills success white matter

项目摘要

DESCRIPTION (provided by applicant): Anterior temporal lobectomy (ATL) is a highly sucessful treatment for eliminating seizures in patients with temporal lobe epilepsy (TLE). However, ATL-induced cognitive decline is frequent and often severe, having a deleterious impact on quality of life and functional outcomes. Recently, stereotactic laser amygdalohippocampectomy (SLAH) has been introduced as a minimally-invasive alternative that could minimize risk of cognitive decline. However, it is unclear which patients would benefit from SLAH and in which cognitive domains. During the initial grant funding period, we demonstrated the clinical value of combining information from structural, diffusion and functional imaging to better characterize the neural networks that underlie preoperative language (re)organization and impairment in TLE. We propose that the same multimodal imaging (MMI) approach can be used to quantify risk for postoperative cognitive decline. In this competing renewal application we expand our research in several key ways. First, we address how MMI can be used to predict postoperative outcomes in three important cognitive domains: language, memory, and executive functioning. Second, we evaluate how MMI can be used to quantify risk for cognitive decline following ATL versus SLAH. In a preliminary analysis, we will also evaluate whether postoperative reorganization occurs in a subset of patients that may further influence cognitive outcomes. These goals will be accomplished using the following methods. First, neural activations will be examined in frontal, temporal, and parietal regions using task-related and resting state functional MRI (fMRI) to probe the brain networks that underlie language, memory, and executive functioning in patients with TLE. Second, the integrity of critical white matter fibe tracts will be quantified using an advanced diffusion technique, restriction spectrum imaging (RSI). Third, hippocampal volumes will be quantified from structural MRI (sMRI). Fourth, information from fMRI, RSI, and sMRI will be combined to predict individual risk for surgically-induced cognitive changes on measures of language, memory, and executive functioning. 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 cognitive decline that can help to guide surgical decisions an possibly reduce morbidity associated with removal of eloquent cortex.

描述（由适用提供）：前临时肺切除术（ATL）是一种非常成功的治疗方法，可消除临时叶癫痫（TLE）患者的癫痫发作。但是，ATL引起的认知下降经常且通常是严重的，对生活质量和功能结果产生有害影响。最近，引入了立体定向激光杏仁核膜切除术（SLAH），作为一种微创的替代方案，可以最大程度地减少认知能力下降的风险。但是，目前尚不清楚哪些患者将从Slah和哪些认知领域中受益。在最初的赠款期间，我们证明了将信息从结构，扩散和功能成像结合在一起的临床价值，以更好地表征术前语言（RE）组织和TLE损害的神经网络。我们建议可以使用相同的多模式成像（MMI）方法来量化术后认知下降的风险。在此相互竞争的更新应用中，我们以几种关键的方式扩展了研究。首先，我们解决了如何使用MMI来预测三个重要认知领域的术后结果：语言，记忆和执行功能。其次，我们评估了如何使用MMI来量化ATL与SLAH后认知能力下降的风险。在初步分析中，我们还将评估术后重组是否发生在可能进一步影响认知结果的患者中。这些目标将使用以下方法实现。首先，将使用与任务相关和静止状态功能性MRI（fMRI）在额叶，临时和顶区域检查神经激活，以探测TLE患者中语言，记忆和执行功能的大脑网络。其次，将使用先进的扩散技术，限制频谱成像（RSI）来量化关键白质纤维区域的完整性。第三，海马体积将从结构MRI（SMRI）中进行定量。第四，FMRI，RSI和SMRI的信息将合并，以预测语言诱发的语言，记忆和执行功能的认知能力变化的个人风险。这种更新的目标与2014年NINDS基准进行癫痫研究（第四部分，限制或预防癫痫发作的不利后果及其在整个寿命中的不利后果），这鼓励了手术干预措施对癫痫病认知能力的影响的影响。我们的续签直接解决了这一要求，努力改善手术决策，这将对患者护理产生直接和持续的影响。癫痫病是一种常见的神经系统疾病，每年约有155亿美元的医疗保健系统，可能会对生活质量，就业和健康状况产生负面影响。当前的项目对公共卫生具有很大的影响，因为它通过使用先进的无创技术来识别认知能力下降的个体预测因素，以帮助指导外科决策，可能会降低与删除雄辩的皮质相关的发病率。