Epilepsy is a broad syndrome that results in societal, economic and medical burdens. Identification and development of MRI based biomarkers that are predictive of epileptogenesis are urgently needed. We describe the development of one such biomarker for febrile seizures. Once definitive biomarker imaging approaches have been validated, therapeutic interventions can then be investigated.
Highlights
• Review current imaging biomarkers of epilepsy
• T2WI is a predicative biomarker for epileptogenesis in febrile seizures
• Personalized predicators for epilepsy for improved clinical intervention
OBJECTIVES
The participants will have an enhanced knowledge of: 1) current imaging modalities for epilepsy, 2) describe a novel imaging signal that is predicative in febrile seizures, and 3) discuss potential personalized predictors for epileptogenesis/seizures.PURPOSE
Epilepsy is a broad syndrome that impacts all ages from a variety of causes. Neuroimaging is often utilized to assist in the definitive diagnosis of epilepsy and is particularly relevant in pharmacologically resistant phenotypes. Existing and emerging MRI, CT, PET and magnetoencephalography (MEG) imaging approaches provide unique and complementary diagnostic information about epilepsy [1,2]. In addition, we will highlight a novel imaging biomarker for febrile seizures that is predicative of future epileptogenesis.METHODS
We will describe current state of art in epilepsy neuroimaging, both from a diagnostic and research perspective. The focus will be predominately MRI but will also touch on other imaging modalities (CT, PET MEG). Our own research has utilized T2 and T2* at early time points following febrile seizures for identification of a predicative marker for future epileptogenesis. [3,4,5]. In addition, we also examined the temporal evolution of this T2/T2* signal.RESULTS
There exist relatively few imaging biomarkers that are predictive of epileptogenesis. We report that in febrile seizures, we have found a T2/T2* biomarker that in a neonatal rodent model is able to robustly predict which neonate will go on to develop long term epilepsy. Similarly, in the literature there a number of novel MR imaging approaches that can identify epilepsy induced alterations in brain structure and function.DISCUSSION
Identification of neuroimaging biomarkers that are predictive of epileptogenesis are urgently needed, particularly for febrile seizures. Once the appropriate imaging biomarkers have validated, the efficacy of putative therapeutic interventions can be undertaken. Such advances would do much to alleviate the societal, economic and medical costs associated in epilepsy.CONCLUSION
Advancements in neuroimaging of epilepsy will assist the clinician in enhancing diagnosis and allow researchers to probe the cellular and molecular causes underlying this disease.[1] Vattoth S, Manzil FF, Singhal A, Riley KO, Bag AK. (2014) State of the art epilepsy imaging: an update. Clin Nucl Med. 2014 Jun;39(6):511-23
[2] Obenaus A. (2013) Neuroimaging biomarkers for epilepsy: advances and relevance to glial cells. Neurochem Int. 2013 Dec;63(7):712-8.
[3] Choy M, Dubé CM, Patterson K, Barnes SR, Maras P, Blood AB, Hasso AN, Obenaus A, Baram TZ. (2014) A novel, noninvasive, predictive epilepsy biomarker with clinical potential. J Neurosci. 2014 Jun 25;34(26):8672-84.
[4] Patterson KP, Brennan GP, Curran M, Kinney-Lang E, Dubé C, Rashid F, Ly C, Obenaus A, Baram TZ. (2015) Rapid, Coordinate Inflammatory Responses after Experimental Febrile Status Epilepticus: Implications for Epileptogenesis. eNeuro. 2015 Nov 9;2(5). pii: ENEURO.0034-15.2015.
[5] Barry JM, Choy M, Dube C, Robbins A, Obenaus A, Lenck-Santini PP, Scott RC, Baram TZ, Holmes GL. (2015) T2 relaxation time post febrile status epilepticus predicts cognitive outcome. Exp Neurol. 2015 Jul;269:242-52.