Future Diagnosis in Epilepsy: Plumbing the Potential of EEG-fMRI

Doctor poses in picture

Jerzy Szaflarski, MD, PhD, at the Center for Imaging Research at UC. Photo by Cindy Starr/Mayfield Clinic.

The day of personalized medicine has arrived at the UC Epilepsy Center, and researchers are hard at work taking it a step further.

Earlier this year Associate Professor Jerzy Szaflarski, MD, PhD, and his research team published a retrospective study of 322 patients that showed that an encephalogram (EEG), a tracing of brain waves, can help predict whether patients will respond to one medication versus another.

“We have suspected for a long time that patients with certain EEG characteristics may have a more or less successful response to medications,” says Dr. Szaflarski (pronounced Sha-FLAHR-ski), Associate Director of the Center for Imaging Research. “We’ve been using this information intuitively. We now have evidence that supports our intuition.”

A patient with symmetrical electrical discharges on an EEG reading, for example, is likely to respond positively to valproic acid (marketed as Depakote), while a patient with asymmetrical discharges is unlikely to respond as well. “In these non-responding patients we frequently will have to go to great length in choosing medications,” Dr. Szaflarski says.

The patients in the study suffered from idiopathic, generalized seizures, which have no known cause and whose underlying electrical discharges sweep concurrently throughout both hemispheres of the brain. About one-third of people with generalized seizures do not respond well to medications.

In a new study, believed to be one of only two to three studies of this kind, Dr. Szaflarski and his team are processing that same EEG data with functional MRI (fMRI) data from the same population to see whether the EEG-fMRI patterns and the site where seizures begin can provide enhanced prediction of seizure outcomes and response to medications.

EEG-fMRI merges information about where electrical disturbances in the brain are originating with information about how those disturbances impact blood flow. While conducting this ground-breaking research, Dr. Szaflarski simultaneously combines the electrical information, derived from EEG testing, with the information about blood-flow patterns, derived from fMRI with a 4 Tesla magnet. The data enable him to determine where a seizure begins, how it spreads, and whether and how it impacts parts of the brain that are important for speech, memory and movement.

“I’m hoping that a year from now I’ll be able to tell a patient with a specific pattern of brain changes and responses that he or she is more or less likely to respond to a medication,” Dr. Szaflarski says. “If we can identify these early markers of medication response, then we can make much more educated choices about medications and not end up trying multiple medications before actually choosing the correct one. In so doing we will shorten the time from the point of diagnosis to the point where the patient’s condition is controlled and he or she has returned to a normal, productive life.”

The EEG-fMRI study is not the only one on Dr. Szaflarski’s research agenda. Already an author or co-author of 80 publications, he is investigating multiple aspects of epilepsy. Other cutting-edge projects include:

* An ongoing study at Cincinnati Children’s Hospital Medical Center, led by Scott Holland, PhD, that involves the collection of EEG-fMRI data of children who are performing various cognitive tasks. The researchers seek to correlate the changes in EEG with these tasks as well as monitor for children’s alertness to determine how alertness affects performance.

 

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