Dealing with patients jenny crinion adam liston Dealing

Dealing with patients… jenny crinion adam liston

Dealing with patient’s data jenny crinion adam liston

Overview • SPM 2 in Chalfont • SPM 2 in Queens Square

Overview • SPM 2 in Chalfont Epilepsy • Pre-surgical – f. MRI: avoid? (null hypothesis) / predict • Lesions – advanced MRI techniques and VBM • Psychosis – TLE with and without psychosis • EEG-f. MRI – focal and generalised epilepsy • SPM 2 in Queens Square

Overview • SPM 2 in Chalfont Epilepsy • Pre-surgical – f. MRI: avoid? (null hypothesis) / predict • Lesions – advanced MRI techniques and VBM • Psychosis – TLE with and without psychosis • EEG-f. MRI – focal and generalised epilepsy • SPM 2 in Queens Square Stroke • Cross-sectional / longitudinal f. MRI, DTI, TMS, VBM Dementia • VBM and treatment studies with f. MRI

Anatomical - Lesions Advanced MRI techniques • Voxel Based Morphometry (VBM) – SPM 99 • Magnetisation Transfer (MTR), Fast Flair T 2 - (FFT 2) and Double Inversion Recovery (DIR) imaging to identify abnormalities unseen in normal T 1 -weighted • 2 nd level - template from 40 patients and 30 normals • Concordance with EEG focus? ? Frontal lobe epilepsy and normal conventional MRI: a b c d (a) Normalized axial T 1 -weighted, (b) MTR, (c) FFT 2 maps (d) and DIR images.

Anatomical - Temporal Epilepsy Interictal psychosis (not related to seizure / years after onset of epilepsy) • Optimised VBM – SPM 99 study of schizophrenia (Good Neuroimage 2001) Brain (2001) 124, 882 -892 • Led to study of interictal psychosis - MTR reductions specific to interictal psychosis?

f. MRI - Presurgical • 75% fully controlled by medication • Some of remainder may be eligible for surgery • Cost? NULL hypothesis: Cognitive Experiments Presurgical Experiments region is NOT active region IS active

f. MRI - Presurgical Temporal Lobe Epilepsy (TLE) - resection of part of temporal lobe… Avoid eloquent cerebral areas: memory verb generation • SPM 2 Analysis: patient-specific; block/event-related design • Lateralisation word generation reading

f. MRI - 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 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

1 st level Pictures remembered 3 contrasts per subject (1) PR-minus-PN (2) WR-minus-WN (3) FR–minus-FN

2 nd level Pictures remembered (controls) 2 nd level 2 -way interaction: group (r. TLE-l. TLE) / memory

EEG-f. MRI - 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

Motion

suspicious?

Scan nulling?

EEG-f. MRI - generalised epilepsy Problems • Syndrome: Idiopathic Generalised Epilepsy (IGE); secondary generalised “splitters” and “lumpers” • Runs of 3 Hz “spike-and-wave” • Bad experimental design – low efficiency: 1 - 120 events runs of 1 – 30 seconds (mean 2 -3 s) • motion – jerks / scanner naivity • drugs – cured(!) / effect on haemodynamic response function (hrf) • effect of lesions on hrf

activation • unbalanced • valid grouping? 60 events p<0. 05 corrected deactivation 24 events p<0. 05 corrected SGE Problems IGE 2 nd level? 46 events p<0. 05 corrected 57 events p<0. 001 uncorrected