ruben kuzniecky, m.d. nyu comprehensive epilepsy center new york university new york...
Post on 22-Dec-2015
215 Views
Preview:
TRANSCRIPT
Ruben Kuzniecky, M.D.NYU Comprehensive Epilepsy Center
New York University
New York
Ruben.kuzniecky@med.nyu.edu
Neuroimaging of Epilepsy
Imaging in EpilepsyImaging in Epilepsy
• Neuroimaging in Epilepsy
1- Diagnosis
2- Classification
3- Genetics
4- Treatment Strategies
5- Prognosis
• Pathology of Epilepsy
• Neoplasia• H. Sclerosis• Trauma• MCD’s• Vascular• Post-infectious
Neuroimaging in EpilepsyNeuroimaging in Epilepsy
Diagnos Classif Genetics Neurodevel Surgery
CT +
MRI ++ ++ ++ ++ ++
PET-FDG ++ + + ++
iSPECT + + ++
MEG + + + ++
Where is the focus ?
• Brian– 17 y/o high school boy
– Traumatic birth, CP
– Left UL hemiparesis 4/5
– CPSz without GTC
– EEG: Right F-T
– IQ:101
Temporal Lobe Epilepsy
• Ganglioglioma
• Seizure onset 4 years• CPSz• Surgical Failure• Watch out for
extensive pathology
Tuberous Sclerosis
Multiple LesionsMultiple or single Epileptogenic areas
TSC2 gene (1993)16p13 Tuberin
TSC1 gene (1996)9q34Hamartin
Malformation of Cortical Development
Hemimegalencephaly
Intractable SeizuresHemiparesisDevelopmental Delay
Etiology : ?Pathology: VariableTreatment: Mostly effective
Image AveragingFocal Cortical dysplasiaFocal Cortical dysplasia
Knowlton et al
4 SPGR series1 SPGR series
NeuroImaging in Patients with Normal MRI
• SPECT– Ictal Spect and SISCOM
• PET– FDG PET– Receptor PET
• MEG– Epilepsy Localization– Mapping
• MR Spectroscopy
PET Techniques in Epilepsy
• FDG : Glucose metabolism• H2O : rCBF• [11C]CARFENTANIL: binds to mu-opiate receptors• [11C]DOXEPINE: binds to histamine H1 receptors• [11C]FLUMAZENIL: binds to benzodiazepine site on GABA-A
receptor• ALPHA[11C]METHYL-L-TRYPTOPHAN: measures
tryptophan metabolism by serotonin and kynurenine pathways
R L
A B
Seizure onsetVery frequent spikingFrequent spikingModerate spiking
FLUMAZENIL PET: NON-LESIONAL CASE
TSC, Autism and Epileptic Spasms (7 year old boy)
AMT PETFDG PETFLAIR MRI
EEG: spike and wave activity in the right frontal region.
Children’s Hospital of MichiganWayne State University
• Measures magnetic fields generated by Measures magnetic fields generated by
electrophysiological activityelectrophysiological activity
• Analyzes spatial distribution of magnetic field to Analyzes spatial distribution of magnetic field to
localize its sourceslocalize its sources
• Overlays source locations onto anatomical Overlays source locations onto anatomical
image to create composite MSI imageimage to create composite MSI image
• Provides noninvasive view of cellular function Provides noninvasive view of cellular function
with high spatio-temporal resolutionwith high spatio-temporal resolution
• Measures magnetic fields generated by Measures magnetic fields generated by
electrophysiological activityelectrophysiological activity
• Analyzes spatial distribution of magnetic field to Analyzes spatial distribution of magnetic field to
localize its sourceslocalize its sources
• Overlays source locations onto anatomical Overlays source locations onto anatomical
image to create composite MSI imageimage to create composite MSI image
• Provides noninvasive view of cellular function Provides noninvasive view of cellular function
with high spatio-temporal resolutionwith high spatio-temporal resolution
Magnetic Source Imaging Magnetic Source Imaging (MSI)(MSI)Magnetic Source Imaging Magnetic Source Imaging (MSI)(MSI)
Focal Diffuse
Medical Tx Response
No Response
PET/MEG
Response AEDyes
No Response
Concordant
Surgery
Discordant
Surgery
Localized
PETIctal SPECT
MEGMRS
Localization
MRInormal
Abnormal MRI
EPILEPSYDIAGNOSIS
0
25
50
75
100
N=26Post-stroke
N=57Vascular
malformation
N=50Tumor
N=268Normal
MRI
N=50Closed Head trauma
N=81Cortical
dysgenesis
N=224Isolated
HS
N=38Dual
pathology
54%50%
46%42%
30%24%
11%3%
% o
f se
izur
e-fr
ee p
atie
nts
Seizure Control in Patients With Partial Epilepsy: The Role of Brain Abnormalities Detected by MRI
Semah F, et al. Neurology. 1998;51:1256-1262.
HS = hippocampal sclerosis.
top related