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Dealing with patients…

Dealing with patients…. jenny crinion adam liston. Dealing with patient’s data. jenny crinion adam liston. Overview. SPM2 in Chalfont SPM2 in Queens Square. Overview. SPM2 in Chalfont SPM2 in Queens Square. Epilepsy Pre-surgical – fMRI: avoid? (null hypothesis) / predict

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Dealing with patients…

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  1. Dealing with patients… jenny crinion adam liston

  2. Dealing with patient’s data jenny crinion adam liston

  3. Overview • SPM2 in Chalfont • SPM2 in Queens Square

  4. Overview • SPM2 in Chalfont • SPM2 in Queens Square • Epilepsy • Pre-surgical – fMRI: avoid? (null hypothesis) / predict • Lesions – advanced MRI techniques and VBM • Psychosis – TLE with and without psychosis • EEG-fMRI – focal and generalised epilepsy

  5. Overview • SPM2 in Chalfont • SPM2 in Queens Square • Epilepsy • Pre-surgical – fMRI: avoid? (null hypothesis) / predict • Lesions – advanced MRI techniques and VBM • Psychosis – TLE with and without psychosis • EEG-fMRI – focal and generalised epilepsy • Stroke • Cross-sectional / longitudinalfMRI, DTI, TMS, VBM • Dementia • VBM and treatment studies with fMRI

  6. c d b a Anatomical - Lesions • Advanced MRI techniques • Voxel Based Morphometry (VBM) – SPM 99 • Magnetisation Transfer (MTR), Fast Flair T2- (FFT2) and • Double Inversion Recovery (DIR) imaging to identify • abnormalities unseen in normal T1-weighted • 2nd level - template from 40 patients and 30 normals • Concordance with EEG focus?? Frontal lobe epilepsy and normal conventional MRI: (a) Normalized axial T1-weighted, (b) MTR, (c) FFT2 maps (d) and DIR images.

  7. Anatomical - Temporal Epilepsy • Interictal psychosis (not related to seizure / years after onset of epilepsy) • Optimised VBM – SPM99 study of schizophrenia (Good Neuroimage 2001) • Led to study of interictal psychosis - MTR reductions specific to • interictal psychosis? Brain (2001) 124, 882-892

  8. fMRI - Presurgical • 75% fully controlled by medication • Some of remainder may be eligible for surgery • Cost? NULL hypothesis: Cognitive Experiments region is NOT active Presurgical Experiments region IS active

  9. fMRI - Presurgical Temporal Lobe Epilepsy (TLE) - resection of part of temporal lobe… Avoid eloquent cerebral areas: word generation memory verb generation reading • SPM2 Analysis: patient-specific; block/event-related design • Lateralisation

  10. fMRI - Presurgical • Predicted memory deficits: • Medial Temporal Lobe (MTL) structures • Lateralisation / localisation of memory function • 10 normals, 8 patients with left TLE and 9 patients with right TLE 60min SPM2 7 blocks of 10 pictures (P), 10 words (W) + 10 faces (F) pleasant? / unpleasant? Recognition tests of 210 stimuli + 105 foils recognise? (R) or new (N) 3 contrasts per subject (1) PR-minus-PN (2) WR-minus-WN (3) FR–minus-FN

  11. 1st level Pictures remembered 3 contrasts per subject (1) PR-minus-PN (2) WR-minus-WN (3) FR–minus-FN

  12. 2nd level Pictures remembered (controls) 2nd level 2-way interaction: group (rTLE-lTLE) / memory 2nd level

  13. EEG-fMRI - focal epilepsy • Problems • Every case individual • Bad experimental design – low efficiency: 0 to 638 events • motion – jerks / scanner naivity • drugs – cured(!) / effect on haemodynamic response function (hrf) • effect of lesions on hrf

  14. Motion

  15. suspicious?

  16. Scan nulling?

  17. EEG-fMRI - generalised epilepsy • Problems • Syndrome: Idiopathic Generalised Epilepsy (IGE); secondary generalised • “splitters” and “lumpers” • Runs of 3Hz “spike-and-wave” • Bad experimental design – low efficiency: 1 - 120 events • runs of 1 – 30 seconds (mean 2-3s) • motion – jerks / scanner naivity • drugs – cured(!) / effect on haemodynamic response function (hrf) • effect of lesions on hrf

  18. activation 2nd level? • Problems • unbalanced • valid grouping? IGE 60 events p<0.05 corrected 24 events p<0.05 corrected deactivation SGE 46 events p<0.05 corrected 57 events p<0.001 uncorrected

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