Novel DWI Methods to Minimize Postoperative Deficits in Pediatric Epilepsy Surgery
Wayne State University
Summary
This project will test the accuracy of a novel diffusion-weighted magnetic resonance imaging (DWMRI) approach using a deep convolutional neural network (DCNN) to predict an optimal resection margin for pediatric epilepsy surgery objectively. Its primary goal is to minimize surgical risk probability (i.e., functional deficit) and maximize surgical benefit probability (i.e., seizure freedom) by precisely localizing eloquent white matter pathways in children and adolescents with drug-resistant focal epilepsy. This new imaging approach, which will acquire a DWMRI scan before pediatric epilepsy surgery in about 10 minutes without contrast administration (and also without sedation even in young children), can be readily applied to improve preoperative benefit-risk evaluation for pediatric epilepsy surgery in the future. The investigators will also study how the advanced DWMRI-DCNN connectome approach can detect complex signs of brain neuronal reorganization that help improve neurological and cognitive outcomes following pediatric epilepsy surgery. This new imaging approach could benefit targeted interventions in the future to minimize neurocognitive deficits in affected children. All enrolled subjects will undergo advanced brain MRI and neurocognitive evaluation to achieve these goals. The findings of this project will not guide any clinical decision-making or clinical intervention until the studied approach is thoroughly validated.
Description
This project will combine advanced brain MRI with detailed neuro-psychology evaluation, performed in children and adolescents affected by drug-resistant focal epilepsy, to address two main aims, each of them with the following research hypotheses: AIM 1. To determine the accuracy of deep learning tractography-based benefit-risk analysis compared to a standard electrical stimulation mapping (ESM) which is the current clinical standard for detecting eloquent cortical regions before epilepsy surgery. Hypothesis 1.1 In healthy controls, DCNN-based tract classification will localize eloquent cort…
Eligibility
- Age range
- 3–19 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: 1. Subjects with drug-resistant focal epilepsy 1\. Age 3-19 years. 2. Planned two-stage epilepsy surgery with subdural electrodes. 2. Healthy control subjects 1. Age 5-19 years. 2. No cognitive, motor, and/or language impairment or clinical elevations on a measure of behavioral problems. 3. Brain MRI interpreted as normal. Exclusion Criteria: For all subjects: 1\. History of prematurity or perinatal hypoxic-ischemic event. 2. Hemiplegia on preoperative neurological examination by pediatric neurologists. 3. Dysmorphic features suggestive of a clinical syndrome. 4. Di…
Interventions
- Diagnostic TestBrain magnetic resonance imaging
Brain magnetic resonance imaging (MRI) will be done using multiple sequences to evaluate the presence, type, and severity of brain abnormalities in enrolled subjects.
- BehavioralNeuro-psychology testing
Participants will undergo age-appropriate neuro-psychology testing to assess motor, language, and other neurocognitive functions potentially affected by drug-resistant epilepsy.
Location
- Wayne State University/Children's Hospital of MichiganDetroit, Michigan