1H AND 31P MRSI FOR EPILEPSY LOCALIZATION

Summary

Principal Investigator: Kenneth Laxer
Affiliation: California Pacific Medical Center
Country: USA
Abstract: The long term goal of this application is to improve the outcome of seizure surgery by better presurgical localization of medically refractory epilepsy using a combination of neuroimaging techniques including magnetic resonance imaging (MRI), 1H and 31P MR spectroscopic imaging (MRSI), and 18F-PET. These techniques will be directed at three groups with medically refractory epilepsy who are being evaluated for seizure surgery (numbers for 5 years): 1)patients with medial temporal lobe epilepsy in whom MRI is non-concordant i.e., MRI shows no abnormality, or an abnormality contralateral to the EEG-defined seizure focus (NC-mTLE, n=75), 2) patients with non-lesional neocortical epilepsy (NE, n=100), and 3) children with Infantile Spasms (IS, n=100). NC-mTLE and NE patients frequently require invasive EEG recording, have less than a 50 percent probability of becoming seizure free with surgery, and are often not considered for surgery. Post-operative surgical outcome will be analyzed in relation to the pre-operative neuroimaging findings. Hypotheses: 1) NC-mTLE -Patients with medically refractory mTLE without MRI concordance, who have 1H and 31P MRSI measures concordant with the EEG localization (i.e., lobe and side), will have a significantly better post surgical outcome than patients without MRSI concordance. 2a) NE - NE patients without lesions on MRI, will have 1H and 31P MRSI concordant with the EEG localization (i.e., lobe and side), and this concordance will be greater than that provided by 18FDG-PET. 2b) NE - NE patients, who have 1H and 31P MRSI measures concordant with the EEG localization will have a significantly better post surgical outcome than patients without MRSI concordance. 3a) IS - Children with medically refractory Infantile Spasms will have 1H and 31P MRSI concordant with the seizure focus determined by a combination of two or more studies (VET, 18FDG-PET, and/or MRI) and this concordance will be greater than that provided by MRI or 18FDG-PET. 3b) IS - IS children, who have 1H and 31P MRSI concordant with the localization provided by the other clinical and imaging studies will have a significantly better post surgical outcome than patients without such concordance. These studies are expected to lead to improved surgical outcome, and to reduce unnecessary surgery, in patients with intractable epilepsy.
Funding Period: 1994-05-01 - 2005-03-31
more information: NIH RePORT

Top Publications

  1. ncbi Metabolic characteristics of cortical malformations causing epilepsy
    S G Mueller
    Dept. of Veterans Affairs (DVA, Medical Center, Magnetic Resonance Spectroscopy Unit, San Francisco, CA 94115, USA
    J Neurol 252:1082-92. 2005
  2. ncbi Alzheimer's Disease Neuroimaging Initiative (ADNI): clinical characterization
    R C Petersen
    Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
    Neurology 74:201-9. 2010
  3. ncbi Relationships between biomarkers in aging and dementia
    W J Jagust
    Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94620, USA
    Neurology 73:1193-9. 2009
  4. ncbi Subfield atrophy pattern in temporal lobe epilepsy with and without mesial sclerosis detected by high-resolution MRI at 4 Tesla: preliminary results
    Susanne G Mueller
    Department of Radiology, Center for Imaging of Neurodegenerative Diseases, University of California, San Francisco, California 94121, USA
    Epilepsia 50:1474-83. 2009
  5. ncbi Widespread neocortical abnormalities in temporal lobe epilepsy with and without mesial sclerosis
    S G Mueller
    Center for Imaging of Neurodegenerative Diseases and Department of Radiology, University of California, San Francisco, CA 94121, USA
    Neuroimage 46:353-9. 2009
  6. ncbi Accelerated 3D echo-planar spectroscopic imaging at 4 Tesla using modified blipped phase-encoding
    Andreas Ebel
    Northern California Institute for Research and Education, Department of Radiology, University of California San Francisco, Department of Veterans Affairs Medical Center San Francisco, San Francisco, California 94121, USA
    Magn Reson Med 58:1061-6. 2007
  7. ncbi Voxel-based T2 relaxation rate measurements in temporal lobe epilepsy (TLE) with and without mesial temporal sclerosis
    Susanne G Mueller
    Center for Imaging of Neurodegenerative Diseases, VAMC San Francisco, California, USA
    Epilepsia 48:220-8. 2007
  8. ncbi Voxel-based optimized morphometry (VBM) of gray and white matter in temporal lobe epilepsy (TLE) with and without mesial temporal sclerosis
    Suzanne G Mueller
    Center for Imaging of Neurodegenerative Diseases, VAMC San Francisco, San Francisco, CA, USA
    Epilepsia 47:900-7. 2006
  9. ncbi Spectroscopic evidence of hippocampal abnormalities in neocortical epilepsy
    S G Mueller
    Department of Veterans Affairs (DVA) Medical Center, Magnetic Resonance Unit, San Francisco, CA, USA
    Eur J Neurol 13:256-60. 2006
  10. ncbi Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy
    H E Kirsch
    UCSF Epilepsy Center, Department of Neurology, University of California, School of Medicine, San Francisco, CA, USA
    Neurology 65:676-80. 2005

Detail Information

Publications11

  1. ncbi Metabolic characteristics of cortical malformations causing epilepsy
    S G Mueller
    Dept. of Veterans Affairs (DVA, Medical Center, Magnetic Resonance Spectroscopy Unit, San Francisco, CA 94115, USA
    J Neurol 252:1082-92. 2005
    ..Metabolic abnormalities in the perilesional zone share several characteristics of CMs and might therefore represent areas with microscopic malformations and/or intrinsic epileptogenicity...
  2. ncbi Alzheimer's Disease Neuroimaging Initiative (ADNI): clinical characterization
    R C Petersen
    Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
    Neurology 74:201-9. 2010
    ..Neuroimaging measures and chemical biomarkers may be important indices of clinical progression in normal aging and mild cognitive impairment (MCI) and need to be evaluated longitudinally...
  3. ncbi Relationships between biomarkers in aging and dementia
    W J Jagust
    Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94620, USA
    Neurology 73:1193-9. 2009
    ..Relationships between biomarkers and with disease severity are incompletely understood...
  4. ncbi Subfield atrophy pattern in temporal lobe epilepsy with and without mesial sclerosis detected by high-resolution MRI at 4 Tesla: preliminary results
    Susanne G Mueller
    Department of Radiology, Center for Imaging of Neurodegenerative Diseases, University of California, San Francisco, California 94121, USA
    Epilepsia 50:1474-83. 2009
    ..The aim of this study was to test if distinct subfield atrophy patterns can be detected in temporal lobe epilepsy (TLE) with mesial temporal sclerosis (TLE-MTS) and without (TLE-no) hippocampal sclerosis...
  5. ncbi Widespread neocortical abnormalities in temporal lobe epilepsy with and without mesial sclerosis
    S G Mueller
    Center for Imaging of Neurodegenerative Diseases and Department of Radiology, University of California, San Francisco, CA 94121, USA
    Neuroimage 46:353-9. 2009
    ..The aim of this study was to seek and characterize patterns of cortical thinning in TLE-MTS and TLE-no...
  6. ncbi Accelerated 3D echo-planar spectroscopic imaging at 4 Tesla using modified blipped phase-encoding
    Andreas Ebel
    Northern California Institute for Research and Education, Department of Radiology, University of California San Francisco, Department of Veterans Affairs Medical Center San Francisco, San Francisco, California 94121, USA
    Magn Reson Med 58:1061-6. 2007
    ..While the proposed method allows substantial reduction in metabolite ghosting, it may be limited by the presence of a relatively large spurious signal at the Nyquist frequency...
  7. ncbi Voxel-based T2 relaxation rate measurements in temporal lobe epilepsy (TLE) with and without mesial temporal sclerosis
    Susanne G Mueller
    Center for Imaging of Neurodegenerative Diseases, VAMC San Francisco, California, USA
    Epilepsia 48:220-8. 2007
    ..Therefore, the aim of this study was to characterize extent and distribution pattern of extrahippocampal relaxation abnormalities in TLE with (TLE-MTS) and without MRI evidence of mesial-temporal sclerosis (TLE-no)...
  8. ncbi Voxel-based optimized morphometry (VBM) of gray and white matter in temporal lobe epilepsy (TLE) with and without mesial temporal sclerosis
    Suzanne G Mueller
    Center for Imaging of Neurodegenerative Diseases, VAMC San Francisco, San Francisco, CA, USA
    Epilepsia 47:900-7. 2006
    ..In contrast, no GM/WM volume or concentration reductions were found in TLE-no. This further supports the hypothesis that TLE-no is a distinct clinicopathologic entity from TLE-MTS and probably heterogeneous in itself...
  9. ncbi Spectroscopic evidence of hippocampal abnormalities in neocortical epilepsy
    S G Mueller
    Department of Veterans Affairs (DVA) Medical Center, Magnetic Resonance Unit, San Francisco, CA, USA
    Eur J Neurol 13:256-60. 2006
    ..Evidence for unilateral hippocampal damage/dysfunction was demonstrated in 50% of the NE patients. The type of NE, i.e. NE-Les or NE-no, NE-T or NE-ET, had no influence on the occurrence of hippocampal damage/dysfunction...
  10. ncbi Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy
    H E Kirsch
    UCSF Epilepsy Center, Department of Neurology, University of California, School of Medicine, San Francisco, CA, USA
    Neurology 65:676-80. 2005
    ..Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series. Reports also suggest that UA is associated with greater decline in verbal memory after left ATL (L-ATL)...
  11. ncbi Testing the limits: cautions and concerns regarding the new Wechsler IQ and Memory scales
    David W Loring
    Department of Neurology, Emory University, 101 Woodruff Circle, Suite 6000, Atlanta, GA, USA
    Neurology 74:685-90. 2010
    ....