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UPDATE in the DIAGNOSTIC APPROACH to EPILEPSY

Jeffrey M Politsky, MD FRCP(C) Northeast Regional Epilepsy Group Atlantic Neuroscience institute. UPDATE in the DIAGNOSTIC APPROACH to EPILEPSY. Windows to the human brain. Anatomical Computerized X-ray Tomography (CT) Magnetic Resonance Imaging (MRI)

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UPDATE in the DIAGNOSTIC APPROACH to EPILEPSY

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  1. Jeffrey M Politsky, MD FRCP(C) Northeast Regional Epilepsy Group Atlantic Neuroscience institute UPDATE in the DIAGNOSTIC APPROACH to EPILEPSY

  2. Windows to the human brain • Anatomical • Computerized X-ray Tomography (CT) • Magnetic Resonance Imaging (MRI) • Functional, metabolic activity/blood flow • Positron Emission Tomography (PET) • Functional MRI (fMRI) • Near Infrared Spectroscopy (NIRS) • Functional, information processing • Electroencephalography (EEG) • Magnetoencephalography (MEG)

  3. Summary • 3-T MRI • V-EEG (at least 5 seizures separated over time) • PET • MEG • Functional Mapping • Intra-cranial Monitoring

  4. Comparison of Methods 1msec 1sec 1min 10min 1hour 10 SPECT EEG 8 6 PET Spatial resolution (mm) f MRI MEG 4 MRI 2 CT 0 0.0001 0.001 0.01 0.1 1 10 100 1000 10000 Temporal Resolution

  5. Comprehensive Epilepsy Center • MEG • a technique for mapping brain activity by recording magnetic fields produced by inherently occurring electrical currents in the brain using arrays of SQUIDS (superconducting quantum interference devices); • Main Clinical Applications: • Epilepsy Localization • Functional brain mapping prior to brain tumor/lesion resection; • Clinical Research Applications: • perceptual and cognitive brain processes; • Psychiatric conditions, • Autism • Traumatic brain injury

  6. First MEG (MIT – 1970’s)David Cohen and Jim Zimmerman

  7. Failed ideas Dual 14 (28)-Channel MEG System (1987)

  8. Historical Development 1986 by HUT 7 channels 93 mm in diameter (coverage: 68 cm2) Axial 1983 by HUT 4 channels 30 mm in diameter (coverage: 7 cm2) Axial 1989 by HUT 24 channels 125 mm in diameter (coverage: 123 cm2) Planar 1992 by Neuromag 122 channels whole head (coverage: 1100 cm2) Planar 12 Deliveries 1998 by Neuromag 306 channels whole head (coverage: 1220 cm2) Planar gradiometers & Magnetometers

  9. Patient undergoing MEG

  10. MEG door

  11. Magnetic fields

  12. The MEG (and EEG) signals derive from the net effect of ionic currents flowing in neuronal dendrites during synaptic transmission.

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