A Snapshot of Progress and Promise in Brain Imaging

Galen of Pergamon, a physician and philosopher during the Roman Empire, through his scientific and philosophic writings strove to demystify the structure of the human brain, recognizing the importance of anatomy in the understanding of disease. As interest in studying anatomy increased, physicians and scientists made steady progress in advancing knowledge as they dedicated their efforts to unraveling brain structure by applying careful dissection and illustration, intraoperative observations and, in the past century, the innovative technologies revolutionizing brain imaging.

The Introduction of the MRI

One of the most critical discoveries in visualizing the brain in high resolution came with the introduction of magnetic resonance imaging (MRI) in 1978 through the work of scientists Raymond Damadian, Paul Lauterbur and Peter Mansfield.

MRI evaluation has allowed for improved identification and characterization of brain lesions and provided insight into how alterations in brain structure contribute to neurologic disease. MRI has proven a valuable tool in revealing the underlying causes of epilepsy, for steering treatment decisions, monitoring progression of disease, prognosticating the course of an individual’s epilepsy, and supporting surgical treatments. MRI can also be important for genetic counseling in epilepsy as imaging findings may help lead to and support accurate genetic diagnosis. 

Advancements in the MRI

The breadth of MRI techniques emerging over recent decades have furthered the utility of this brain imaging bastion beyond structure and into the realm of biochemistry, metabolism and function.

• Functional MRI (fMRI) takes advantage of the fact that neural activity can be detected by increased cerebral blood flow and changes in oxygenation concentration (Blood Oxygen Level Dependent BOLD-fMRI). 
• Diffusion tensor imaging (DTI) exploits water molecule diffusion and tissue differences in the brain, and has the ability to define microstructure in the brain, as well as to demonstrate the brain’s white matter fibers and tracts to visualize how the brain regions are connected.
• Both fMRI and DTI are high-powered brain imaging tools which have provided new capabilities that allow for neuroscientists and clinicians to better map and understand epileptic networks in the brain.         

The ability to pair fMRI with simultaneously-recorded EEG has allowed for brain wave data to be collected and analyzed with high spatiotemporal resolution to estimate the localization of epileptic foci during presurgical evaluation. Magnetic resonance spectroscopy (MRS) can provide supporting biochemical information on epileptogenic regions of the brain, and may be helpful in delineating seizure foci even in the absence of structural brain changes. Advances have also allowed for MRI to be paired with PET (Positron Emission Tomography) which measures brain metabolism. MRI-PET makes possible enhanced images that combine molecular, anatomic, and functional information that can help to direct treatment decisions.

Imagine that it is possible to leverage these new and evolving techniques to create a map of your unique brain traffic patterns to better understand how a seizure begins and how it spreads throughout the brain. This elevated understanding of epilepsy made possible through images helps to lay the groundwork for identifying key brain regions unique to each individual.

Beyond diagnostic capabilities, MRI has changed the way surgical epilepsy treatment is delivered as evidenced by 3D intraoperative renderings, MRI-guided laser therapy and neuromodulatory electrode implantation which rely on the information found in high-resolution MRI images, fMRI and DTI to elevate surgical precision with the goal of improved surgical outcomes and seizure freedom for people with epilepsy.

How We Make a Difference

The Epilepsy Foundation has previously invested in several of these areas to improve patient outcomes. For example, in 2011 the Foundation supported the development of Visualase^® by Medtronic. Visualase^® is an MRI-Guided Laser Ablation Technology for Minimally Invasive Neurosurgery to reduce the risk of open-brain surgery for people living with epilepsy. More recently, in 2018, we supported a 3D Machine Vision System for surgical navigation of the human brain (Advanced Scanners) which aims to reduce uncertainties and risks during open brain epilepsy surgery.