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Huang H, Zhang M, Zhao Y, Li Y, Jin W, Guo R, Liu W, Cai B, Li J, Yuan S, Huang X, Lin X, Liang ZP, Li B, Luo J. Simultaneous high-resolution whole-brain MR spectroscopy and [ 18F]FDG PET for temporal lobe epilepsy. Eur J Nucl Med Mol Imaging 2024; 51:721-733. [PMID: 37823910 DOI: 10.1007/s00259-023-06465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Precise lateralizing the epileptogenic zone in patients with drug-resistant mesial temporal lobe epilepsy (mTLE) remains challenging, particularly when routine MRI scans are inconclusive (MRI-negative). This study aimed to investigate the synergy of fast, high-resolution, whole-brain MRSI in conjunction with simultaneous [18F]FDG PET for the lateralization of mTLE. METHODS Forty-eight drug-resistant mTLE patients (M/F 31/17, age 12-58) underwent MRSI and [18F]FDG PET on a hybrid PET/MR scanner. Lateralization of mTLE was evaluated by visual inspection and statistical classifiers of metabolic mappings against routine MRI. Additionally, this study explored how disease status influences the associations between altered N-acetyl aspartate (NAA) and FDG uptake using hierarchical moderated multiple regression. RESULTS The high-resolution whole-brain MRSI data offers metabolite maps at comparable resolution to [18F]FDG PET. Visual examinations of combined MRSI and [18F]FDG PET showed an mTLE lateralization accuracy rate of 91.7% in a 48-patient cohort, surpassing routine MRI (52.1%). Notably, out of 23 MRI-negative mTLE, combined MRSI and [18F]FDG PET helped detect 19 cases. Logistical regression models combining hippocampal NAA level and FDG uptake improved lateralization performance (AUC=0.856), while further incorporating extrahippocampal regions such as amygdala, thalamus, and superior temporal gyrus increased the AUC to 0.939. Concurrent MRSI/PET revealed a moderating influence of disease duration and hippocampal atrophy on the association between hippocampal NAA and glucose uptake, providing significant new insights into the disease's trajectory. CONCLUSION This paper reports the first metabolic imaging study using simultaneous high-resolution MRSI and [18F]FDG PET, which help visualize MRI-unidentifiable lesions and may thus advance diagnostic tools and management strategies for drug-resistant mTLE.
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Affiliation(s)
- Hui Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Miao Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yibo Zhao
- Beckman Institute for Advanced Sciences and Technology, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Yudu Li
- Beckman Institute for Advanced Sciences and Technology, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
- National Center for Supercomputing Applications, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Wen Jin
- Beckman Institute for Advanced Sciences and Technology, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Rong Guo
- Beckman Institute for Advanced Sciences and Technology, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
- Siemens Medical Solutions USA, Inc, Urbana, IL, 61801, USA
| | - Wei Liu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Bingyang Cai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jiwei Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Siyu Yuan
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xinyun Huang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaozhu Lin
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhi-Pei Liang
- Beckman Institute for Advanced Sciences and Technology, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Jie Luo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
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Hines K, Wu C. Epilepsy Networks and Their Surgical Relevance. Brain Sci 2023; 14:31. [PMID: 38248246 PMCID: PMC10813558 DOI: 10.3390/brainsci14010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
Surgical epilepsy is a rapidly evolved field. As the understanding and concepts of epilepsy shift towards a network disorder, surgical outcomes may shed light on numerous components of these systems. This review documents the evolution of the understanding of epilepsy networks and examines the data generated by resective, ablative, neuromodulation, and invasive monitoring surgeries in epilepsy patients. As these network tools are better integrated into epilepsy practice, they may eventually inform surgical decisions and improve clinical outcomes.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
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Azeem A, von Ellenrieder N, Royer J, Frauscher B, Bernhardt B, Gotman J. Integration of white matter architecture to stereo-EEG better describes epileptic spike propagation. Clin Neurophysiol 2023; 146:135-146. [PMID: 36379837 DOI: 10.1016/j.clinph.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereo-electroencephalography (SEEG)-derived epilepsy networks are used to better understand a patient's epilepsy; however, a unimodal approach provides an incomplete picture. We combine tractography and SEEG to determine the relationship between spike propagation and the white matter architecture and to improve our understanding of spike propagation mechanisms. METHODS Probablistic tractography from diffusion imaging (dMRI) of matched subjects from the Human Connectome Project (HCP) was combined with patient-specific SEEG-derived spike propagation networks. Two regions-of-interest (ROIs) with a significant spike propagation relationship constituted a Propagation Pair. RESULTS In 56 of 59 patients, Propagation Pairs were more often tract-connected as compared to all ROI pairs (p < 0.01; d = -1.91). The degree of spike propagation between tract-connected ROIs was greater (39 ± 21%) compared to tract-unconnected ROIs (31 ± 18%; p < 0.0001). Within the same network, ROIs receiving propagation earlier were more often tract-connected to the source (59.7%) as compared to late receivers (25.4%; p < 0.0001). CONCLUSIONS Brain regions involved in spike propagation are more likely to be connected by white matter tracts. Between nodes, presence of tracts suggests a direct course of propagation, whereas the absence of tracts suggests an indirect course of propagation. SIGNIFICANCE We demonstrate a logical and consistent relationship between spike propagation and the white matter architecture.
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Affiliation(s)
- Abdullah Azeem
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Nicolás von Ellenrieder
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jessica Royer
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Birgit Frauscher
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; Department of Neurology & Neurosurgery, Montreal Neurological Hospital, Montréal, QC, Canada
| | - Boris Bernhardt
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Jean Gotman
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, QC, Canada
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Zheng B, Liu DD, Theyel BB, Abdulrazeq H, Kimata AR, Lauro PM, Asaad WF. Thalamic neuromodulation in epilepsy: A primer for emerging circuit-based therapies. Expert Rev Neurother 2023; 23:123-140. [PMID: 36731858 DOI: 10.1080/14737175.2023.2176752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Epilepsy is a common, often debilitating disease of hyperexcitable neural networks. While medically intractable cases may benefit from surgery, there may be no single, well-localized focus for resection or ablation. In such cases, approaching the disease from a network-based perspective may be beneficial. AREAS COVERED Herein, the authors provide a narrative review of normal thalamic anatomy and physiology and propose general strategies for preventing and/or aborting seizures by modulating this structure. Additionally, they make specific recommendations for targeting the thalamus within different contexts, motivated by a more detailed discussion of its distinct nuclei and their respective connectivity. By describing important principles governing thalamic function and its involvement in seizure networks, the authors aim to provide a primer for those now entering this fast-growing field of thalamic neuromodulation for epilepsy. EXPERT OPINION The thalamus is critically involved with the function of many cortical and subcortical areas, suggesting it may serve as a compelling node for preventing or aborting seizures, and so it has increasingly been targeted for the surgical treatment of epilepsy. As various thalamic neuromodulation strategies for seizure control are developed, there is a need to ground such interventions in a mechanistic, circuit-based framework.
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Affiliation(s)
- Bryan Zheng
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian B Theyel
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Anna R Kimata
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Peter M Lauro
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA.,The Carney Institute for Brain Science, Brown University, Providence, RI, USA.,The Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA
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Interictal Gamma Event Connectivity Differentiates the Seizure Network and Outcome in Patients after Temporal Lobe Epilepsy Surgery. eNeuro 2022; 9:ENEURO.0141-22.2022. [PMID: 36418173 PMCID: PMC9770020 DOI: 10.1523/eneuro.0141-22.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Studies of interictal EEG functional connectivity in the epileptic brain seek to identify abnormal interactions between brain regions involved in generating seizures, which clinically often is defined by the seizure onset zone (SOZ). However, there is evidence for abnormal connectivity outside the SOZ (NSOZ), and removal of the SOZ does not always result in seizure control, suggesting, in some cases, that the extent of abnormal connectivity indicates a larger seizure network than the SOZ. To better understand the potential differences in interictal functional connectivity in relation to the seizure network and outcome, we computed event connectivity in the theta (4-8 Hz, ThEC), low-gamma (30-55 Hz, LGEC), and high-gamma (65-95 Hz, HGEC) bands from interictal depth EEG recorded in surgical patients with medication-resistant seizures suspected to begin in the temporal lobe. Analysis finds stronger LGEC and HGEC in SOZ than NSOZ of seizure-free (SF) patients (p = 1.10e-9, 0.0217), but no difference in not seizure-free (NSF) patients. There were stronger LGEC and HGEC between mesial and lateral temporal SOZ of SF than NSF patients (p = 0.00114, 0.00205), and stronger LGEC and ThEC in NSOZ of NSF than SF patients (p = 0.0089, 0.0111). These results show that event connectivity is sensitive to differences in the interactions between regions in SOZ and NSOZ and SF and NSF patients. Patients with differential strengths in event connectivity could represent a well-localized seizure network, whereas an absence of differences could indicate a larger seizure network than the one localized by the SOZ and higher likelihood for seizure recurrence.
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