Epilepsy

Epilepsy adversely affects almost 3 million people in the United States. 15%-30% of these individuals do not respond to medication and may be candidates for surgical intervention. Due to excellent soft tissue contrast and high-resolution visualization of brain anatomy, magnetic resonance imaging (MRI) plays a vital role in the preoperative localization and characterization of brain abnormalities for patients undergoing epilepsy surgery. Ultrahigh field MRI has great potential to unearth subtle abnormalities in vivo that are undetectable at lower fields. At Mount Sinai, we have available to us a state-of-the-art research-dedicated 7 Tesla (7T) human MRI scanner to design and validate new imaging techniques and apply them to study disease. 7T MR is a powerful noninvasive tool to 1) increase conspicuity of epileptogenic abnormalities resulting in improved detection efficiency and reduced use of invasive electrophysiological evaluation and 2) provide more accurate delineation of lesion boundaries aiding in neurosurgical planning and leading to better patient outcomes. Unfortunately, multiple technical issues associated with high field operation, including inhomogeneity of the main magnetic and applied radiofrequency (RF) fields, result in artifacts for imaging and spectroscopy, limiting the utility of current high-field scanners. Our lab is designing innovative RF pulses and pulse sequences to overcome these limitations in order to fully utilize the signal-to-noise ratio and novel contrast mechanisms offered by high-field MR magnets for imaging and spectroscopy of epilepsy. These tools will be combined to compose a comprehensive 7T epilepsy imaging protocol. We are collaborating with neurologists Drs. Madeline Fields and Lara Marcuse to evaluate this protocol in a pilot study of epilepsy patients who are candidates for surgical intervention.