QUANTITATIVE MRI IN EPILEPSY

Project: Research project

Project Details

Description

All patients with refractory epilepsy undergo anatomic imaging studies (MR
or CT) prior to surgery in order to identify (or exclude) potential
epileptogenic mass lesions (tumor or AVM). State-of-the-art T2-weighted MR
imaging will identify close to 100% of all such mass lesions. However in
our and other's experience, T2-weighted MR imaging typically will not
provide definite preoperative seizure lateralizing information in most
patients with temporal lobe epilepsy who are subsequently found
histologically to have mesial sclerosis. Functional imaging studies
(PET/SPECT) have been found to be more useful than T-2-weighted MR imaging
for seizure lateralization in patients with mesial sclerosis.

We have developed a technique of MR-based hippocampal formation volume
measurement (HF) volumetry) which is both sensitive and highly specific in
seizure lateralization in patients with mesial sclerosis. Therefore, the
clinical role of our volumetric technique clearly overlaps the domain
occupied by functional imaging (PET/SPECT). No data exists to indicate how
these two vastly different approaches to the same problem (seizure
lateralization by neuroimaging in patients without an epileptogenic mass
lesion).

We propose to evaluate HF volumetry in 180 patients who will undergo
surgery at Mayo Medical Center for medically refractory partial epilepsy of
temporal lobe origin over a 3 year period, who have pathologically
documented mesial sclerosis in the surgical specimen. We hypothesize that
I) unilateral hippocampal atrophy as determined by MR-based volume
measurements, will be an accurate, non-invasive marker identifying the side
of the seizure disorder, 2) the degree of unilateral hippocampal atrophy on
MR will be useful in predicting the level of post surgical seizure control
(surgical outcome).

We also propose a comparative evaluation of 1) the percentage of cases in
which the seizure focus is correctly and incorrectly identified by HF
volumetry versus brain SPECT, 2) whether these imaging studies are, or are
not complimentary in lateralizing the epileptogenic focus.
StatusNot started

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