Tracking cognitive changes in new-onset epilepsy: functional imaging challenges

29 Nov

Does the onset of epilepsy bring on a change in cognition? I’ve heard people, people who purport to know, state clearly yes…and clearly no.

A recent article poses the question of if such studies could be performed with the fairly recent advances in fMRI and ERPs.

Tracking cognitive changes in new-onset epilepsy: functional imaging challenges.

Functional imaging has potential for tracking changes in cognition during the onset and evolution of epilepsy. Although the concept of imaging such changes over time is an exciting new direction, feasibility remains an open question. The current article outlines a case example in which functional magnetic resonance imaging (fMRI) and event-related potentials (ERPs) were used to monitor memory changes before and after selective temporal lobe resection. From this example, three key methodologic challenges for new-onset epilepsy are identified and discussed. The first challenge relates to the interpretation of results in regions near epileptogenic tissue. We argue that this is best addressed by collecting information from multiple modalities to test for convergent evidence. The second challenge relates to optimizing the methods for sensitivity to detecting changes. In this case, enhanced imaging methods and a region-of-interest approach provide necessary focus. The third and final challenge relates to the practical difficulties of conducting research in new-onset epilepsy cases. We suggest that greater integration of imaging research within the clinical setting is needed.

The example given (monitoring changes after temporal lobe resection) is something quite distinct from new onset epilepsy, but the authors are presenting it as a starting point for what questions to ask and what problems might arise. “feasibility remains an open question” is a major understatement. How does one track an individual before onset of epilepsy or very soon after onset (the third challenge)? And, what regions should be tracked? It gets to be a very hairy problem. But I appreciate the proposal.

2 Responses to “Tracking cognitive changes in new-onset epilepsy: functional imaging challenges”

  1. RAJ November 29, 2011 at 23:21 #

    An fMRI study by scientists at Dartmouth questioned the use of fMRI and its validity in making interpretations of fMRI. In one of the great and hilarious studies in science the Dartmouth researchers put a dead salmon under fMRI and reported:

    In the fMRI scan, it looked like the dead salmon was actually thinking about the pictures it had been shown.

    “By complete, random chance, we found some voxels that were significant that just happened to be in the fish’s brain,” Bennett said. “And if I were a ridiculous researcher, I’d say, ‘A dead salmon perceiving humans can tell their emotional state.’”

  2. Kassiane December 4, 2011 at 07:41 #

    I find this direction of study very interesting…I have epilepsy & am working towards becoming a pediatric neurology (hoping to work with kids with epilepsy added onto developmental differences…an example of ‘the system frustrates me, better fix it myself’).

    I’m not sure if what they’re trying to test is feasible at this point in time, but there are similar things they could look at–like cognitive differences during times of good vs not so good seizure control–that’d have all sorts of applications in helping people.

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