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Pergamon Magnetic Resonance Imaging, Vol. 13, No. 8, p. 1045, 1995 Copyright 0 1995 Elsevier Science Inc. Printed in the USA. All rights reserved 0730-725X195 $9.50 + .OO 0730-725X(95)02050-0 l Editorial The pathophysiology of epilepsy has been studied for generations. Yet the abnormal synchronous events of a seizure that convert normal neural networks to dys- functional bioelectric generators still largely eludes investigators. Basic laboratory research has added important bio- chemical, molecular, electrophysiological, and anatom- ical data regarding in vitro and in vivo animal models of epilepsy. Why are we not closer to solving the hu- man epileptic condition? It may be because we are stuck in a paradigm that regards epilepsy as a disease with an, as yet undefined, unifying abnormality. This con- cept is problematic in not recognizing that the thresh- old for excessexcitation in the brain can be imbalanced in a number of ways and that most animal models are poor representatives of human epilepsy. Thus, perhaps the paradigm of epilepsy needs a re- statement. The problem is not necessarily to define epi- lepsy the disease but, to investigate the peculiarities of the human diseases that express epilepsy as a promi- nent symptom. In particular, by concentrating on the pathophysiology of the various substrates causing hu- man seizures we may come to better understand the common mechanisms and the variations. Dissecting the substrates of the human symptomatic epilepsies has become a reality with the revolutionary advances in magnetic resonance techniques. It is, I be- lieve, safe to predict that no single force since the EEG will do more to push this field forward over the next 10 years. We have already become dependent on the an- atomical detail of static MRI anatomy and upon the ability to quantify rather small variations in that anat- omy. Software advances, increasing magnet strength, and head coil technology are constantly refining our detection of pathology. It is the concordance of these images with the standard patient evaluation technique of cognitive testing, EEG, and the other imaging modalities of single photon emission computerized tomography (SPECT) and positron emission tomography (PET) that have strengthened our diagnostic acumen and sim- plified noninvasive patient selection for surgical treatment. The obvious importance of MR in epilepsy led the neurologists at Queen Square to organize a NATO, sup- ported MR and epilepsy symposium in the fall of 1992. The workshop invited an international audience of clin- ical epilepotolgoists, physicists, and other basic scien- tists to share research in progress. The meeting was overwhelmingly successful in providing a forum for in- terdisciplinary communication. It was decided to repeat the same forum every 2 yrs depending on progress in the field, and this special MRI issue is the product of the second of these symposiums, held at Yale University in October of 1994. The theme of these papers empha- size technical advances made in anatomical imaging, quantified volumetry, functional MR, MR spectros- copy, and clinical research protocols that correlate pa- tient evaluation with new MR techniques. The authors have provided succinct papers that characterize these advances in anatomy, volumetrics, spectroscopy, and functional MR. In this issue you will examine certain static techniques that enhance our present clinical di- agnosis primarily through more sophisticated classifi- cations of the underlying substrates responsible for the symptomatic epilepsies (those being sclerosis, neoplastic, developmental, and vascular.) You will identify the fu- ture of spectroscopic and functional methods in further elucidating how these diseases may be epileptogenic, and finally, one can appreciate how this technology is providing ore logical surgical and pharmacological de- cision making. On behalf of the organizing committee, I want to acknowledge the American Epilepsy Society, the Na- tional Institutes of Health, and the companies listed be- low for their generous support. Dennis Spencer Department of Surgery Yale University School of Medicine Acknowledgment- We gratefully acknowledge contributions from: Ad-Tech, American Epilepsy Society, Ayerst, Biomagnetic Technol- ogies, Burroughs Wellcome, CIBA Geigy, Elekta Instruments, Marion Merrell Dow, NIH, NOMOS, Parke-Davis, PMT Corpora- tion, Radionics, Squibb Diagnostics, and Upjohn. EDITORIAL 1045
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Pergamon Magnetic Resonance Imaging, Vol. 13, No. 8, p. 1045, 1995
Copyright 0 1995 Elsevier Science Inc. Printed in the USA. All rights reserved
0730-725X195 $9.50 + .OO
0730-725X(95)02050-0
l Editorial
The pathophysiology of epilepsy has been studied for generations. Yet the abnormal synchronous events of a seizure that convert normal neural networks to dys- functional bioelectric generators still largely eludes investigators.
Basic laboratory research has added important bio- chemical, molecular, electrophysiological, and anatom- ical data regarding in vitro and in vivo animal models of epilepsy. Why are we not closer to solving the hu- man epileptic condition? It may be because we are stuck in a paradigm that regards epilepsy as a disease with an, as yet undefined, unifying abnormality. This con- cept is problematic in not recognizing that the thresh- old for excess excitation in the brain can be imbalanced in a number of ways and that most animal models are poor representatives of human epilepsy.
Thus, perhaps the paradigm of epilepsy needs a re- statement. The problem is not necessarily to define epi- lepsy the disease but, to investigate the peculiarities of the human diseases that express epilepsy as a promi- nent symptom. In particular, by concentrating on the pathophysiology of the various substrates causing hu- man seizures we may come to better understand the common mechanisms and the variations.
Dissecting the substrates of the human symptomatic epilepsies has become a reality with the revolutionary advances in magnetic resonance techniques. It is, I be- lieve, safe to predict that no single force since the EEG will do more to push this field forward over the next 10 years. We have already become dependent on the an- atomical detail of static MRI anatomy and upon the ability to quantify rather small variations in that anat- omy. Software advances, increasing magnet strength, and head coil technology are constantly refining our detection of pathology. It is the concordance of these images with the standard patient evaluation technique of cognitive testing, EEG, and the other imaging modalities of single photon emission computerized tomography (SPECT) and positron emission tomography (PET) that have strengthened our diagnostic acumen and sim- plified noninvasive patient selection for surgical treatment.
The obvious importance of MR in epilepsy led the neurologists at Queen Square to organize a NATO, sup- ported MR and epilepsy symposium in the fall of 1992. The workshop invited an international audience of clin- ical epilepotolgoists, physicists, and other basic scien- tists to share research in progress. The meeting was overwhelmingly successful in providing a forum for in- terdisciplinary communication. It was decided to repeat the same forum every 2 yrs depending on progress in the field, and this special MRI issue is the product of the second of these symposiums, held at Yale University in October of 1994. The theme of these papers empha- size technical advances made in anatomical imaging, quantified volumetry, functional MR, MR spectros- copy, and clinical research protocols that correlate pa- tient evaluation with new MR techniques. The authors have provided succinct papers that characterize these advances in anatomy, volumetrics, spectroscopy, and functional MR. In this issue you will examine certain static techniques that enhance our present clinical di- agnosis primarily through more sophisticated classifi- cations of the underlying substrates responsible for the symptomatic epilepsies (those being sclerosis, neoplastic, developmental, and vascular.) You will identify the fu- ture of spectroscopic and functional methods in further elucidating how these diseases may be epileptogenic, and finally, one can appreciate how this technology is providing ore logical surgical and pharmacological de- cision making.
On behalf of the organizing committee, I want to acknowledge the American Epilepsy Society, the Na- tional Institutes of Health, and the companies listed be- low for their generous support.
Dennis Spencer Department of Surgery Yale University School of Medicine
Acknowledgment- We gratefully acknowledge contributions from: Ad-Tech, American Epilepsy Society, Ayerst, Biomagnetic Technol- ogies, Burroughs Wellcome, CIBA Geigy, Elekta Instruments, Marion Merrell Dow, NIH, NOMOS, Parke-Davis, PMT Corpora- tion, Radionics, Squibb Diagnostics, and Upjohn.
EDITORIAL
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