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Neuroimaging of Epilepsy

Neuroimaging of Epilepsy. Ruben Kuzniecky, M.D. NYU Comprehensive Epilepsy Center New York University New York. Ruben.kuzniecky@med.nyu.edu. Neuroimaging in Epilepsy 1- Diagnosis 2- Classification 3- Genetics 4- Treatment Strategies 5- Prognosis. Pathology of Epilepsy Neoplasia

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Neuroimaging of Epilepsy

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  1. Neuroimaging of Epilepsy Ruben Kuzniecky, M.D. NYU Comprehensive Epilepsy Center New York University New York Ruben.kuzniecky@med.nyu.edu

  2. 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 Imaging in Epilepsy

  3. Neuroimaging in Epilepsy

  4. CT Scans

  5. 3.0 Tesla 1.5 Tesla

  6. MR Compatible Incubator

  7. Find the Abnormality…

  8. Hippocampal Sclerosis

  9. Wrong MRI Angulation for HS

  10. Correct MRI Angulation-HS

  11. 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

  12. Temporal Lobe Epilepsy • Ganglioglioma • Seizure onset 4 years • CPSz • Surgical Failure • Watch out for extensive pathology

  13. Tuberous Sclerosis Multiple Lesions Multiple or single Epileptogenic areas TSC2 gene (1993) 16p13 Tuberin TSC1 gene (1996) 9q34 Hamartin

  14. Malformation of Cortical Development Intractable Seizures Hemiparesis Developmental Delay Etiology : ? Pathology: Variable Treatment: Mostly effective

  15. Focal Cortical Dysplasia Bottom of Sulcus FCD

  16. Lissencephaly/ DCX

  17. Unilateral Polymicrogyria

  18. Lissencephaly/SBH- DCX 16 y/o Sister 12 y/o Male

  19. Frontal Lobe Epilepsy Normal MRI What do you do to improve Imaging Yield ?

  20. High Resolution 8S-coils Grant et al 2004 MGH

  21. Image Averaging Focal Cortical dysplasia 1 SPGR series 4 SPGR series Knowlton et al

  22. NeuroImaging in Patients with Normal MRI • SPECT • Ictal Spect and SISCOM • PET • FDG PET • Receptor PET • MEG • Epilepsy Localization • Mapping • MR Spectroscopy

  23. DWI in Epilepsy

  24. ICTAL SPECT 6 Months old boy with Frontal lobe FCD

  25. Focal Cortical Dysplasia T1-WT\ CISPECT FLAIR

  26. Temporal Lobe EpilepsySISCOM

  27. PET PET/CT

  28. 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

  29. FDG-PET Arrows point to abnormalities

  30. FLUMAZENIL PET: NON-LESIONAL CASE A B R L Seizure onset Very frequent spiking Frequent spiking Moderate spiking

  31. 3 year old girl with TSC FLAIR AMT PET Children’s Hospital of Michigan Wayne State University

  32. TSC, Autism and Epileptic Spasms (7 year old boy) FLAIR MRI FDG PET AMT PET EEG: spike and wave activity in the right frontal region. Children’s Hospital of Michigan Wayne State University

  33. Magnetic Source Imaging (MSI) • Measures magnetic fields generated by electrophysiological activity • Analyzes spatial distribution of magnetic field to localize its sources • Overlays source locations onto anatomical image to create composite MSI image • Provides noninvasive view of cellular function with high spatio-temporal resolution

  34. MEG System 248 Channels Superior Temporal Resolution MEG-NYU Epilepsy Center

  35. Focal Cortical DysplasiaMagnetoencephalography Spike Clustering

  36. Seizure Control in Patients With Partial Epilepsy: The Role of Brain Abnormalities Detected by MRI 54% % of seizure-free patients 50% 46% 42% 30% 24% 11% 3% N=38 Dual pathology N=57 Vascular malformation N=26 Post-stroke N=50 Tumor N=268 Normal MRI N=50 Closed Head trauma N=81 Cortical dysgenesis N=224 Isolated HS HS = hippocampal sclerosis. Semah F, et al. Neurology. 1998;51:1256-1262.

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