Zeitschrift für Epileptologie

, Volume 25, Issue 3, pp 188–193

Funktionelle Magnetresonanztomographie von Gedächtnisfunktionen

Bedeutung in der Epilepsiediagnostik
Leitthema
  • 107 Downloads

Zusammenfassung

Patienten mit chronischer Epilepsie zeigen häufig Beeinträchtigungen kognitiver Funktionen. Gedächtnisstörungen treten insbesondere bei Patienten mit Temporallappenepilepsie (TLE) auf. Nicht alle TLE-Patienten profitieren ausreichend von einer medikamentösen Behandlung. Bei unilateraler TLE kann durch einen epilepsiechirurgischen Eingriff in 60–70% der Fälle Anfallsfreiheit erreicht werden. Ziel dabei ist es, das Hirngewebe, von dem Anfälle ausgehen, komplett zu entfernen, ohne Gedächtnisstörungen zu verursachen oder zu verstärken. Dazu müssen in der prächirurgischen Diagnostik funktionstragende Areale („eloquenter Kortex“) möglichst genau lokalisiert werden. Die funktionelle Magnetresonanztomographie (fMRT) wird zunehmend zu Lateralisation und Lokalisation von Gedächtnisfunktionen eingesetzt, um das individuelle Risiko für postoperative Defizite zu bestimmen. Die Gedächtnis-fMRT hat bereits einen gewissen prädiktiven Wert gezeigt und hat, insbesondere in Kombination mit anderen strukturellen und funktionellen bildgebenden Verfahren, das Potenzial, die Vorhersage des kognitiven Risikos eines epilepsiechirurgischen Eingriffs zu verbessern.

Schlüsselwörter

Episodisches Gedächtnis Arbeitsgedächtnis Lateralisation Lokalisation Epilepsiechirurgie 

Abkürzungsverzeichnis

ATLR

anteriore Temporallappenresektion

BOLD

„blood oxygen level dependent“

EPI

„echo planar imaging“

fMRT

funktionelle Magnetresonanztomographie

MTL

mesialer Temporallappen

TLE

Temporallappenepilepsie

Functional magnetic resonance imaging of memory functions

Importance in the diagnostics of epilepsy patients

Abstract

Chronic epilepsy is frequently accompanied by cognitive deficits. Temporal lobe epilepsy (TLE) as well as resection surgery on the temporal lobe may affect cognitive function, in particular verbal and visual memory but also working memory. Epilepsy arising from the brain’s temporal lobe can be controlled surgically in up to 70% of patients. The goals of epilepsy surgery are to remove the brain areas generating the seizures without causing or aggravating memory dysfunction. This requires accurate localization of areas responsible for memory function (eloquent cortex). Functional magnetic resonance imaging (fMRI) is increasingly being used to lateralize and localize brain areas involved in memory processes and shows promise for predicting the effects of temporal lobe resection on memory function, especially when combined with other structural as well as functional imaging methods.

Keywords

Episodic memory Working memory Lateralization Localization Epilepsy surgery 

Literatur

  1. 1.
    Axmacher N, Mormann F, Fernandez G et al (2007) Sustained neural activity patterns during working memory in the human medial temporal lobe. J Neurosci 27:7807–7816PubMedCrossRefGoogle Scholar
  2. 2.
    Tisi J de, Bell GS, Peacock JL et al (2011) The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet 378:1388–1395PubMedCrossRefGoogle Scholar
  3. 3.
    Hermann BP, Seidenberg M, Haltiner A, Wyler AR (1995) Relationship of age at onset, chronologic age, and adequacy of preoperative performance to verbal memory change after anterior temporal lobectomy. Epilepsia 36:137–145PubMedCrossRefGoogle Scholar
  4. 4.
    Sabsevitz DS, Swanson SJ, Morris GL et al (2001) Memory outcome after left anterior temporal lobectomy in patients with expected and reversed Wada memory asymmetry scores. Epilepsia 42:1408–1415PubMedCrossRefGoogle Scholar
  5. 5.
    Helmstaedter C, Elger CE (1996) Cognitive consequences of two-thirds anterior temporal lobectomy on verbal memory in 144 patients: a three-month follow-up study. Epilepsia 37:171–180PubMedCrossRefGoogle Scholar
  6. 6.
    Haag A, Knake S, Hamer HM et al (2008) The Wada test in Austrian, Dutch, German, and Swiss epilepsy centers from 2000 to 2005: a review of 1421 procedures. Epilepsy Behav 13:83–89PubMedCrossRefGoogle Scholar
  7. 7.
    Fernandez G, Effern A, Grunwald T et al (1999) Real-time tracking of memory formation in the human rhinal cortex and hippocampus. Science 285:1582–1585PubMedCrossRefGoogle Scholar
  8. 8.
    Ojemann JG, Akbudak E, Snyder AZ et al (1997) Anatomic localization and quantitative analysis of gradient refocused echo-planar fMRI susceptibility artifacts. Neuroimage 6:156–167PubMedCrossRefGoogle Scholar
  9. 9.
    Greicius MD, Krasnow B, Boyett-Anderson JM et al (2003) Regional analysis of hippocampal activation during memory encoding and retrieval: fMRI study. Hippocampus 13:164–174PubMedCrossRefGoogle Scholar
  10. 10.
    Lipschutz B, Friston KJ, Ashburner J et al (2001) Assessing study-specific regional variations in fMRI signal. Neuroimage 13:392–398PubMedCrossRefGoogle Scholar
  11. 11.
    Powell HW, Koepp MJ, Symms MR et al (2005) Material-specific lateralization of memory encoding in the medial temporal lobe: blocked versus event-related design. Neuroimage 27:231–239PubMedCrossRefGoogle Scholar
  12. 12.
    Ivnik RJ, Sharbrough FW, Laws ER Jr (1987) Effects of anterior temporal lobectomy on cognitive function. J Clin Psychol 43:128–137PubMedCrossRefGoogle Scholar
  13. 13.
    Spiers HJ, Burgess N, Maguire EA et al (2001) Unilateral temporal lobectomy patients show lateralized topographical and episodic memory deficits in a virtual town. Brain 124:2476–2489PubMedCrossRefGoogle Scholar
  14. 14.
    Squire LR, Zola-Morgan S (1991) The medial temporal lobe memory system. Science 253:1380–1386PubMedCrossRefGoogle Scholar
  15. 15.
    Golby AJ, Poldrack RA, Brewer JB et al (2001) Material-specific lateralization in the medial temporal lobe and prefrontal cortex during memory encoding. Brain 124:1841–1854PubMedCrossRefGoogle Scholar
  16. 16.
    Detre JA, Maccotta L, King D et al (1998) Functional MRI lateralization of memory in temporal lobe epilepsy. Neurology 50:926–932PubMedCrossRefGoogle Scholar
  17. 17.
    Bonelli SB, Powell RH, Yogarajah M et al (2010) Imaging memory in temporal lobe epilepsy: predicting the effects of temporal lobe resection. Brain 133:1186–1199PubMedCrossRefGoogle Scholar
  18. 18.
    Jokeit H, Okujava M, Woermann FG (2001) Memory fMRI lateralizes temporal lobe epilepsy. Neurology 57:1786–1793PubMedCrossRefGoogle Scholar
  19. 19.
    Powell HW, Richardson MP, Symms MR et al (2007) Reorganization of verbal and nonverbal memory in temporal lobe epilepsy due to unilateral hippocampal sclerosis. Epilepsia 48:1512–1525PubMedCrossRefGoogle Scholar
  20. 20.
    Janszky J, Jokeit H, Kontopoulou K et al (2005) Functional MRI predicts memory performance after right mesiotemporal epilepsy surgery. Epilepsia 46:244–250PubMedCrossRefGoogle Scholar
  21. 21.
    Richardson MP, Strange BA, Duncan JS, Dolan RJ (2003) Preserved verbal memory function in left medial temporal pathology involves reorganisation of function to right medial temporal lobe. Neuroimage 20(Suppl 1):112–119CrossRefGoogle Scholar
  22. 22.
    Vannest J, Szaflarski JP, Privitera MD et al (2008) Medial temporal fMRI activation reflects memory lateralization and memory performance in patients with epilepsy. Epilepsy Behav 12:410–418PubMedCrossRefGoogle Scholar
  23. 23.
    Jokeit H, Ebner A, Holthausen H et al (1997) Individual prediction of change in delayed recall of prose passages after left-sided anterior temporal lobectomy. Neurology 49:481–487PubMedCrossRefGoogle Scholar
  24. 24.
    Wiebe S, Blume WT, Girvin JP, Eliasziw M (2001) A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:311–318PubMedCrossRefGoogle Scholar
  25. 25.
    Frings L, Wagner K, Halsband U et al (2008) Lateralization of hippocampal activation differs between left and right temporal lobe epilepsy patients and correlates with postsurgical verbal learning decrement. Epilepsy Res 78:161–170PubMedCrossRefGoogle Scholar
  26. 26.
    Loring DW, Meador KJ, Lee GP et al (1995) Wada memory asymmetries predict verbal memory decline after anterior temporal lobectomy. Neurology 45:1329–1333PubMedCrossRefGoogle Scholar
  27. 27.
    Lee TM, Yip JT, Jones-Gotman M (2002) Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review. Epilepsia 43:283–291PubMedCrossRefGoogle Scholar
  28. 28.
    Chelune GJ (1995) Hippocampal adequacy versus functional reserve: predicting memory functions following temporal lobectomy. Arch Clin Neuropsychol 10:413–432PubMedGoogle Scholar
  29. 29.
    Trenerry MR, Jack CR Jr, Ivnik RJ et al (1993) MRI hippocampal volumes and memory function before and after temporal lobectomy. Neurology 43:1800–1805PubMedCrossRefGoogle Scholar
  30. 30.
    Baxendale S, Thompson P, Harkness W, Duncan J (2006) Predicting memory decline following epilepsy surgery: a multivariate approach. Epilepsia 47:1887–1894PubMedCrossRefGoogle Scholar
  31. 31.
    Baxendale S (2002) The role of functional MRI in the presurgical investigation of temporal lobe epilepsy patients: a clinical perspective and review. J Clin Exp Neuropsychol 24:664–676PubMedCrossRefGoogle Scholar
  32. 32.
    Binder JR, Sabsevitz DS, Swanson SJ et al (2008) Use of preoperative functional MRI to predict verbal memory decline after temporal lobe epilepsy surgery. Epilepsia 49:1377–1394PubMedCrossRefGoogle Scholar
  33. 33.
    Dupont S, Duron E, Samson S et al (2010) Functional MR imaging or Wada test: which is the better predictor of individual postoperative memory outcome? Radiology 255:128–134PubMedCrossRefGoogle Scholar
  34. 34.
    Rabin ML, Narayan VM, Kimberg DY et al (2004) Functional MRI predicts post-surgical memory following temporal lobectomy. Brain 127:2286–2298PubMedCrossRefGoogle Scholar
  35. 35.
    Baxendale S, Thompson PJ, Duncan JS (2008) Improvements in memory function following anterior temporal lobe resection for epilepsy. Neurology 71:1319–1325PubMedCrossRefGoogle Scholar
  36. 36.
    Richardson MP, Strange BA, Duncan JS, Dolan RJ (2006) Memory fMRI in left hippocampal sclerosis: optimizing the approach to predicting postsurgical memory. Neurology 66:699–705PubMedCrossRefGoogle Scholar
  37. 37.
    Richardson MP, Strange BA, Thompson PJ et al (2004) Pre-operative verbal memory fMRI predicts post-operative memory decline after left temporal lobe resection. Brain 127:2419–2426PubMedCrossRefGoogle Scholar
  38. 38.
    Powell HW, Richardson MP, Symms MR et al (2008) Preoperative fMRI predicts memory decline following anterior temporal lobe resection. J Neurol Neurosurg Psychiatry 79:686–693PubMedCrossRefGoogle Scholar
  39. 39.
    Binder JR, Swanson SJ, Sabsevitz DS et al (2010) A comparison of two fMRI methods for predicting verbal memory decline after left temporal lobectomy: language lateralization versus hippocampal activation asymmetry. Epilepsia 51:618–626PubMedCrossRefGoogle Scholar
  40. 40.
    Voets NL, Adcock JE, Stacey R et al (2009) Functional and structural changes in the memory network associated with left temporal lobe epilepsy. Hum Brain Mapp 30:4070–4081PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2012

Authors and Affiliations

  • S.B. Bonelli
    • 1
    • 2
    • 3
  • A. Haag
    • 2
    • 3
  • F.G. Woermann
    • 4
  • M.J. Koepp
    • 2
    • 3
  1. 1.Universitätsklinik für NeurologieMedizinische Universität WienWienÖsterreich
  2. 2.Department of Clinical and Experimental Epilepsy, UCL Institute of NeurologyNational Hospital for Neurology and NeurosurgeryLondonVereinigtes Königreich
  3. 3.Epilepsy SocietyChalfont St. PeterVereinigtes Königreich
  4. 4.Epilepsiezentrum BethelKrankenhaus MaraBielefeldDeutschland

Personalised recommendations