Advanced Techniques in Dealing with Patients' Conditions for Optimal Care

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