The best hope for survival and improved quality of life in patients with epilepsy is to remove of as much of the lesion causing seizures as possible, while preserving as much normal functioning brain as possible. Currently, presurgical mapping of patients with epilepsy requires a multi-layered approach that involves several different procedures and tests. Many young children cannot have presurgical mapping due to the inability to follow tasks and often need anesthesia for a MRI. We hope to develop a neuroimaging method that can be performed in virtually any patient that maps all relevant eloquent cortex-including the motor system, language systems, and memory systems-in about 10 minutes, and without the need of patient active participation. We hypothesize that essential areas of cortex can be accurately mapped based on intrinsic functional connectivity using functional connectivity magnetic resonance imaging (fcMRI). While at rest, and even under anestheisa, patient compliance will not be required and a single, simple procedure could be used for functional mapping of specific neural systems. This technique makes it possible to map language, memory, and motor systems in patients who might have difficulty following English directions, such as children, the developmentally impaired, and even people who are unconscious. This type of neuroimaging may lead to a new language and memory lateralization technique, and might be useful when the traditional invasive Wada test and invasive brain mapping are not possible. Here, we propose a plan to develop the technique in healthy subjects and then validate it in patients who undergo surgery to correct their epilepsy. This project proposes a new approach for presurgical mapping for epilepsy patients that, if successful, would allow presurgical functional neuroimaging in patients who currently are unable to have functional mapping.
Epilepsy affects about 1.5 million people in the United States. The goal of this project is to use a new method of imaging to locate the site in the brain where the seizures originate. Further, with the same test, determine where language, memory and motor function are in the brain. This test will be performed on a standard magnetic resonance imaging scanner (MRI) that is widely available in the United State. After a ten minute scan, it will give a neurosurgeon the complete map of the brain for surgical treatment of epilepsy.
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