Dealing with patients…

jenny crinionadam liston

Dealing with patient’s data

jenny crinionadam liston

• SPM2 in Chalfont• SPM2 in Queens Square

Overview

• SPM2 in Chalfont

• SPM2 in Queens Square

Overview

EpilepsyEpilepsy• Pre-surgicalPre-surgical – fMRI: – fMRI: avoid? (null hypothesis) / predictavoid? (null hypothesis) / predict• LesionsLesions – – advanced MRI techniques and VBMadvanced MRI techniques and VBM• PsychosisPsychosis – – TLE with and without psychosisTLE with and without psychosis• EEG-fMRIEEG-fMRI – – focal and generalised epilepsyfocal and generalised epilepsy

Stroke Stroke • Cross-sectional / longitudinalCross-sectional / longitudinal fMRI, DTI, fMRI, DTI,

TMS, VBMTMS, VBMDementiaDementia • VBM and treatment studies with fMRIVBM and treatment studies with fMRI

Overview

EpilepsyEpilepsy• Pre-surgicalPre-surgical – fMRI: – fMRI: avoid? (null hypothesis) / predictavoid? (null hypothesis) / predict• LesionsLesions – – advanced MRI techniques and VBMadvanced MRI techniques and VBM• PsychosisPsychosis – – TLE with and without psychosisTLE with and without psychosis• EEG-fMRIEEG-fMRI – – focal and generalised epilepsyfocal and generalised epilepsy

• SPM2 in Chalfont

• SPM2 in Queens Square

Anatomical - LesionsAdvanced MRI techniquesAdvanced MRI techniques• Voxel Based Morphometry (VBM) – SPM 99• Magnetisation Transfer (MTR), Fast Flair T2- (FFT2) and

Double Inversion Recovery (DIR) imaging to identify abnormalities unseen in normal T1-weighted

• 2nd level - template from 40 patients and 30 normals• Concordance with EEG focus??

a b c d

(a) Normalized axial T1-weighted, (b) MTR, (c) FFT2 maps (d) and DIR images.

Frontal lobe epilepsy and normal conventional MRI:

Anatomical - Temporal EpilepsyInterictal psychosis Interictal psychosis (not related to seizure / years after onset of epilepsy)(not related to seizure / years after onset of epilepsy)

• Optimised VBM – SPM99 study of schizophrenia (Good Neuroimage 2001)

• Led to study of interictal psychosis - MTR reductions specific tointerictal psychosis?

Brain (2001) 124, 882-892

• 75% fully controlled by medication• Some of remainder may be eligible for surgery• Cost? NULL hypothesis:

fMRI - Presurgical

Cognitive ExperimentsCognitive Experiments region is NOT active

Presurgical ExperimentsPresurgical Experiments region IS active

Temporal Lobe Epilepsy (TLE)Temporal Lobe Epilepsy (TLE) - resection of part of temporal lobe…

fMRI - Presurgical

Avoid eloquent cerebral areas:Avoid eloquent cerebral areas:

memoryword generation

verb generation reading

• SPM2 Analysis: patient-specific; block/event-related design• Lateralisation

fMRI - PresurgicalPredicted memory deficits:Predicted memory deficits:• Medial Temporal Lobe (MTL) structures• Lateralisation / localisation of memory function• 10 normals, 8 patients with left TLE and 9 patients with right TLE

7 blocks of 10 pictures (P), 10 words (W) +

10 faces (F)pleasant? / unpleasant?

Recognition tests of210 stimuli + 105 foils

recognise? (R) or new (N)

3 contrasts per subject(1) PR-minus-PN

(2) WR-minus-WN (3) FR–minus-FN

3 contrasts per subject(1) PR-minus-PN

(2) WR-minus-WN (3) FR–minus-FN

11stst level levelPictures rememberedPictures remembered

22ndnd level levelPictures remembered (controls)Pictures remembered (controls)

22ndnd level level2-way interaction: 2-way interaction: group (rTLE-lTLE) / memorygroup (rTLE-lTLE) / memory

EEG-fMRI - focal epilepsyProblemsProblems• Every case individual• Bad experimental design – low efficiency: 0 to 638 events• motion – jerks / scanner naivity• drugs – cured(!) / effect on haemodynamic response function (hrf)• effect of lesions on hrf

Motion

suspicious?

Scan nulling?

EEG-fMRI - generalised epilepsyProblemsProblems• Syndrome: Idiopathic Generalised Epilepsy (IGE); secondary generalised

“splitters” and “lumpers”• Runs of 3Hz “spike-and-wave”• Bad experimental design – low efficiency: 1 - 120 events

runs of 1 – 30 seconds (mean 2-3s)• motion – jerks / scanner naivity• drugs – cured(!) / effect on haemodynamic response function (hrf)• effect of lesions on hrf

IGE

SG

E

activation

deactivation60 events p<0.05 corrected

24 events p<0.05 corrected

57 events p<0.001 uncorrected

46 events p<0.05 corrected

2nd level?ProblemsProblems• unbalanced• valid grouping?