Project Details

High Resolution Quantitative MR Imaging of Focal Cortical Dysplasia in Pediatric Epilepsy

Simon Warfield, PhD

Summary

BACKGROUND: One of the most common causes of pediatric epilepsy is malformations of cortical development. Often the best treatment option for these patients is early and complete resection of the epileptogenic focus, which improves their quality of life, improves cognitive and developmental outcomes, and allows the child to lead a normal life. GAP: Despite continuous improvements in MRI technologies, a significant number of lesions are still not detected by diagnostic imaging. For example, in cases of focal cortical dysplasia (FCD), up to 87% of patients with type I FCD, and 33% of those with type II FCD, had unremarkable, qualitative MRI that failed to identify the lesion, primarily because high quality clinical imaging is still limited by contrast and resolution. The inability to see these malformations prevents the most effective type of treatment – complete surgical removal of the epileptogenic lesion. This study will evaluate the efficacy of our novel MRI imaging methods to detect such lesions and increase the number of patients for whom resective surgery may be curative. HYPOTHESIS: Our hypothesis is that we will substantially increase the rate of detection of FCDs, and thereby increase the rate of seizure freedom in subjects who undergo surgery. Furthermore, the detection of previously overlooked lesions will dramatically increase the number of pediatric epilepsy patients identified as candidates for curative resection. METHODS: We will recruit study participants from patients with pediatric epilepsy being considered for the possibility of surgical intervention at the BCH epilepsy clinic. The subjects will undergo advanced MRI using 3T and 7T scanners. RESULTS: The utilization of advanced imaging with MRI increases the conspicuity of malformations of cortical development, and identifies more subjects than conventional 3T MRI as potential surgical candidates. IMPACT: The detection of epileptogenic lesions undiscovered by current clinical MRI is critical to enabling early in life, effective surgical resection, allowing for a surgical cure of epilepsy, and avoiding cognitive and behavioral deficits associated with extended duration of epilepsy. The efficacy of advanced 3T and 7T MRI imaging will be assessed for the detection of epileptogenic lesions.