Abstract
This paper presents a theoretical elaboration aimed to explain the correlation found between a new rs-fMRI modality and electrophysiology and nuclear medicine neuroimaging, performed to localize epileptogenic brain areas. We present in detail the clinical history, and electrophysiological and neuroimaging results of one child with intractable epilepsy, who was submitted for Phase-1 work-up as candidate for epilepsy surgery. The patient underwent a thorough workup including video-telemetry, ictal and interictal nuclear medicine imaging, resting-state fMRI, EEG-fMRI, intracranial electroencephalography (ECoG), deep electrode implantation, and resective surgery. Electrophysiology and neuroimaging findings were concordant with findings provided by the resting-state mean signal. The patient became seizure-free after the resection of the target area. A theoretical discussion is provided that considers the presence of a stable BOLD effect explaining the findings of the observed resting-state mean signal. This stable BOLD is linked to low regional metabolism usually present in the epileptogenic area during interictal periods, coupled with low oxygen extraction. Low oxygen extraction leaves more oxygen for the draining venule and consequently increases the BOLD signal.
Highlights
This paper presents a theoretical elaboration aimed to explain the correlation found between a new rs-fMRI modality and electrophysiology and nuclear medicine neuroimaging, performed to localize epileptogenic brain areas
We present in detail the clinical history, and electrophysiological and neuroimaging results of one child with intractable epilepsy, who was submitted for Phase-1 work-up as candidate for epilepsy surgery
We have showed that patients with epilepsy have resting-state “mean” images that differ from normal subjects [11]
Summary
Ogawa and co-workers in 1992 [1] This physiological response of the brain tissue to external and endogenous stimuli has been the foundation for the MRI-based functional neuroimaging, which has led to the most fruitful period in modern neuroscience. The discovery and posterior development of BOLD-sensitive sequences in MRI signified the advent of functional MRI, functional connectivity, regional homogeneity, and more recently, the discovery of the spontaneous brain fluctuations and the resting state networks. All of these functional assessment techniques are non-invasive as they do not require administration of contrast or radioactive agent
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