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Funktionelle Magnetresonanztomographie von Gedächtnisfunktionen

Bedeutung in der Epilepsiediagnostik

Functional magnetic resonance imaging of memory functions

Importance in the diagnostics of epilepsy patients

  • Leitthema
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Zeitschrift für Epileptologie Aims and scope Submit manuscript

Zusammenfassung

Patienten mit chronischer Epilepsie zeigen häufig Beeinträchtigungen kognitiver Funktionen. Gedächtnisstörungen treten insbesondere bei Patienten mit Temporallappenepilepsie (TLE) auf. Nicht alle TLE-Patienten profitieren ausreichend von einer medikamentösen Behandlung. Bei unilateraler TLE kann durch einen epilepsiechirurgischen Eingriff in 60–70% der Fälle Anfallsfreiheit erreicht werden. Ziel dabei ist es, das Hirngewebe, von dem Anfälle ausgehen, komplett zu entfernen, ohne Gedächtnisstörungen zu verursachen oder zu verstärken. Dazu müssen in der prächirurgischen Diagnostik funktionstragende Areale („eloquenter Kortex“) möglichst genau lokalisiert werden. Die funktionelle Magnetresonanztomographie (fMRT) wird zunehmend zu Lateralisation und Lokalisation von Gedächtnisfunktionen eingesetzt, um das individuelle Risiko für postoperative Defizite zu bestimmen. Die Gedächtnis-fMRT hat bereits einen gewissen prädiktiven Wert gezeigt und hat, insbesondere in Kombination mit anderen strukturellen und funktionellen bildgebenden Verfahren, das Potenzial, die Vorhersage des kognitiven Risikos eines epilepsiechirurgischen Eingriffs zu verbessern.

Abstract

Chronic epilepsy is frequently accompanied by cognitive deficits. Temporal lobe epilepsy (TLE) as well as resection surgery on the temporal lobe may affect cognitive function, in particular verbal and visual memory but also working memory. Epilepsy arising from the brain’s temporal lobe can be controlled surgically in up to 70% of patients. The goals of epilepsy surgery are to remove the brain areas generating the seizures without causing or aggravating memory dysfunction. This requires accurate localization of areas responsible for memory function (eloquent cortex). Functional magnetic resonance imaging (fMRI) is increasingly being used to lateralize and localize brain areas involved in memory processes and shows promise for predicting the effects of temporal lobe resection on memory function, especially when combined with other structural as well as functional imaging methods.

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Abb. 1

Abbreviations

ATLR:

anteriore Temporallappenresektion

BOLD:

„blood oxygen level dependent“

EPI:

„echo planar imaging“

fMRT:

funktionelle Magnetresonanztomographie

MTL:

mesialer Temporallappen

TLE:

Temporallappenepilepsie

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Authors and Affiliations

  1. Universitätsklinik für Neurologie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    S.B. Bonelli

  2. Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, Vereinigtes Königreich

    S.B. Bonelli, A. Haag & M.J. Koepp

  3. Epilepsy Society, Chalfont St. Peter, Vereinigtes Königreich

    S.B. Bonelli, A. Haag & M.J. Koepp

  4. Epilepsiezentrum Bethel, Krankenhaus Mara, Bielefeld, Deutschland

    F.G. Woermann

Authors
  1. S.B. Bonelli
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  2. A. Haag
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  3. F.G. Woermann
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  4. M.J. Koepp
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Correspondence to S.B. Bonelli.

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Bonelli, S., Haag, A., Woermann, F. et al. Funktionelle Magnetresonanztomographie von Gedächtnisfunktionen. Z. Epileptol. 25, 188–193 (2012). https://doi.org/10.1007/s10309-012-0258-2

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  • DOI: https://doi.org/10.1007/s10309-012-0258-2

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