Swiss Epilepsy Centre
Clinical approaches to cognitive and neurobehavioural neurosciences to improve diagnostics and therapy in patients with epilepsy and deep developmental disorders (dyslexia, ADHD); presurgical evaluation of limbic and neocortical functions using neuropsychological tests, fMRI, cognitive evoked potentials, and psychophysiological methods; influence of antiepileptic drugs on cognition, memory, and behaviour; long-term changes in cognitive functions of patients with medically refractory epilepsy; dysregulation of the autonomic nervous system in epilepsy and ADHD; comorbidity of ADHD and developmental dyslexia; mnestic and cognitive dysfunctions in children and adults with developmental dyslexia.
1 senior scientist, 1 PhD student, 2 postgraduate students, 3 research students
FMRI: Although functional magnetic resonance imaging techniques (fMRI) are usually considered to be very useful in mapping and evaluation of higher brain functions, clinical application of fMRI has various constraints due to statistical shortcomings of single case studies and clinical reasons. We have studied the feasibility of individual functional diagnostics of limbic structures (parahippocampal gyrus, amygdala) using tailored and optimised activation paradigms. Moreover, we continue to perform validation studies of single case fMRI by results from patients who undergo the intracarotid amobarbital procedure (Wada test) and anterior temporal lobectomy.
Figure 1: Bilateral amygdala activation in a single subject while watching video-sequences showing fearful human facial expressions and gestures. (Variante 2)
Antiepileptic drugs change electric and metabolic activity of neurons. FMRI is considered to measure indirectly neuronal activity by local changes in the cerebral blood flow. Using sensitive and stable activation paradigms we study the influence of antiepileptic drugs on the BOLD-response. This study is aimed to reveal whether fMRI might contribute to the detection of cognitive side-effects of certain antiepileptic drugs.
Evoked Potentials: Using invasive intracranial depth electrodes in patients with refractory temporal lobe epilepsy functional impairment of limbic structures (hippocampus, entorhinal cortex, amygdala) can be revealed. Knowing the architecture of normal and pathological evoked potentials recorded by depth electrodes may help to decomposite potentials gained from the scalp in order to improve non-invasive presurgical diagnostics.
Attention deficit and hyperactivity disorder (ADHD) and developmental dyslexia belong to the most frequent developmental disorders in children with and without epilepsy. Interestingly benign epilepsy of childhood (i.e. Rolando epilepsy) is frequently associated with dyslexia and attentional impairments. In running projects we study neuropsychological deficits in children with ADHD and dyslexia with the hypothesis that certain subtypes of ADHD are associated with an increased risk of accompanying dyslexia. Because Rolando epilepsy causes in some children very similar patterns of deficits, we assume that it could serve as a model to localise affected brain regions. The diagnosis of ADHD is usually based on observational data. We currently test certain psychophysiological measures that may improve the diagnostic process of ADHD and may serve as an objective dependent variable in treatment studies. In studies on developmental dyslexia, we focus on constraints of rapid phonological encoding and retrieval as well as on non-lingual functional deficits and resources.
We will continue our efforts to bring results of successful feasibility studies into clinical diagnostics. Moreover, multimodal approaches using EEG, fMRI, neuropsychological tests, and psychophysiological methods for studies in patients and healthy subjects are clearly favoured.
Neuropsychological laboratory, psychophysical methods, 64 channel EEG, MRI facilities at the Hirslanden Hospital, MRI postprocessing.
Novartis Foundation, Novartis Pharma AG Switzerland, INTAS, Swiss Epilepsy Foundation
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