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Ngo A, Royer J, Rodriguez-Cruces R, Xie K, DeKraker J, Auer H, Tavakol S, Lam J, Schrader DV, Dudley RWR, Bernasconi A, Bernasconi N, Frauscher B, Lariviere S, Bernhardt BC. Associations of Cerebral Blood Flow Patterns With Gray and White Matter Structure in Patients With Temporal Lobe Epilepsy. Neurology 2024; 103:e209528. [PMID: 39008785 PMCID: PMC11314957 DOI: 10.1212/wnl.0000000000209528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuroimaging studies in patients with temporal lobe epilepsy (TLE) show widespread brain network alterations beyond the mesiotemporal lobe. Despite the critical role of the cerebrovascular system in maintaining whole-brain structure and function, changes in cerebral blood flow (CBF) remain incompletely understood in the disease. Here, we studied whole-brain perfusion and vascular network alterations in TLE and assessed its associations with gray and white matter compromises and various clinical variables. METHODS We included individuals with and without pharmaco-resistant TLE who underwent multimodal 3T MRI, including arterial spin labelling, structural, and diffusion-weighted imaging. Using surface-based MRI mapping, we generated individualized cortico-subcortical profiles of perfusion, morphology, and microstructure. Linear models compared regional CBF in patients with controls and related alterations to morphological and microstructural metrics. We further probed interregional vascular networks in TLE, using graph theoretical CBF covariance analysis. The effects of disease duration were explored to better understand the progressive changes in perfusion. We assessed the utility of perfusion in separating patients with TLE from controls using supervised machine learning. RESULTS Compared with control participants (n = 38; mean ± SD age 34.8 ± 9.3 years; 20 females), patients with TLE (n = 24; mean ± SD age 35.8 ± 10.6 years; 12 females) showed widespread CBF reductions predominantly in fronto-temporal regions (Cohen d -0.69, 95% CI -1.21 to -0.16), consistent in a subgroup of patients who remained seizure-free after surgical resection of the seizure focus. Parallel structural profiling and network-based models showed that cerebral hypoperfusion may be partially constrained by gray and white matter changes (8.11% reduction in Cohen d) and topologically segregated from whole-brain perfusion networks (area under the curve -0.17, p < 0.05). Negative effects of progressive disease duration further targeted regional CBF profiles in patients (r = -0.54, 95% CI -0.77 to -0.16). Perfusion-derived classifiers discriminated patients from controls with high accuracy (71% [70%-82%]). Findings were robust when controlling for several methodological confounds. DISCUSSION Our multimodal findings provide insights into vascular contributions to TLE pathophysiology affecting and extending beyond mesiotemporal structures and highlight their clinical potential in epilepsy diagnosis. As our work was cross-sectional and based on a single site, it motivates future longitudinal studies to confirm progressive effects, ideally in a multicentric setting.
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Affiliation(s)
- Alexander Ngo
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jessica Royer
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raul Rodriguez-Cruces
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ke Xie
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jordan DeKraker
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hans Auer
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shahin Tavakol
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jack Lam
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dewi V Schrader
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Roy W R Dudley
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrea Bernasconi
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neda Bernasconi
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Birgit Frauscher
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sara Lariviere
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Boris C Bernhardt
- From the Department of Neurology and Neurosurgery (A.N., J.R., R.R.-C., K.X., J.D., H.A., S.T., J.L., A.B., N.B., B.F., B.C.B.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec; Department of Pediatrics (D.V.S.), University of British Columbia, Vancouver; Department of Pediatric Surgery (R.W.R.D.), Montreal Children's Hospital, McGill University, Montreal, Québec, Canada; and Center for Brain Circuit Therapeutics (S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Meng X, Deng K, Huang B, Lin X, Wu Y, Tao W, Lin C, Yang Y, Chen F. Classification of temporal lobe epilepsy based on neuropsychological tests and exploration of its underlying neurobiology. Front Hum Neurosci 2023; 17:1100683. [PMID: 37397855 PMCID: PMC10307531 DOI: 10.3389/fnhum.2023.1100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/09/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To assist improving long-term postoperative seizure-free rate, we aimed to use machine learning algorithms based on neuropsychological data to differentiate temporal lobe epilepsy (TLE) from extratemporal lobe epilepsy (extraTLE), as well as explore the relationship between magnetic resonance imaging (MRI) and neuropsychological tests. Methods Twenty-three patients with TLE and 23 patients with extraTLE underwent neuropsychological tests and MRI scans before surgery. The least absolute shrinkage and selection operator were firstly employed for feature selection, and a machine learning approach with neuropsychological tests was employed to classify TLE using leave-one-out cross-validation. A generalized linear model was used to analyze the relationship between brain alterations and neuropsychological tests. Results We found that logistic regression with the selected neuropsychological tests generated classification accuracies of 87.0%, with an area under the receiver operating characteristic curve (AUC) of 0.89. Three neuropsychological tests were acquired as significant neuropsychological signatures for the diagnosis of TLE. We also found that the Right-Left Orientation Test difference was related to the superior temporal and the banks of the superior temporal sulcus (bankssts). The Conditional Association Learning Test (CALT) was associated with the cortical thickness difference in the lateral orbitofrontal area between the two groups, and the Component Verbal Fluency Test was associated with the cortical thickness difference in the lateral occipital cortex between the two groups. Conclusion These results showed that machine learning-based classification with the selected neuropsychological data can successfully classify TLE with high accuracy compared to previous studies, which could provide kind of warning sign for surgery candidate of TLE patients. In addition, understanding the mechanism of cognitive behavior by neuroimaging information could assist doctors in the presurgical evaluation of TLE.
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Affiliation(s)
- Xianghong Meng
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, China
| | - Kan Deng
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
- MSC Clinical and Technical Solutions, Philips Healthcare, Guangzhou, China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xiaoyi Lin
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yingtong Wu
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Wei Tao
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, China
| | - Chuxuan Lin
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yang Yang
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Fuyong Chen
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, China
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Gajdoš M, Říha P, Kojan M, Doležalová I, Mutsaerts HJMM, Petr J, Rektor I. Epileptogenic zone detection in MRI negative epilepsy using adaptive thresholding of arterial spin labeling data. Sci Rep 2021; 11:10904. [PMID: 34035336 PMCID: PMC8149682 DOI: 10.1038/s41598-021-89774-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022] Open
Abstract
Drug-resistant epilepsy is a diagnostic and therapeutic challenge, mainly in patients with negative MRI findings. State-of-the-art imaging methods complement standard epilepsy protocols with new information and help epileptologists to increase the reliability of their decisions. In this study, we investigate whether arterial spin labeling (ASL) perfusion MRI can help localize the epileptogenic zone (EZ). To that end, we developed an image processing method to detect the EZ as an area with hypoperfusion relative to the contralateral unaffected side, using subject-specific thresholding of the asymmetry index in ASL images. We demonstrated three thresholding criteria (termed minimal product criterion, minimal distance criterion, and elbow criterion) on 29 patients with MRI-negative epilepsy (age 32.98 ± 10.4 years). The minimal product criterion showed optimal results in terms of positive predictive value (mean 0.12 in postoperative group and 0.22 in preoperative group) and true positive rate (mean 0.71 in postoperative group and 1.82 in preoperative group). Additionally, we found high accuracy in determining the EZ side (mean 0.86 in postoperative group and 0.73 in preoperative group out of 1.00). ASL can be easily incorporated into the standard presurgical MR protocol, and it provides an additional benefit in EZ localization.
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Affiliation(s)
- Martin Gajdoš
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic
| | - Pavel Říha
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic.,Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Martin Kojan
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic.,Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Irena Doležalová
- Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, University Hospital Ghent, Ghent, Belgium
| | - Jan Petr
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Ivan Rektor
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic. .,Department of Neurology, Brno Epilepsy Center, St. Anne's University Hospital and Medical Faculty of Masaryk University, Pekařská 53, Brno, 656 91, Czech Republic.
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4
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Kojan M, Gajdoš M, Říha P, Doležalová I, Řehák Z, Rektor I. Arterial Spin Labeling is a Useful MRI Method for Presurgical Evaluation in MRI-Negative Focal Epilepsy. Brain Topogr 2021; 34:504-510. [PMID: 33783670 DOI: 10.1007/s10548-021-00833-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/16/2021] [Indexed: 12/25/2022]
Abstract
Arterial spin labeling (ASL) is an MRI technique measuring brain perfusion using magnetically labeled blood as a tracer. The clinical utility of ASL for presurgical evaluation in non-lesional epilepsy as compared with the quantitative analysis of interictal [18F] fluorodeoxyglucose PET (FDG-PET) was studied. In 10 patients (4 female; median age 29 years) who underwent a complete presurgical evaluation followed by surgical resection, the presurgical FDG-PET and ASL scans were compared with the resection masks using asymmetry index (AI) maps. The positive predictive value (PPV) and sensitivity (SEN), were calculated from the number of voxels inside the mask (true positive), and outside the mask (false positive). The comparison of the PPVs showed better PPV in 6 patients using ASL and in 2 patients with PET. SEN was better in 4 patients using ASL and in 5 patients with PET. According to the Wilcoxon signed rank test for PPV (p = 0.74) and for SEN (p = 0.43), these methods have similar predictive power. ASL is a useful method for presurgical evaluation in non-lesional epilepsy. The main benefits of ASL over PET are that it avoids radiation exposure for patients, and it offers lower costs, higher availability, and better time efficiency.
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Affiliation(s)
- Martin Kojan
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic
| | - Martin Gajdoš
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic
| | - Pavel Říha
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic
| | - Irena Doležalová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Zdeněk Řehák
- Department of Nuclear Medicine, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ivan Rektor
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic.
- CEITEC - Central European Institute of Technology, Neuroscience Center, Masaryk University, Brno, Czech Republic.
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Lam J, Tomaszewski P, Gilbert G, Moreau JT, Guiot MC, Albrecht S, Farmer JP, Atkinson J, Saint-Martin C, Wintermark P, Bernhardt B, Baillet S, Dudley RWR. The utility of arterial spin labeling in the presurgical evaluation of poorly defined focal epilepsy in children. J Neurosurg Pediatr 2021; 27:243-252. [PMID: 33361483 DOI: 10.3171/2020.7.peds20397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to assess the utility of arterial spin labeling (ASL) perfusion 3T-MRI for the presurgical evaluation of poorly defined focal epilepsy in pediatric patients. METHODS Pseudocontinuous ASL perfusion 3T-MRI was performed in 25 consecutive children with poorly defined focal epilepsy. ASL perfusion abnormalities were detected qualitatively by visual inspection and quantitatively by calculating asymmetry index (AI) maps and significant z-score cluster maps based on successfully operated cases. ASL results were prospectively compared to scalp EEG, structural 3T-MRI, FDG-PET, ictal/interictal SPECT, magnetoencephalography (MEG), and intracranial recording results, as well as the final surgically proven epileptogenic zone (EZ) in operated patients who had at least 1 year of good (Engel class I/II) seizure outcome and positive histopathology results. RESULTS Qualitative ASL perfusion abnormalities were found in 17/25 cases (68%), specifically in 17/20 MRI-positive cases (85.0%) and in none of the 5 MRI-negative cases. ASL was concordant with localizing scalp EEG findings in 66.7%, structural 3T-MRI in 90%, FDG-PET in 75%, ictal/interictal SPECT in 62.5%, and MEG in 75% of cases, and with intracranial recording results in 40% of cases. Eleven patients underwent surgery; in all 11 cases the EZ was surgically proven by positive histopathology results and the patient having at least 1 year of good seizure outcome. ASL results were concordant with this final surgically proven EZ in 10/11 cases (sensitivity 91%, specificity 50%). All 10 ASL-positive patients who underwent surgery had positive surgical pathology results and good long-term postsurgical seizure outcome at a mean follow-up of 39 months. Retrospective quantitative analysis based on significant z-score clusters found 1 true-positive result that was missed by qualitative analysis and 3 additional false-positive results (sensitivity 100%, specificity 23%). CONCLUSIONS ASL supports the hypothesis regarding the EZ in poorly defined focal epilepsy cases in children. Due to its convenience and noninvasive nature, the authors recommend that ASL be added routinely to the presurgical MRI evaluation of epilepsy. Future optimized quantitative methods may improve the diagnostic yield of this technique.
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Affiliation(s)
- Jack Lam
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | - Patricia Tomaszewski
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | - Guillaume Gilbert
- 2Philips Canada, MRI Research Department, Montréal; and Departments of
| | - Jeremy T Moreau
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | | | | | | | | | | | - Pia Wintermark
- 6Neonatology, McGill University Health Network, Montréal, Quebec, Canada
| | - Boris Bernhardt
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
| | - Sylvain Baillet
- 1McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal
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Arterial spin-labelling and magnetic resonance spectroscopy as imaging biomarkers for detection of epileptogenic zone in non-lesional focal impaired awareness epilepsy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00326-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The proper identification of an epileptic focus is a pivotal diagnostic issue; particularly in non-lesional focal impaired awareness epilepsy (FIAE). Seizures are usually accompanied by alterations of regional cerebral blood flow (rCBF) and metabolism. Arterial spin labeling-MRI (ASL-MRI) and proton magnetic resonance spectroscopy (1H-MRS) are MRI techniques that can, non-invasively, define the regions of cerebral perfusion and metabolic changes, respectively. The aim of the current study was to recognize the epileptogenic zone in patients with non-lesional FIAE by evaluating the interictal changes in rCBF and cerebral metabolic alterations, using PASL-MRI and 1H-MRS.
Results
For identification of the epileptogenic zone, increased ASLAI% assessed by PASL-MRI (at a cut-off value ≥ 5.96%) showed 95.78% accuracy, and increased %AF (at a cut-off value ≥ 9.98%) showed 98.14% accuracy, while decreased NAA/(Cho + Cr) ratio estimated by multi-voxels (MV) 1H-MRS (at a cut-off value ≥ 0.59) showed 97.74% accuracy. Moreover, the combined use of PASL-MRI and MV 1H-MRS yielded 100% sensitivity, 98.45% specificity and 98.86% accuracy.
Conclusion
The combined use of PASL-MRI and MV 1H-MRS can be considered as in-vivo proficient bio-marker for proper identification of epileptogenic zone in patients with non-lesional FIAE.
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Perera T, Gaxiola-Valdez I, Singh S, Peedicail J, Sandy S, Lebel RM, Li E, Milne-Ives M, Szostakiwskyj J, Federico P. Localizing the seizure onset zone by comparing patient postictal hypoperfusion to healthy controls. J Neurosci Res 2020; 98:1517-1531. [PMID: 32476173 DOI: 10.1002/jnr.24646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 11/10/2022]
Abstract
Arterial spin labeling (ASL) MRI can provide seizure onset zone (SOZ) localizing information in up to 80% of patients. Clinical implementation of this technique is limited by the need to obtain two scans per patient: a postictal scan that is subtracted from an interictal scan. We aimed to determine whether it is possible to limit the number of ASL scans to one per patient by comparing patient postictal ASL scans to baseline scans of 100 healthy controls. Eighteen patients aged 20-55 years underwent ASL MRI <90 min after a seizure and during the interictal period. Each postictal cerebral blood flow (CBF) map was statistically compared to average baseline CBF maps from 100 healthy controls (pvcASL; patient postictal CBF vs. control baseline CBF). The pvcASL maps were compared to subtraction ASL maps (sASL; patient baseline CBF minus patient postictal CBF). Postictal CBF reductions from pvcASL and sASL maps were seen in 17 of 18 (94.4%) and 14 of 18 (77.8%) patients, respectively. Maximal postictal hypoperfusion seen in pvcASL and sASL maps was concordant with the SOZ in 10 of 17 (59%) and 12 of 14 (86%) patients, respectively. In seven patients, both pvcASL and sASL maps showed similar results. In two patients, sASL showed no significant hypoperfusion, while pvcASL showed significant hypoperfusion concordant with the SOZ. We conclude that pvcASL is clinically useful and although it may have a lower overall concordance rate than sASL, pvcASL does provide localizing or lateralizing information for specific cases that would be otherwise missed through sASL.
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Affiliation(s)
- Tefani Perera
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Ismael Gaxiola-Valdez
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Shaily Singh
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joseph Peedicail
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sherry Sandy
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - R Marc Lebel
- GE Healthcare, Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Emmy Li
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | - Madison Milne-Ives
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
| | | | - Paolo Federico
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.
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Brotis A, Giannis T, Kapsalaki E, Dardiotis E, Fountas K. Complications after Anterior Temporal Lobectomy for Medically Intractable Epilepsy: A Systematic Review and Meta-Analysis. Stereotact Funct Neurosurg 2019; 97:69-82. [DOI: 10.1159/000500136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/03/2019] [Indexed: 11/19/2022]
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Gaxiola-Valdez I, Singh S, Perera T, Sandy S, Li E, Federico P. Seizure onset zone localization using postictal hypoperfusion detected by arterial spin labelling MRI. Brain 2017; 140:2895-2911. [PMID: 29053782 DOI: 10.1093/brain/awx241] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/03/2017] [Indexed: 11/15/2022] Open
Abstract
Neurological dysfunction following epileptic seizures is a well-recognized phenomenon. Several potential mechanisms have been suggested to explain postictal dysfunction, with alteration in cerebral blood flow being one possibility. These vascular disturbances may be long lasting and localized to brain areas involved in seizure generation and propagation, as supported by both animal and human studies. Therefore, measuring perfusion changes in the postictal period may help localize the seizure onset zone. Arterial spin labelling is a non-invasive, rapid and reproducible magnetic resonance imaging technique that measures cerebral perfusion. To this end, we measured postictal perfusion in patients with drug resistant focal epilepsy who were admitted to our seizure-monitoring unit for presurgical evaluation. Twenty-one patients were prospectively recruited and underwent arterial spin labelling scanning within 90 min of a habitual seizure. Patients also underwent a similar scan in the interictal period, after they were seizure-free for at least 24 h. The acquired scans were subtracted to identify the areas of significant postictal hypoperfusion. The location of the maximal hypoperfusion was compared to the presumed seizure onset zone to assess for concordance. Also, the localizing value of this technique was compared to other structural and functional imaging modalities. Postictal perfusion reductions of >15 units (ml/100 g/l) were seen in 15/21 patients (71.4%). In 12/15 (80%) of these patients, the location of the hypoperfusion was partially or fully concordant with the location of the presumed seizure onset zone. This technique compared favourably to other neuroimaging modalities, being similar or superior to structural magnetic resonance imaging in 52% of cases, ictal single-photon emission computed tomography in 60% of cases and interictal positron emission tomography in 71% of cases. Better arterial spin labelling results were obtained in patients in whom the seizure onset zone was discernible based on non-invasive data. Thus, this technique is a safe, non-invasive and relatively inexpensive tool to detect postictal hypoperfusion that may provide useful data to localize the seizure onset zone. This technique may be incorporated into the battery of conventional investigations for presurgical evaluation of patients with drug resistant focal epilepsy.
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Affiliation(s)
- Ismael Gaxiola-Valdez
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada
| | - Shaily Singh
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Tefani Perera
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada
| | - Sherry Sandy
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Emmy Li
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada.,Department of Neuroscience, University of Calgary, Calgary, Canada
| | - Paolo Federico
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Seaman Family MR Research Centre, University of Calgary, Calgary, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.,Department of Neuroscience, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
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11
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Kwan BY, Salehi F, Kope R, Lee DH, Sharma M, Hammond R, Burneo JG, Steven D, Peters T, Khan AR. Evaluation of ex-vivo 9.4T MRI in post-surgical specimens from temporal lobe epilepsy patients. J Neuroradiol 2017; 44:377-380. [DOI: 10.1016/j.neurad.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/03/2017] [Accepted: 05/25/2017] [Indexed: 12/28/2022]
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12
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Patel SH, Halpern CH, Shepherd TM, Timpone VM. Electrical stimulation and monitoring devices of the CNS: An imaging review. J Neuroradiol 2017; 44:175-184. [DOI: 10.1016/j.neurad.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/12/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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13
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Serial MRI images of an unusual presentation of anti-GAD encephalitis: A new pattern? J Neuroradiol 2017; 44:167-169. [PMID: 28162787 DOI: 10.1016/j.neurad.2016.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 03/26/2016] [Accepted: 12/21/2016] [Indexed: 11/21/2022]
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Zhang Y, Gao Y, Zhou M, Wu J, Zee C, Wang D. A diffusional kurtosis imaging study of idiopathic generalized epilepsy with unilateral interictal epileptiform discharges in children. J Neuroradiol 2016; 43:339-45. [DOI: 10.1016/j.neurad.2016.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 12/22/2022]
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TEKRIWAL A, BALTUCH G. Deep Brain Stimulation: Expanding Applications. Neurol Med Chir (Tokyo) 2015; 55:861-77. [PMID: 26466888 PMCID: PMC4686449 DOI: 10.2176/nmc.ra.2015-0172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/15/2015] [Indexed: 12/13/2022] Open
Abstract
For over two decades, deep brain stimulation (DBS) has shown significant efficacy in treatment for refractory cases of dyskinesia, specifically in cases of Parkinson's disease and dystonia. DBS offers potential alleviation from symptoms through a well-tolerated procedure that allows personalized modulation of targeted neuroanatomical regions and related circuitries. For clinicians contending with how to provide patients with meaningful alleviation from often debilitating intractable disorders, DBSs titratability and reversibility make it an attractive treatment option for indications ranging from traumatic brain injury to progressive epileptic supra-synchrony. The expansion of our collective knowledge of pathologic brain circuitries, as well as advances in imaging capabilities, electrophysiology techniques, and material sciences have contributed to the expanding application of DBS. This review will examine the potential efficacy of DBS for neurologic and psychiatric disorders currently under clinical investigation and will summarize findings from recent animal models.
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Affiliation(s)
- Anand TEKRIWAL
- University of Pennsylvania, Department of Neurosurgery, Philadelphia, USA
- University of Colorado School of Medicine and Graduate School of Neuroscience, MSTP, Colorado, USA (current affiliation)
| | - Gordon BALTUCH
- University of Pennsylvania, Department of Neurosurgery, Philadelphia, USA
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