Multimodal Imaging for Surgical Planning in Epilepsy

Epilepsy is a disorder of the brain characterized by attacks involving loss of consciousness and changes in behaviour. Epilepsy dramatically impacts the quality of life of those affected, and is often associated with learning difficulties, emotional distress, and psychosocial problems. Although medication is available to control some cases, often epilepsy is resistant to medication. Thus neurosurgery is required to remove diseased tissue that causes attacks. When planning to remove tissue from a patient's brain, the neurosurgeon must avoid damage to areas critical for functions such as language and memory. Traditional tests to localize brain function are often invasive, time consuming, and uncomfortable for the patient. Non-invasive neuroimaging techniques such as functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), electro- and magneto-encephalography (E/MEG) are available to identify functional and diseased areas of the cerebral cortex prior to surgery. However, these technologies, which look at brain structure and activity, are not yet widely available for clinical application. This research aims to advance treatment of epilepsy by using multimodal imaging to guide neurosurgical planning in epilepsy. The proposed study has three parts. Part one will compare people with epilepsy with healthy people to identify problem areas and deficits. Part two will use multimodal brain mapping (fMRI, EEG, MEG, and DTI) both before and after surgery to assess the effects of surgical treatment for epilepsy. Part three will assess the extent to which, if any, multimodal preoperative imaging improves the accuracy of localization of function. This research has the potential to ameliorate the risks and costs of neurosurgery, and provide surgeons with improved navigational tools to advance the efficiency and reliability of neurosurgery.