Language and Emotional Function in Patients With Temporal Lobe Epilepsy
| Status: | Completed |
|---|---|
| Conditions: | Neurology, Epilepsy |
| Therapuetic Areas: | Neurology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | April 2004 |
| End Date: | April 2010 |
Functional MRI (fMRI) and Diffusion Tensor Imaging (DTI) in Temporal Lobe Epilepsy
This study uses functional magnetic resonance imaging (fMRI) and diffusion tensor imaging
(DTI) to examine how the brain processes tasks involving language and emotion in normal
volunteers and in patients with epilepsy. MRI is a diagnostic and research tool that uses a
strong magnetic field and radio waves to obtain images of body organs and tissues. The MRI
scanner is a metal cylinder surrounded by a magnetic field. During the test, the subject
lies on a table that can slide in and out of the cylinder. DTI involves taking pictures of
the brain while the subject is at rest in order to learn about the structure of the brain.
Information gained from this study will help scientists evaluate the organization of
language and emotional functions in the brain.
Normal volunteers and patients with temporal lobe epilepsy 18 years of age and older who are
native English speakers and who will undergo surgery for uncontrolled seizures may be
eligible for this study. Candidates are initially screened by telephone, then with physical
and neurologic examinations and cognitive testing.
The study has two parts, conducted 6 to 12 months apart. Each part consists of the same sets
of tests described below, using fMRI and DTI. In patients with epilepsy, Part 1 is scheduled
before surgery and Part 2 after surgery.
- fMRI: Subjects are asked to perform two types of tasks while they undergo fMRI. In one
task, they are shown pictures of animals and tools and are asked to name them. In a
second task, they are shown pictures that range in content from sexually explicit
material, to human injury and surgical slides, to pleasant images of children and
wildlife and are asked to decide whether they find the pictures pleasant, neutral, or
unpleasant.
- DTI: Subjects relax and remain still in the MRI scanner for about 45 minutes.
- Neuropsychological testing: Subjects may be asked to complete questionnaires, take
pen-and-paper or computerized tests, and perform motor tasks.
Participants may be asked to repeat the MRI studies, but not the neuropsychological tests,
up to four times to investigate different brain functions or to confirm findings.
(DTI) to examine how the brain processes tasks involving language and emotion in normal
volunteers and in patients with epilepsy. MRI is a diagnostic and research tool that uses a
strong magnetic field and radio waves to obtain images of body organs and tissues. The MRI
scanner is a metal cylinder surrounded by a magnetic field. During the test, the subject
lies on a table that can slide in and out of the cylinder. DTI involves taking pictures of
the brain while the subject is at rest in order to learn about the structure of the brain.
Information gained from this study will help scientists evaluate the organization of
language and emotional functions in the brain.
Normal volunteers and patients with temporal lobe epilepsy 18 years of age and older who are
native English speakers and who will undergo surgery for uncontrolled seizures may be
eligible for this study. Candidates are initially screened by telephone, then with physical
and neurologic examinations and cognitive testing.
The study has two parts, conducted 6 to 12 months apart. Each part consists of the same sets
of tests described below, using fMRI and DTI. In patients with epilepsy, Part 1 is scheduled
before surgery and Part 2 after surgery.
- fMRI: Subjects are asked to perform two types of tasks while they undergo fMRI. In one
task, they are shown pictures of animals and tools and are asked to name them. In a
second task, they are shown pictures that range in content from sexually explicit
material, to human injury and surgical slides, to pleasant images of children and
wildlife and are asked to decide whether they find the pictures pleasant, neutral, or
unpleasant.
- DTI: Subjects relax and remain still in the MRI scanner for about 45 minutes.
- Neuropsychological testing: Subjects may be asked to complete questionnaires, take
pen-and-paper or computerized tests, and perform motor tasks.
Participants may be asked to repeat the MRI studies, but not the neuropsychological tests,
up to four times to investigate different brain functions or to confirm findings.
OBJECTIVES: Epilepsy surgery is emerging as a potent therapeutic intervention for a large
group of patients with uncontrolled temporal lobe epilepsy, particularly when performed
early in the course of the illness. Seizure freedom is an important goal of seizure surgery,
but post-operative neuropsychological functioning is another equally important outcome
measure. Both endpoints require careful pre-operative evaluation of the individual patient
and better understanding of the functional neuroanatomy of the temporal lobe. In this study
fMRI and DTI will be performed in patients with temporal lobe epilepsy and normal volunteers
in an attempt to
1. investigate the role of the anterior temporal cortex in semantic processing,
2. evaluate the role of the amygdala in affective processing,
3. correlate the extent of white matter pathway resection with cognitive outcome after
temporal lobectomy.
STUDY POPULATION: We plan to study 30 patients with temporal lobe epilepsy (right-sided,
left-sided seizure foci) pre and post temporal lobectomy as well as 30 normal volunteers.
DESIGN: The study will be done in two parts both consisting of identical tasks. For the
patient group part 1 will be performed prior to temporal lobectomy and part 2, 6-12 months
after temporal lobectomy. For the normal volunteer group parts 1 and 2 will be performed at
time interval of 6-12 months.
During part 1 all study subjects will undergo neuropsychological evaluation. FMRI will be
performed with two tasks: animal and tool naming (to evaluate semantic processing) and
rating of emotionally pleasant or unpleasant pictures (to evaluate affective processing).
All subjects will also undergo diffusion tensor imaging (DTI) for the visualization of white
matter pathways.
During part 2 of the study all of the above tests will be repeated.
FMRI data will be analyzed within the framework of the general linear model in a program
such as AFNI 2.5. Statistical comparisons between activation patterns in scans acquired
during part 1 and part 2 within either group (intragroup comparison) will be done by voxel
wise paired t-test. In a second analysis all 4 groups will be compared in a mixed model. The
DTI data will be correlated with the neuropsychological outcome to asses the contribution of
white matter abnormalities pre-operatively or severance of white matter pathways
post-operative on neuropsychological functioning.
OUTCOME PARAMETERS: Outcome parameters are changes in the fMRI activation pattern post
temporal lobectomy and disruption of anisotropy on the diffusion tensor images.
group of patients with uncontrolled temporal lobe epilepsy, particularly when performed
early in the course of the illness. Seizure freedom is an important goal of seizure surgery,
but post-operative neuropsychological functioning is another equally important outcome
measure. Both endpoints require careful pre-operative evaluation of the individual patient
and better understanding of the functional neuroanatomy of the temporal lobe. In this study
fMRI and DTI will be performed in patients with temporal lobe epilepsy and normal volunteers
in an attempt to
1. investigate the role of the anterior temporal cortex in semantic processing,
2. evaluate the role of the amygdala in affective processing,
3. correlate the extent of white matter pathway resection with cognitive outcome after
temporal lobectomy.
STUDY POPULATION: We plan to study 30 patients with temporal lobe epilepsy (right-sided,
left-sided seizure foci) pre and post temporal lobectomy as well as 30 normal volunteers.
DESIGN: The study will be done in two parts both consisting of identical tasks. For the
patient group part 1 will be performed prior to temporal lobectomy and part 2, 6-12 months
after temporal lobectomy. For the normal volunteer group parts 1 and 2 will be performed at
time interval of 6-12 months.
During part 1 all study subjects will undergo neuropsychological evaluation. FMRI will be
performed with two tasks: animal and tool naming (to evaluate semantic processing) and
rating of emotionally pleasant or unpleasant pictures (to evaluate affective processing).
All subjects will also undergo diffusion tensor imaging (DTI) for the visualization of white
matter pathways.
During part 2 of the study all of the above tests will be repeated.
FMRI data will be analyzed within the framework of the general linear model in a program
such as AFNI 2.5. Statistical comparisons between activation patterns in scans acquired
during part 1 and part 2 within either group (intragroup comparison) will be done by voxel
wise paired t-test. In a second analysis all 4 groups will be compared in a mixed model. The
DTI data will be correlated with the neuropsychological outcome to asses the contribution of
white matter abnormalities pre-operatively or severance of white matter pathways
post-operative on neuropsychological functioning.
OUTCOME PARAMETERS: Outcome parameters are changes in the fMRI activation pattern post
temporal lobectomy and disruption of anisotropy on the diffusion tensor images.
- INCLUSION CRITERIA:
Patient Group:
Temporal lobe epilepsy (right-sided, left-sided foci) with or without lesion on a
structural MRI scan.
Native English speaker.
Age 18 years or older.
Signed informed consent.
Volunteer Group:
Native English speaker.
Age 18 years or older.
Signed informed consent.
EXCLUSION CRITERIA:
Patient Group:
Medical or technical contraindications to MRI procedures (e.g. no braces, pacemakers,
cochlear devices, surgical clips, etc;
History of mental retardation;
Pregnancy;
Claustrophobia;
Inability to comply with the protocol.
Volunteer Group:
Medical or technical contraindications to MRI procedures (e.g. no braces, pacemakers,
cochlear devices, surgical clips, etc.);
History of neurologic or psychiatric disease or a learning or attention disorder or mental
retardation.
Pregnancy.
Claustrophobia.
Inability to comply with the protocol.
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
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