Neuroimaging has advanced the knowledge of genetic generalised epilepsy via the improvement of methods and technology. The current understanding is that patients with GGE are characterised by abnormalities in the cortical-thalamic network, functionally and also structurally; and in the default mode network, mainly functionally. However, most studies have been performed on treated patients often with poor seizure control. This leaves uncertainty regarding the status of the brain at the onset of the disease and mechanisms that lead to positive and negative treatment outcome. Also, the systematic measurements of epileptic activity during resting fMRI has left questions about the interaction between cognitive status and the brain networks that have been identified as associated with generalised spike waves (GSW). In this thesis I focused on three rarely and/or uniquely explored issues in the field of neuroimaging in GGE to reach a more comprehensive understanding of GGE. First, I undertook a study of brain structure and function free from any effects of anti-epileptic medication. In drug naïve patients, I measured grey matter volume and shape and fMRI BOLD changes related to GSW onset and prior to GSW. I showed that previous findings can be interpreted and confirmed without the potential influence of AEDs. Secondly, I applied a prospective approach via longitudinally following patients from pre-treatment to post-treatment stages to explore treatment response and to identify markers of treatment outcome. I compared grey matter volume and shape between drug naïve pre-treatment patients with good and bad outcomes. I identified a trend of decreased grey matter volume in patients with bad outcome suggesting the existence of differences at baseline between patients with different treatment response. I compared cerebral blood flow (CBF) longitudinally and found a trend of decreased CBF post-treatment. This suggests that BOLD changes post-treatment may be related to CBF differences. Thirdly, I explored the relationship between brain networks associated with GSW and the brain state via measuring BOLD changes associated with GSW recorded during periods of rest and while watching a cartoon. Evidence of different BOLD maps during rest and cartoon is reported suggesting the need to consider initial brain state in defining the GSW related BOLD response. Methodological constraints, clinical applications and future perspectives are discussed.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:724275 |
| Date | January 2016 |
| Creators | Perani, Suejen |
| Contributors | Richardson, Mark Philip |
| Publisher | King's College London (University of London) |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://kclpure.kcl.ac.uk/portal/en/theses/multimodal-neuroimaging-in-drug-naive-genetic-generalised-epilepsy-patients(220dd4d7-a6f3-455f-9b8b-2f3d97deca5d).html |
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