A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Mouhsin M. Shafi; Susan Whitfield-Gabrieli; Catherine J. Chu; Alvaro Pascual-Leone; Bernard S. Chang

doi:10.3791/53727

Un método multimodal Imaging- y basados en la estimulación de evaluar relacionados con la conec...

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A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Un método multimodal Imaging- y basados en la estimulación de evaluar relacionados con la conectividad cerebral excitabilidad en pacientes con epilepsia

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08:23 min

November 13, 2016

DOI: 10.3791/53727-v

Mouhsin M. Shafi^1,2,3, Susan Whitfield-Gabrieli⁴, Catherine J. Chu^1,5, Alvaro Pascual-Leone^1,2,3, Bernard S. Chang^1,2

¹Department of Neurology,Harvard Medical School, ²Department of Neurology,Beth Israel Deaconess Medical Center, ³Berenson-Allen Center for Noninvasive Brain Stimulation,Beth Israel Deaconess Medical Center, ⁴Department of Brain and Cognitive Sciences,Massachusetts Institute of Technology, ⁵Department of Neurology,Massachusetts General Hospital

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Overview

This study evaluates regional cortical hyperexcitability in epilepsy patients using resting-state functional connectivity and MRI-guided transcranial magnetic stimulation (TMS) combined with EEG. The approach aims to identify hyperexcitability in areas of the brain associated with the epileptogenic network.

Key Study Components

Area of Science

Neuroscience
Neurophysiology
Epilepsy research

Background

Resting-state functional-connectivity MRI reveals abnormalities in neuropsychiatric disorders.
Patients with epilepsy often exhibit cortical hyperexcitability.
Transcranial Magnetic Stimulation can assess cortical reactivity.
Identifying hyperexcitability can improve diagnosis and treatment strategies.

Purpose of Study

To evaluate cortical hyperexcitability in epilepsy patients.
To determine if hyperexcitability correlates with abnormal connectivity.
To explore implications for therapeutic targeting of epileptogenic circuits.

Methods Used

Resting-state functional connectivity analysis.
MRI-guided transcranial magnetic stimulation.
Simultaneous EEG recording.
Superimposing functional connectivity maps onto structural images.

Main Results

Evidence of cortical hyperexcitability in specific brain regions.
Identification of differences in cerebral excitability based on connectivity.
Potential for targeting epileptogenic circuits therapeutically.
Findings may enhance understanding of epilepsy mechanisms.

Conclusions

Cortical hyperexcitability can be detected even with normal routine EEG.
This method provides insights into the epileptogenic network.
Results support the use of TMS and EEG in epilepsy diagnosis and treatment.

Frequently Asked Questions

What is the significance of cortical hyperexcitability in epilepsy?

Cortical hyperexcitability is associated with the propensity for seizures and can inform treatment strategies.

How does TMS contribute to epilepsy research?

TMS helps assess cortical reactivity and identify hyperexcitability in specific brain regions.

What role does EEG play in this study?

EEG is used to record brain activity simultaneously with TMS, providing insights into cortical dynamics.

Can this method be used for other neuropsychiatric disorders?

Yes, the technique may have applications in various neuropsychiatric conditions beyond epilepsy.

What are the implications of identifying hyperexcitability?

Identifying hyperexcitability can lead to targeted therapies and improved patient outcomes.

Who conducted the experiment?

The experiment was conducted by Tamara Gedankian, a research assistant in the laboratory.

What is the advantage of using MRI-guided TMS?

MRI-guided TMS allows for precise targeting of brain regions based on individual connectivity maps.

La resonancia magnética de conectividad funcional en estado de reposo ha identificado anomalías en pacientes con una amplia gama de trastornos neuropsiquiátricos, incluida la epilepsia debida a malformaciones del desarrollo cortical. La estimulación magnética transcraneal en combinación con el EEG puede demostrar que los pacientes con epilepsia tienen hiperexcitabilidad cortical en regiones con conectividad anormal.

El objetivo general de este experimento es evaluar la hiperexcitabilidad cortical regional en pacientes con epilepsia utilizando conectividad funcional en estado de reposo, estimulación magnética transcraneal guiada por resonancia magnética en combinación con registro simultáneo de EEG. Este método puede ayudar a responder preguntas clave en el campo de la epilepsia y la neurofisiología, como si los pacientes con epilepsia tienen evidencia de hiperexcitabilidad en regiones que se cree que forman parte de la red epileptógena. La principal ventaja de esta técnica es que se puede utilizar para evaluar las diferencias en la excitabilidad cerebral en función de la conectividad y se puede utilizar para evaluar la reactividad cortical en una variedad de regiones cerebrales diferentes.

Esta técnica tiene implicaciones para el diagnóstico y tratamiento de la epilepsia, ya que la hiperexcitabilidad cortical se puede identificar incluso cuando el EEG de rutina es normal, y los circuitos epileptogénicos se pueden dirigir terapéuticamente. La demostradora del procedimiento estará a cargo de Tamara Gedankian, asistente de investigación en mi laboratorio. Antes de la prueba, determine las dos regiones objetivo de TMS superponiendo el mapa de conectividad funcional de cada sujeto en la imagen estructural de cada sujeto.

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