Authors :
Presenting Author: Madeline Klipfel, BS – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Myriam Abdennadher, MD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
William Theodore, MD – National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
Ning Hua, PhD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Lena Václavů, PhD – Leiden University Medical Center, Leiden, The Netherlands
Meher Juttukonda, PhD – Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Bruce Rosen, MD, PhD – Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Sara Inati, PhD – National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
Lee Goldstein, MD, PhD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Matthias van Osch, PhD – Leiden University Medical Center, Leiden, The Netherlands
Osamu Sakai, MD PhD – MGB, Harvard University, Boston, MA USA
Chad Farris, MD PhD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Abrar Al-Faraj, MD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Maria Stefanidou, MD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Klesta Cocoli, MD – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Leylanis Barbot, BS Candidate – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Joseph Sisto, MPH – Boston Medical Center, BU Chobanian and Avedisian school of Medicine, Boston, MA USA
Rationale:
Non-invasive brain imaging plays a crucial role in the evaluation of patients with epilepsy, particularly in identifying seizure foci. Arterial Spin Labeling (ASL) MRI is a method that quantifies cerebral blood flow (CBF) without radioactive agents. Our recent work has revealed the co-existence of both hypo- and hyperperfusion areas in epilepsy. In this study, we explore whether baseline interictal epileptiform activity is associated with directional CBF alterations and assess whether baseline CBF can predict long-term seizure frequency. Methods:
This study included 13 patients (mean age = 42 years, SD = 11; 38% women) with drug-resistant epilepsy (10 temporal lobe epilepsy, 3 temporal plus), who underwent single post-labeling delay (PLD) ASL MRI and continuous video EEG as part of surgical evaluation. Imaging was processed on AFNI. Spike frequency was measured using Persyst software and validated by an expert epileptologist. Participants were categorized into rare/no spikes and abundant/moderate spikes groups for comparison using the Mann-Whitney test. Pearson correlation (α = 0.05) was used to correlate spike frequency and temporal lobe CBF.
We incorporated data from a related study of 26 epilepsy patients (mean age = 41 years, SD = 10; 52% women), including 22 with temporal lobe epilepsy, 9 with controlled epilepsy, and 17 with uncontrolled epilepsy, who underwent multi-PLD ASL MRI and were followed longitudinally. CBF was quantified using custom MATLAB code and analyzed with FreeSurfer, with values normalized to each subject’s cortical grey matter. To investigate whether baseline CBF predicts seizure control, seizure frequency was recorded at a 12-18-month follow-up. Pearson correlation (α = 0.05) was used to correlate CBF with long-term seizure frequency.Results:
Nearly all participants in the surgical cohort (12 of 13) exhibited hypoperfusion in the ipsilateral temporal lobe, reflected by negative z-scores in seizure foci relative to cortex. To explore the relationship between interictal epileptiform activity and CBF, we analyzed EEG and ASL data in 7 subjects to date. We observed a significant positive correlation between spike frequency and temporal lobe CBF (r = 0.822, p = 0.023), with higher spike rates associated with higher CBF.
To evaluate whether baseline CBF predicts long-term seizure outcomes, we examined 26 subjects, including 9 with controlled and 17 with uncontrolled epilepsy. Participants with increased seizure frequency at follow-up had significantly lower cortical grey matter CBF (p< 0.05) compared to those who were stable or improved.