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Lucas A, Revell A, Davis KA. Artificial intelligence in epilepsy - applications and pathways to the clinic. Nat Rev Neurol 2024; 20:319-336. [PMID: 38720105 DOI: 10.1038/s41582-024-00965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 06/06/2024]
Abstract
Artificial intelligence (AI) is rapidly transforming health care, and its applications in epilepsy have increased exponentially over the past decade. Integration of AI into epilepsy management promises to revolutionize the diagnosis and treatment of this complex disorder. However, translation of AI into neurology clinical practice has not yet been successful, emphasizing the need to consider progress to date and assess challenges and limitations of AI. In this Review, we provide an overview of AI applications that have been developed in epilepsy using a variety of data modalities: neuroimaging, electroencephalography, electronic health records, medical devices and multimodal data integration. For each, we consider potential applications, including seizure detection and prediction, seizure lateralization, localization of the seizure-onset zone and assessment for surgical or neurostimulation interventions, and review the performance of AI tools developed to date. We also discuss methodological considerations and challenges that must be addressed to successfully integrate AI into clinical practice. Our goal is to provide an overview of the current state of the field and provide guidance for leveraging AI in future to improve management of epilepsy.
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Affiliation(s)
- Alfredo Lucas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Revell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Hickling AL, Clark IA, Wu YI, Maguire EA. Automated protocols for delineating human hippocampal subfields from 3 Tesla and 7 Tesla magnetic resonance imaging data. Hippocampus 2024; 34:302-308. [PMID: 38593279 DOI: 10.1002/hipo.23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Researchers who study the human hippocampus are naturally interested in how its subfields function. However, many researchers are precluded from examining subfields because their manual delineation from magnetic resonance imaging (MRI) scans (still the gold standard approach) is time consuming and requires significant expertise. To help ameliorate this issue, we present here two protocols, one for 3T MRI and the other for 7T MRI, that permit automated hippocampus segmentation into six subregions, namely dentate gyrus/cornu ammonis (CA)4, CA2/3, CA1, subiculum, pre/parasubiculum, and uncus along the entire length of the hippocampus. These protocols are particularly notable relative to existing resources in that they were trained and tested using large numbers of healthy young adults (n = 140 at 3T, n = 40 at 7T) whose hippocampi were manually segmented by experts from MRI scans. Using inter-rater reliability analyses, we showed that the quality of automated segmentations produced by these protocols was high and comparable to expert manual segmenters. We provide full open access to the automated protocols, and anticipate they will save hippocampus researchers a significant amount of time. They could also help to catalyze subfield research, which is essential for gaining a full understanding of how the hippocampus functions.
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Affiliation(s)
- Alice L Hickling
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ian A Clark
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Yan I Wu
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Eleanor A Maguire
- Wellcome Centre for Human Neuroimaging, Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, University College London, London, UK
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Lucas A, Mouchtaris S, Tranquille A, Sinha N, Gallagher R, Mojena M, Stein JM, Das S, Davis KA. Mapping hippocampal and thalamic atrophy in epilepsy: A 7-T magnetic resonance imaging study. Epilepsia 2024; 65:1092-1106. [PMID: 38345348 DOI: 10.1111/epi.17908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Epilepsy patients are often grouped together by clinical variables. Quantitative neuroimaging metrics can provide a data-driven alternative for grouping of patients. In this work, we leverage ultra-high-field 7-T structural magnetic resonance imaging (MRI) to characterize volumetric atrophy patterns across hippocampal subfields and thalamic nuclei in drug-resistant focal epilepsy. METHODS Forty-two drug-resistant epilepsy patients and 13 controls with 7-T structural neuroimaging were included in this study. We measured hippocampal subfield and thalamic nuclei volumetry, and applied an unsupervised machine learning algorithm, Latent Dirichlet Allocation (LDA), to estimate atrophy patterns across the hippocampal subfields and thalamic nuclei of patients. We studied the association between predefined clinical groups and the estimated atrophy patterns. Additionally, we used hierarchical clustering on the LDA factors to group patients in a data-driven approach. RESULTS In patients with mesial temporal sclerosis (MTS), we found a significant decrease in volume across all ipsilateral hippocampal subfields (false discovery rate-corrected p [pFDR] < .01) as well as in some ipsilateral (pFDR < .05) and contralateral (pFDR < .01) thalamic nuclei. In left temporal lobe epilepsy (L-TLE) we saw ipsilateral hippocampal and some bilateral thalamic atrophy (pFDR < .05), whereas in right temporal lobe epilepsy (R-TLE) extensive bilateral hippocampal and thalamic atrophy was observed (pFDR < .05). Atrophy factors demonstrated that our MTS cohort had two atrophy phenotypes: one that affected the ipsilateral hippocampus and one that affected the ipsilateral hippocampus and bilateral anterior thalamus. Atrophy factors demonstrated posterior thalamic atrophy in R-TLE, whereas an anterior thalamic atrophy pattern was more common in L-TLE. Finally, hierarchical clustering of atrophy patterns recapitulated clusters with homogeneous clinical properties. SIGNIFICANCE Leveraging 7-T MRI, we demonstrate widespread hippocampal and thalamic atrophy in epilepsy. Through unsupervised machine learning, we demonstrate patterns of volumetric atrophy that vary depending on disease subtype. Incorporating these atrophy patterns into clinical practice could help better stratify patients to surgical treatments and specific device implantation strategies.
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Affiliation(s)
- Alfredo Lucas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sofia Mouchtaris
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashley Tranquille
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nishant Sinha
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Gallagher
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marissa Mojena
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joel M Stein
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sandhitsu Das
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn A Davis
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bertram U, Köveshazi I, Michaelis M, Weidert S, Schmidt TP, Blume C, Zastrow FSV, Müller CA, Szabo S. Man versus machine: Automatic pedicle screw planning using registration-based techniques compared with manual screw planning for thoracolumbar fusion surgeries. Int J Med Robot 2023:e2570. [PMID: 37690099 DOI: 10.1002/rcs.2570] [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: 11/03/2022] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This study evaluates the precision of a commercially available spine planning software in automatic spine labelling and screw-trajectory proposal. METHODS The software uses automatic segmentation and registration of the vertebra to generate screw proposals. 877 trajectories were compared. Four neurosurgeons assessed suggested trajectories, performed corrections, and manually planned pedicle screws. Additionally, automatic identification/labelling was evaluated. RESULTS Automatic labelling was correct in 89% of the cases. 92.9% of automatically planned trajectories were in accordance with G&R grade A + B. Automatic mode reduced the time spent planning screw trajectories by 7 s per screw to 20 s per vertebra. Manual mode yielded differences in screw-length between surgeons (largest distribution peak: 5 mm), automatic in contrast at 0 mm. The size of suggested pedicle screws was significantly smaller (largest peaks in difference between 0.5 and 3 mm) than the surgeon's choice. CONCLUSION Automatic identification of vertebrae works in most cases and suggested pedicle screw trajectories are acceptable. So far, it does not substitute for an experienced surgeon's assessment.
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Affiliation(s)
- Ulf Bertram
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Istvan Köveshazi
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
| | | | - Simon Weidert
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
| | | | - Christian Blume
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Felix Swamy V Zastrow
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | | | - Szilard Szabo
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
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Kilpattu Ramaniharan A, Parpura V, Zhang MW, Martin R, Ver Hoef L. Development of an objective method to quantify hippocampal dentation. Hum Brain Mapp 2023; 44:2967-2980. [PMID: 36971590 PMCID: PMC10171507 DOI: 10.1002/hbm.26222] [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: 09/12/2022] [Revised: 01/02/2023] [Accepted: 01/21/2023] [Indexed: 03/29/2023] Open
Abstract
Hippocampal dentation (HD) refers to a series of ridges (dentes) seen on the inferior aspect of the hippocampus. The degree of HD varies dramatically across healthy individuals, and hippocampal pathology may result in loss of HD. Existing studies show associations between HD and memory performance in healthy adults as well as temporal lobe epilepsy (TLE) patients. However, until now studies relied on visual assessment of HD as no objective methods to quantify HD have been described. In this work, we describe a method to objectively quantify HD by transforming the characteristic 3D surface morphology of HD into a simplified 2D plot for which area under the curve (AUC) was calculated. This was applied to T1w scans of 59 TLE subjects, each with one epileptic hippocampus and one normal appearing hippocampus. Results showed that AUC significantly correlated with the number of dentes based on visual inspection (p < .05) and correctly sorted a set of hippocampi from least to most prominently dentated. Intra- and inter-rater reliability was nearly perfect (ICC ≥ 0.99). AUC values were significantly lower in epileptic hippocampi compared to contralateral hippocampi (p = .00019), consistent with previously published findings. In the left TLE group, the AUC values from the contralateral hippocampi showed a positive trend (p = .07) with verbal memory acquisition scores but was not statistically significant. The proposed approach is the first objective, quantitative measurement of dentation described in the literature. The AUC values numerically capture the complex surface contour information of HD and will enable future study of this interesting morphologic feature.
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Affiliation(s)
| | - Vuga Parpura
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mike Weng Zhang
- Department of Neurology, Baptist Health Medical Group, Louisville, Kentucky, USA
| | - Roy Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lawrence Ver Hoef
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham VA Medical Center, Neurology Service, Birmingham, Alabama, USA
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Kilpattu Ramaniharan A, Zhang MW, Selladurai G, Martin R, Ver Hoef L. Loss of hippocampal dentation in hippocampal sclerosis and its relationship to memory dysfunction. Epilepsia 2022; 63:1104-1114. [PMID: 35243619 DOI: 10.1111/epi.17211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hippocampal dentation (HD) is a "tooth-like" morphological feature observed on the inferior aspect of the human hippocampus. It has been found that HD varies dramatically in healthy adults and is positively associated with verbal and visual memory. In this work, we evaluate the loss of HD and its association to memory dysfunction in patients with temporal lobe epilepsy who have hippocampal sclerosis (HS). METHODS 58 unilateral HS patients with neuropsychological data were identified from a retrospective database. T1w MPRAGE images (~1mm resolution) were upsampled to 0.25mm and were processed using ASHS software to obtain ultra high resolution segmentations and 3D renderings. Dentes were counted on the epileptic and contralateral sides, and associations were tested between dentation on the epileptic versus contralateral sides and measures of verbal and visuospatial memory with respect to the dominant versus non-dominant hemisphere. RESULTS The median number of dentes in epileptic hippocampi was significantly lower than in contralateral hippocampi (p<0.0001). Among cases with HS in the dominant hemisphere, verbal memory was significantly correlated with contralateral non-dominant hemisphere dentation (r = 0.45, p = 0.02). Similarly, among cases of HS in the non-dominant hemisphere, visual memory was significantly correlated with contralateral dominant hemisphere dentation (r = 0.50, p = 0.03). All other analyses were not significant. SIGNIFICANCE This is the first study characterizing dentation in TLE patients with HS and its memory correlates. There is marked loss of dentation in sclerotic hippocampi compared to the unaffected contralateral hippocampi. Material-specific measures of memory performance are paradoxically correlated with dentation contralateral to the side with HS, suggesting that contralateral functional capacity explains some of the variation in memory across TLE patients. Hippocampal dentation is an important variable to consider in understanding memory loss in TLE.
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Affiliation(s)
| | - Mike Weng Zhang
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA
| | - Goutham Selladurai
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA
| | - Roy Martin
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA
| | - Lawrence Ver Hoef
- University of Alabama at Birmingham, Department of Neurology, Birmingham, Alabama, USA.,Baptist Health Medical Group, Department of Neurology, Louisville, Kentucky, USA
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Caldairou B, Foit NA, Mutti C, Fadaie F, Gill R, Lee HM, Demerath T, Urbach H, Schulze-Bonhage A, Bernasconi A, Bernasconi N. MRI-Based Machine Learning Prediction Framework to Lateralize Hippocampal Sclerosis in Patients With Temporal Lobe Epilepsy. Neurology 2021; 97:e1583-e1593. [PMID: 34475125 DOI: 10.1212/wnl.0000000000012699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/30/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES MRI fails to reveal hippocampal pathology in 30% to 50% of temporal lobe epilepsy (TLE) surgical candidates. To address this clinical challenge, we developed an automated MRI-based classifier that lateralizes the side of covert hippocampal pathology in TLE. METHODS We trained a surface-based linear discriminant classifier that uses T1-weighted (morphology) and T2-weighted and fluid-attenuated inversion recovery (FLAIR)/T1 (intensity) features. The classifier was trained on 60 patients with TLE (mean age 35.6 years, 58% female) with histologically verified hippocampal sclerosis (HS). Images were deemed to be MRI negative in 42% of cases on the basis of neuroradiologic reading (40% based on hippocampal volumetry). The predictive model automatically labeled patients as having left or right TLE. Lateralization accuracy was compared to electroclinical data, including side of surgery. Accuracy of the classifier was further assessed in 2 independent TLE cohorts with similar demographics and electroclinical characteristics (n = 57, 58% MRI negative). RESULTS The overall lateralization accuracy was 93% (95% confidence interval 92%-94%), regardless of HS visibility. In MRI-negative TLE, the combination of T2 and FLAIR/T1 intensities provided the highest accuracy in both the training (84%, area under the curve [AUC] 0.95 ± 0.02) and validation (cohort 1 90%, AUC 0.99; cohort 2 76%, AUC 0.94) cohorts. DISCUSSION This prediction model for TLE lateralization operates on readily available conventional MRI contrasts and offers gain in accuracy over visual radiologic assessment. The combined contribution of decreased T1- and increased T2-weighted intensities makes the synthetic FLAIR/T1 contrast particularly effective in MRI-negative HS, setting the basis for broad clinical translation. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in people with TLE and MRI-negative HS, an automated MRI-based classifier accurately determines the side of pathology.
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Affiliation(s)
- Benoit Caldairou
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Niels A Foit
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Carlotta Mutti
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Fatemeh Fadaie
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Ravnoor Gill
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Hyo Min Lee
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Theo Demerath
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Horst Urbach
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Andreas Schulze-Bonhage
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany
| | - Andrea Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany.
| | - Neda Bernasconi
- From the Neuroimaging of Epilepsy Laboratory (B.C., N.A.F., C.M., F.F., R.G., H.M.L., A.B., N.B.), McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Quebec, Canada; and Departments of Neurosurgery (N.A.F.) and Neuroradiology (T.D., H.U.), Freiburg Medical Center, and Department of Neurology (A.S.-B.), University of Freiburg, Germany.
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Hadar PN, Kini LG, Nanga RPR, Shinohara RT, Chen SH, Shah P, Wisse LEM, Elliott MA, Hariharan H, Reddy R, Detre JA, Stein JM, Das S, Davis KA. Volumetric glutamate imaging (GluCEST) using 7T MRI can lateralize nonlesional temporal lobe epilepsy: A preliminary study. Brain Behav 2021; 11:e02134. [PMID: 34255437 PMCID: PMC8413808 DOI: 10.1002/brb3.2134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Drug-resistant epilepsy patients show worse outcomes after resection when standard neuroimaging is nonlesional, which occurs in one-third of patients. In prior work, we employed 2-D glutamate imaging, Glutamate Chemical Exchange Saturation Transfer (GluCEST), to lateralize seizure onset in nonlesional temporal lobe epilepsy (TLE) based on increased ipsilateral GluCEST signal in the total hippocampus and hippocampal head. We present a significant advancement to single-slice GluCEST imaging, allowing for three-dimensional analysis of brain glutamate networks. METHODS The study population consisted of four MRI-negative, nonlesional TLE patients (two male, two female) with electrographically identified left temporal onset seizures. Imaging was conducted on a Siemens 7T MRI scanner using the CEST method for glutamate, while the advanced normalization tools (ANTs) pipeline and the Automated Segmentation of the Hippocampal Subfields (ASHS) method were employed for image analysis. RESULTS Volumetric GluCEST imaging was validated in four nonlesional TLE patients showing increased glutamate lateralized to the hippocampus of seizure onset (p = .048, with a difference among ipsilateral to contralateral GluCEST signal percentage ranging from -0.05 to 1.37), as well as increased GluCEST signal in the ipsilateral subiculum (p = .034, with a difference among ipsilateral to contralateral GluCEST signal ranging from 0.13 to 1.57). CONCLUSIONS The ability of 3-D, volumetric GluCEST to localize seizure onset down to the hippocampal subfield in nonlesional TLE is an improvement upon our previous 2-D, single-slice GluCEST method. Eventually, we hope to expand volumetric GluCEST to whole-brain glutamate imaging, thus enabling noninvasive analysis of glutamate networks in epilepsy and potentially leading to improved clinical outcomes.
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Affiliation(s)
- Peter N Hadar
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lohith G Kini
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Ravi Prakash Reddy Nanga
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie H Chen
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Preya Shah
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura E M Wisse
- Penn Image Computing & Science Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark A Elliott
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hari Hariharan
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ravinder Reddy
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - John A Detre
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel M Stein
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sandhitsu Das
- Penn Image Computing & Science Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn A Davis
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Praticò AD, Giallongo A, Arrabito M, D'Amico S, Gauci MC, Lombardo G, Polizzi A, Falsaperla R, Ruggieri M. SCN2A and Its Related Epileptic Phenotypes. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1727097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractEpilepsies due to SCN2A mutations can present with a broad range of phenotypes that are still not fully understood. Clinical characteristics of SNC2A-related epilepsy may vary from neonatal benign epilepsy to early-onset epileptic encephalopathy, including Ohtahara syndrome and West syndrome, and epileptic encephalopathies occurring at later ages (usually within the first 10 years of life). Some patient may present with intellectual disability and/or autism or movement disorders and without epilepsy. The heterogeneity of the phenotypes associated to such genetic mutations does not always allow the clinician to address his suspect on this gene. For this reason, diagnosis is usually made after a multiple gene panel examination through next generation sequencing (NGS) or after whole exome sequencing (WES) or whole genome sequencing (WGS). Subsequently, confirmation by Sanger sequencing can be obtained. Mutations in SCN2A are inherited as an autosomal dominant trait. Most individuals diagnosed with SCN2A–benign familial neonatal-infantile seizures (BFNIS) have an affected parent; however, hypothetically, a child may present SCN2A-BNFNIS as the result of a de novo pathogenic variant. Almost all individuals with SCN2A and severe epileptic encephalopathies have a de novo pathogenic variant. SNC2A-related epilepsies have not shown a clear genotype–phenotype correlation; in some cases, a same variant may lead to different presentations even within the same family and this could be due to other genetic factors or to environmental causes. There is no “standardized” treatment for SCN2A-related epilepsy, as it varies in relation to the clinical presentation and the phenotype of the patient, according to its own gene mutation. Treatment is based mainly on antiepileptic drugs, which include classic wide-spectrum drugs, such as valproic acid, levetiracetam, and lamotrigine. However, specific agents, which act directly modulating the sodium channels activity (phenytoin, carbamazepine, oxcarbamazepine, lamotrigine, and zonisamide), have shown positive result, as other sodium channel blockers (lidocaine and mexiletine) or even other drugs with different targets (phenobarbital).
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Affiliation(s)
- Andrea D. Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Alessandro Giallongo
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marta Arrabito
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silvia D'Amico
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria Cristina Gauci
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Giulia Lombardo
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Unit of Neonatal Intensive Care and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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Segato A, Marzullo A, Calimeri F, De Momi E. Artificial intelligence for brain diseases: A systematic review. APL Bioeng 2020; 4:041503. [PMID: 33094213 PMCID: PMC7556883 DOI: 10.1063/5.0011697] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI) is a major branch of computer science that is fruitfully used for analyzing complex medical data and extracting meaningful relationships in datasets, for several clinical aims. Specifically, in the brain care domain, several innovative approaches have achieved remarkable results and open new perspectives in terms of diagnosis, planning, and outcome prediction. In this work, we present an overview of different artificial intelligent techniques used in the brain care domain, along with a review of important clinical applications. A systematic and careful literature search in major databases such as Pubmed, Scopus, and Web of Science was carried out using "artificial intelligence" and "brain" as main keywords. Further references were integrated by cross-referencing from key articles. 155 studies out of 2696 were identified, which actually made use of AI algorithms for different purposes (diagnosis, surgical treatment, intra-operative assistance, and postoperative assessment). Artificial neural networks have risen to prominent positions among the most widely used analytical tools. Classic machine learning approaches such as support vector machine and random forest are still widely used. Task-specific algorithms are designed for solving specific problems. Brain images are one of the most used data types. AI has the possibility to improve clinicians' decision-making ability in neuroscience applications. However, major issues still need to be addressed for a better practical use of AI in the brain. To this aim, it is important to both gather comprehensive data and build explainable AI algorithms.
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Affiliation(s)
- Alice Segato
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan 20133, Italy
| | - Aldo Marzullo
- Department of Mathematics and Computer Science, University of Calabria, Rende 87036, Italy
| | - Francesco Calimeri
- Department of Mathematics and Computer Science, University of Calabria, Rende 87036, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan 20133, Italy
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Damodaran N. Automated Segmentation of Hippocampal Volume: The Next Step in Neuroradiologic Diagnosis of Mesial Temporal Sclerosis. AJNR Am J Neuroradiol 2019; 40:E38. [PMID: 31171519 DOI: 10.3174/ajnr.a6092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- N Damodaran
- Department of Neurosurgery Mahatma Gandhi Medical College and Research Institute Pondicherry, India
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