Abstract:Drug-resistant epilepsy is a chronic debilitating disorder, but many cases are potentially curable by surgery. The key to the successful epilepsy surgery with complete postoperative seizure-free status is precise localization of the epileptic zone that must be resected and the adjacent eloquent areas of gray and white matter that must be preserved to avoid neurological defects. This article reviews the current state of the art epilepsy imaging techniques facilitating successful epilepsy surgery. The overview o… Show more
“…Dual pathology like malformations of cortical development may be seen in around 15%. 19 Figure 4.Coronal graphic image (a), coronal FLAIR (b) and coronal high-resolution T2W (c anterior and d posterior) MRI showing the imaging features of mesial temporal sclerosis (MTS). Loss of the normal hippocampal internal architecture including blurring of SRLMS and loss of hippocampal head digitations, hippocampal signal change seen as hyperintensity on high resolution T2/FLAIR temporal lobe images, and hippocampal atrophy (thin red arrow) are the primary signs of MTS.…”
Microscopic neuroanatomy of limbic system and basal forebrain on MRI is complex and is a terra incognita for many radiologists, clinicians, and neuroscientists. Interestingly, most of the important structures/at least anatomical regions containing these structures demonstrable on cadaveric and surgical dissections can be identified on clinical MRI, with 3T being much better than 1.5T. This article teaches the practical MRI identification of these structures which will greatly help in evaluating complex ailments like temporal lobe epilepsy, Alzheimer dementia, and other neuropsychiatric disorders. This knowledge will also aid in accurate reporting of tumor spread along the white matter fasciculi in the temporal stem/basal forebrain region. Limbic system includes the mesial temporal structures and their connections, piriform cortex including “area tempestas,” and the septal area comprising of subcallosal area and paraterminal gyrus. Basal forebrain includes structures like substantia innominata with basal nucleus of Meynert, diagonal gyrus/diagonal band of Broca, and nucleus accumbens lying in between the anterior perforated substance inferiorly and the anterior commissure superiorly.
“…Dual pathology like malformations of cortical development may be seen in around 15%. 19 Figure 4.Coronal graphic image (a), coronal FLAIR (b) and coronal high-resolution T2W (c anterior and d posterior) MRI showing the imaging features of mesial temporal sclerosis (MTS). Loss of the normal hippocampal internal architecture including blurring of SRLMS and loss of hippocampal head digitations, hippocampal signal change seen as hyperintensity on high resolution T2/FLAIR temporal lobe images, and hippocampal atrophy (thin red arrow) are the primary signs of MTS.…”
Microscopic neuroanatomy of limbic system and basal forebrain on MRI is complex and is a terra incognita for many radiologists, clinicians, and neuroscientists. Interestingly, most of the important structures/at least anatomical regions containing these structures demonstrable on cadaveric and surgical dissections can be identified on clinical MRI, with 3T being much better than 1.5T. This article teaches the practical MRI identification of these structures which will greatly help in evaluating complex ailments like temporal lobe epilepsy, Alzheimer dementia, and other neuropsychiatric disorders. This knowledge will also aid in accurate reporting of tumor spread along the white matter fasciculi in the temporal stem/basal forebrain region. Limbic system includes the mesial temporal structures and their connections, piriform cortex including “area tempestas,” and the septal area comprising of subcallosal area and paraterminal gyrus. Basal forebrain includes structures like substantia innominata with basal nucleus of Meynert, diagonal gyrus/diagonal band of Broca, and nucleus accumbens lying in between the anterior perforated substance inferiorly and the anterior commissure superiorly.
“…Epilepsy is characterized by recurrent seizures due to hypersynchronous neuronal discharges . About 1% of the global population has epilepsy, and a substantial minority do not benefit optimally from current antiepileptic drugs (AEDs) .…”
Section: Introductionmentioning
confidence: 99%
“…Epilepsy is characterized by recurrent seizures due to hypersynchronous neuronal discharges. 1 About 1% of the global population has epilepsy, and a substantial minority do not benefit optimally from current antiepileptic drugs (AEDs). 2 Traditional AEDs manage epilepsy by shifting the balance toward inhibitory neurotransmission, such as by potentiating GABA release or synaptic response.…”
Resistance to traditional antiepileptic drugs is a major challenge in chronic epilepsy treatment. MicroRNA-based gene therapy is a promising alternative but has demonstrated limited efficacy due to poor blood-brain barrier permeability, cellular uptake, and targeting efficiency. Adenosine is an endogenous antiseizure agent deficient in the epileptic brain due to elevated adenosine kinase (ADK) activity in reactive A1 astrocytes. We designed a nucleic acid nanoantiepileptic drug (tFNA-ADK ASO @AS1) based on a tetrahedral framework nucleic acid (tFNA), carrying an antisense oligonucleotide targeting ADK (ADK ASO ) and A1 astrocyte-targeted peptide (AS1). This tFNA-ADK ASO @AS1 construct effectively reduced brain ADK, increased brain adenosine, mitigated aberrant mossy fiber sprouting, and reduced the recurrent spontaneous epileptic spike frequency in a mouse model of chronic temporal lobe epilepsy. Further, the treatment did not induce any neurotoxicity or major organ damage. This work provides proof-of-concept for a novel antiepileptic drug delivery strategy and for endogenous adenosine as a promising target for gene-based modulation.
Contrast agents can improve the sensitivity and resolution of magnetic resonance imaging (MRI) by accelerating the relaxation times of surrounding water protons. The MRI performances of contrast agents are closely related to their structural characteristics, including size, shape, surface modification, and so on. Recently, dynamically switchable MRI contrast agents that can undergo structural changes and imaging functional activations upon reaching the disease microenvironment have been developed for high performance MRI. This perspective highlights the ingenious design, controllable structural transformation, and tunable imaging property of dynamic MRI contrast agents. Additionally, the current challenges of the dynamic MRI contrast agents for medical diagnosis are discussed. Furthermore, the future integration of high-resolution ultra-high field MRI technology and cutting-edge dynamic MRI contrast agents for non-invasive histopathological level accurate detection of microscopic lesions are commented.
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