Language Mapping in Patients With Epilepsy
Condition: Epilepsy; Epilepsy, Temporal Lobe; Partial Epilepsy
MeSH terms: Epilepsy; Epilepsies, Partial; Epilepsy, Temporal Lobe
Study type: Observational

Summary: 
      This study will examine how certain language skills, such as naming objects, understanding
      spoken language and reading are organized in the brain and how they are affected by seizures.

      People with epilepsy who are considering surgery and healthy volunteers who are right-handed
      and between the ages of 7 and 55 may be eligible for this study. Participants undergo the
      following procedures twice, and, in some cases, possibly three times, in two or three visits
      of 2 to 4 hours each.

      Neuropsychological tests: Testing includes questionnaires, pen-and-pencil or computerized
      tests and motor tasks.

      Structural MRI: This procedure uses a strong magnetic field and radio waves to obtain
      pictures of brain structure. During the test, the subject lies in the scanner (a metal
      cylinder surrounded by a magnetic field) for about 90 minutes, wearing earmuffs to muffle
      knocking noises the machine makes. Subjects may be asked to lie still for up to 10 minutes at
      a time.

      Functional MRI: This procedure is similar to structural MRI, except a coil is placed over the
      head and the subject performs simple tasks during the procedure. The pictures obtained show
      what parts of the brain are being used to perform the task. The test lasts about 60 minutes,
      with subjects asked to lie still for up to 10 minutes at a time.

      Magnetoencephalography (MEG) and electroencephalography (EEG): For MEG, the subject sits in
      an MEG recording room with a cone containing magnetic field detectors lowered onto his or her
      head. Very small magnetic changes produced by the activity of the brain are recorded while
      the subject sits quietly or performs a research task. An EEG recording of the electrical
      activity of the brain is done at the same time as the MEG.

      ...
    

Detailed description: 
      Objective: This protocol will test the hypothesis that successful left hemisphere epilepsy
      surgery for children and adults improves abnormalities in the functional anatomy of language
      that may be associated with uncontrolled localization-related seizures. We will use an
      established modality, functional magnetic resonance imaging (fMRI), which has been used
      extensively for evaluation of patients with epilepsy, as our primary outcome measure, and an
      emerging modality, magnetoencephalography (MEG), as a secondary measure. We will explore
      methods of MEG data analysis for comparison with fMRI results.

      Study Population:

      150 patients with localization-related epilepsy who are surgical candidates and 50 healthy
      volunteers.

      Design: This is a non-invasive imaging study that will employ a test battery including
      standard neuropsychological tests, structural MRI, fMRI, and a 275-channel whole-head MEG
      recording, for evaluation of the functional anatomy of language. The test battery will be
      performed pre-operatively and at 12 months after surgery.

      Main outcome measure: Measurement of the "laterality index" comparing left and right
      hemisphere regional activation on fMRI before and after surgery, in patients after left sided
      or right-sided surgery, and healthy controls.

      Secondary outcome measure: Measurement of the "laterality index" comparing left and right
      hemisphere regional activation on MEG before and after surgery.
    

Time perspective: Prospective
Keywords: Epilepsy; Language; fMRI; Magnetoencephalogram; Temporal Lobe Epilepsy; Partial Epilepsy; Healthy Volunteer; HV