title: Resting functional MRI with temporal clustering analysis for localization of epileptic activity without EEG.
abstract: We report on the methods and initial findings of a novel noninvasive technique, resting functional magnetic resonance imaging (fMRI) with temporal clustering analysis (TCA), for localizing interictal epileptic activity. Nine subjects were studied including six temporal lobe epilepsy (TLE) patients with confirmed localization indicated by successful seizure control after resection. The remaining three subjects had standard presurgical evaluations with inconsistent results or suspected extratemporal lobe foci. Peaks of activity, presumably epileptic, were detected in all nine subjects, using the resting functional MRI with temporal clustering analysis. In all six patients who underwent resective surgery, the fMRI with temporal clustering analysis accurately determined the epileptogenic hippocampal hemisphere (P = 0.005). In the three subjects without confirmed localization, the technique determined regions of activity consistent with those determined by the presurgical assessments. Though more studies are required to validate this technique, the results demonstrate the potential of the resting fMRI with temporal clustering technique to detect and localize epileptic activity without the need for simultaneous electroencephalography (EEG). The greatest potential benefit of this technique will be in the evaluation of patients with suspected extratemporal lobe epilepsy and patients whose standard assessments are discordant.
authors.affiliation: Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232-2675, USA. victoria.morgan@vanderbilt.edu
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Morgan
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Price
authors.forename: Amir
authors.initials: A
authors.lastname: Arain
authors.forename: Pradeep
authors.initials: P
authors.lastname: Modur
authors.forename: Bassel
authors.initials: B
authors.lastname: Abou-Khalil
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy; D016000:Cluster Analysis; D003937:Diagnosis, Differential; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000503:physiopathology; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery; D006624:Hippocampus / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D009716:Numerical Analysis, Computer-Assisted; D012680:Sensitivity and Specificity; D013702:Temporal Lobe / Q000503:physiopathology*