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Klinischer Einsatz der funktionellen MRT bei chronischer Epilepsie

Clinical application of functional MRI for chronic epilepsy

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Zusammenfassung

Die funktionelle Magnetresonanztomographie (fMRT) wird im Rahmen der Epilepsiediagnostik vor epilepsiechirurgischen Eingriffen insbesondere zur Lateralisation von Sprache und Gedächtnis und zur Lokalisation der Zentralregion eingesetzt, um den eloquenten Kortex von der epilepsieverursachenden, chirurgisch zugänglichen Läsion abzugrenzen. Dabei ist die fMRT Teil einer Sequenz nichtinvasiver klinischer Tests (Anamnese, Anfall-Semiologie, neurologischer Status, interiktales und iktales EEG, strukturelles MRT, Video-EEG-Monitoring, Neuropsychologie). Das Ergebnis dieser Sequenz ist die Entscheidung für oder gegen einen elektiven epilepsiechirurgischen Eingriff bzw. für oder gegen weitere invasive Diagnostik (Wada-Test, intra- oder extraoperative kortikale Stimulation). Komplikationen epilepsiechirurgischer Eingriffe, z. B. Minderungen des Gedächtnisses oder der Benennleistung nach Temporallappenresektion bzw. aphasische Störungen und Paresen nach Frontallappenresektion, sind selten und selten von katastrophalem Ausmaß, was eine Standortbestimmung für das klinische fMRT erschwert. In diesem Artikel werden daher Studien vorgestellt, die die Übereinstimmung zwischen fMRT und anderen „Goldstandards“ oder postoperativer Morbidität untersucht haben.

Abstract

Functional magnetic resonance imaging (fMRI) is frequently used in the presurgical diagnostic procedure of epilepsy patients, in particular for lateralization of speech and memory and for localization of the primary motor cortex to delineate the epileptogenic lesion from eloquent brain areas. fMRI is one of the non-invasive procedures in the presurgical diagnostic process, together with medical history, seizure semiology, neurological examination, interictal and ictal EEG, structural MRI, video EEG monitoring and neuropsychology. This diagnostic sequence leads either to the decision for or against elective epilepsy surgery or to the decision to proceed with invasive diagnostic techniques (Wada test, intra-operative or extra-operative cortical stimulation). It is difficult to evaluate the contribution of the fMRI test in isolation to the validity of the entire diagnostic sequence. Complications such as memory loss and aphasia in temporal lobe resections or paresis after frontal lobe resections are rare and rarely of disastrous extent. This further complicates the evaluation of the clinical relevance of fMRI as a predictive tool. In this article studies which investigated the concordance between fMRI and other diagnostic gold standards will be presented as well as the association between presurgical fMRI and postsurgical morbidity.

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  1. Abteilung für Magentresonanztomographie, Krankenhaus Mara, Epilepsiezentrum Bethel, Maraweg 21, 33517, Bielefeld, Deutschland

    F.G. Woermann & K. Labudda

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  1. F.G. Woermann
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  2. K. Labudda
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Correspondence to F.G. Woermann.

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Woermann, F., Labudda, K. Klinischer Einsatz der funktionellen MRT bei chronischer Epilepsie. Radiologe 50, 123–130 (2010). https://doi.org/10.1007/s00117-009-1894-z

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