Epilepsy Focus Localization in Patients Utilizing BOLD Differences Related to Regional Metabolic Dynamics

• 作者: Byron Bernal Jorge Riera Magno R. Guillen Michael Duchowny Nolan Altman Pedro Valdes Prasanna Jayakar
• 来源期刊: 放射学期刊(英文)
• 学科: 医学
• 关键词: BOLD FMRI rs-fMRI Brain MRI EPILEPSY PET
• 年，卷（期）: fsxqkyw_2019,（3）
• 页码范围: 163-175
• 页数: 13页
• 分类号: R73

摘要

This paper presents a theoretical elaboration aimed to explain the correlation found between a new rs-fMRI modality and electrophysiology and nuclear medicine neuroimaging, performed to localize epileptogenic brain areas. We present in detail the clinical history, and electrophysiological and neuroimaging results of one child with intractable epilepsy, who was submitted for Phase-1 work-up as candidate for epilepsy surgery. The patient underwent a thorough workup including video-telemetry, ictal and interictal nuclear medicine imaging, resting-state fMRI, EEG-fMRI, intracranial electroencephalography (ECoG), deep electrode implantation, and resective surgery. Electrophysiology and neuroimaging findings were concordant with findings provided by the resting-state mean signal. The patient became seizure-free after the resection of the target area. A theoretical discussion is provided that considers the presence of a stable BOLD effect explaining the findings of the observed resting-state mean signal. This stable BOLD is linked to low regional metabolism usually present in the epileptogenic area during interictal periods, coupled with low oxygen extraction. Low oxygen extraction leaves more oxygen for the draining venule and consequently increases the BOLD signal.