Language Mapping in Patients With Epilepsy
Language Mapping in Patients With Epilepsy
This study will examine how certain language skills, such as naming objects, understanding
 spoken language and reading are organized in the brain and how they are affected by seizures.

 People with epilepsy who are considering surgery and healthy volunteers who are right-handed
 and between the ages of 7 and 55 may be eligible for this study. Participants undergo the
 following procedures twice, and, in some cases, possibly three times, in two or three visits
 of 2 to 4 hours each.

 Neuropsychological tests: Testing includes questionnaires, pen-and-pencil or computerized
 tests and motor tasks.

 Structural MRI: This procedure uses a strong magnetic field and radio waves to obtain
 pictures of brain structure. During the test, the subject lies in the scanner (a metal
 cylinder surrounded by a magnetic field) for about 90 minutes, wearing earmuffs to muffle
 knocking noises the machine makes. Subjects may be asked to lie still for up to 10 minutes at
 a time.

 Functional MRI: This procedure is similar to structural MRI, except a coil is placed over the
 head and the subject performs simple tasks during the procedure. The pictures obtained show
 what parts of the brain are being used to perform the task. The test lasts about 60 minutes,
 with subjects asked to lie still for up to 10 minutes at a time.

 Magnetoencephalography (MEG) and electroencephalography (EEG): For MEG, the subject sits in
 an MEG recording room with a cone containing magnetic field detectors lowered onto his or her
 head. Very small magnetic changes produced by the activity of the brain are recorded while
 the subject sits quietly or performs a research task. An EEG recording of the electrical
 activity of the brain is done at the same time as the MEG.

 ...
Objective: This protocol will test the hypothesis that successful left hemisphere epilepsy
 surgery for children and adults improves abnormalities in the functional anatomy of language
 that may be associated with uncontrolled localization-related seizures. We will use an
 established modality, functional magnetic resonance imaging (fMRI), which has been used
 extensively for evaluation of patients with epilepsy, as our primary outcome measure, and an
 emerging modality, magnetoencephalography (MEG), as a secondary measure. We will explore
 methods of MEG data analysis for comparison with fMRI results.

 Study Population:

 150 patients with localization-related epilepsy who are surgical candidates and 50 healthy
 volunteers.

 Design: This is a non-invasive imaging study that will employ a test battery including
 standard neuropsychological tests, structural MRI, fMRI, and a 275-channel whole-head MEG
 recording, for evaluation of the functional anatomy of language. The test battery will be
 performed pre-operatively and at 12 months after surgery.

 Main outcome measure: Measurement of the "laterality index" comparing left and right
 hemisphere regional activation on fMRI before and after surgery, in patients after left sided
 or right-sided surgery, and healthy controls.

 Secondary outcome measure: Measurement of the "laterality index" comparing left and right
 hemisphere regional activation on MEG before and after surgery.
-  INCLUSION CRITERIA FOR PATIENTS:

 1. Age 7-55

 2. Documentation of localization-related epilepsy based on clinical,
 neuropsychological and imaging criteria

 3. Failure of seizures to respond to adequate therapy with at least two standard
 antiepileptic drugs

 4. Willingness to be considered for surgery

 5. Fluency in English. Non-native speakers may be included if their fluency is
 equivalent to that of a native speaker.

 INCLUSION CRITERIA FOR HEALTHY VOLUNTEERS:

 1. Age 7-55

 2. Willingness to participate in and complete the study

 3. Right-handedness assessed by the Edinburg handedness inventory

 4. Fluency in English

 EXCLUSION CRITERIA FOR PATIENTS:

 1. Contra-indications to MRI studies (such as pacemakers, cochlear devices, surgical
 clips etc. metallic implants, orthopedic pins, shrapnel, permanent eyeliner, vagus
 nerve stimulator)

 2. Claustrophobia or anxiety disorders exacerbated by the MRI scanner

 3. People with neurological or psychiatric disease or taking medications that would
 affect fMRI and MEG language studies

 4. Pregnancy. All females of child bearing potential must have a negative test prior to
 MRI scanning

 5. Patients on phenobarbital or chronic benzodiazepines

 EXCLUSION CRITERIA FOR HEALTHY VOLUNTEERS:

 1. Contra-indications MRI studies (metallic implants, recent orthopedic pins, cochlear
 implants, surgical clips, cardiac pacemakers and defibrillation devices, shrapnel,
 permanent eyeliner, vagus nerve stimulator)

 2. Any medical condition or chronic medication that might affect fMRI or MEG language
 activation by affecting cerebral structure or function, such as diabetes,
 hypertension, antihypertensive medications, psychotropic agents.

 3. Pregnancy. All females of child bearing potential must have a negative test prior to
 MRI scanning.